Anaemia

Question 1

Morphological anaemia: LOW MCV

Answer 1

Microcytic anemia:
1.Iron deficiency
2.Anaemia of chronic disease
3.Thalassemia
4.Sideroblastic anaemia (rare)
5.Lead poisoning (very rare)

Question 2

Morphological classification: Normal MCV

Answer 2

Normocytic anaemia:
1. Acute blood loss
2. Anaemia of chronic disease/inflammation
3. Chronic renal failure
4. Haemolysis
5. Bone marrow hypoplasia/malignancy

Question 3

Morphological classification: High MCV

Answer 3

Macrocytic anemia:
1. Megaloblastic (oval macrocytes)
Folate or vitamin B12 deficiency
2.Non-megaloblastic (round macrocytes)
Reticulocytosis (after acute blood loss
or haemolysis)
Liver disease (chronic alcoholism)
Pregnancy (physiological)
Hypothyroidism
Myelodysplastic syndrome
Aplastic anaemia

Question 4

Functional classification: Decreased RBC Production

Answer 4

Stem cell abnormalities
* Decreased erythropoietin
* Defective DNA synthesis
* Defective Hb synthesis
* Displacement of normal bonemarrow
Infiltrationbenign/malignant
* Multi-factorial

Question 5

Functional classification: Abnormal RBC distribution/sequestration:

Answer 5

• Hypersplenism
• Haemangioma

Question 6

functional classification: Increased RBC loss:

Answer 6

Bloodloss
* Haemolysis
Intra-corpuscular (in RBC)
* Enzyme
* Membrane
* Haemoglobin
Extra-corpuscular (outside RBC)
* Alloimmune destruction
* Autoimmune destruction
* Mechanical destruction
* Infections(NB!)

Question 7

Step 4: Assess the bone marrow response to the anaemia – is it appropriate?

Answer 7

NB A normal reticulocyte count/RPI is NOT an appropriate response to anaemia
* The bone marrow should be compensating for the anaemia
- An increased reticulocyte response is appropriate for anaemia

Question 9

STEP 5: assess the peripheral blood smear for clues.
Examples:

Answer 9

• Abnormal red cell shapes, e.g. spherocytes,
  sickle cells, elliptocytes, etc.
• Features of haemolysis, e.g. fragments,
  spherocytes, target cells, etc.
• Features of iron deficiency, e.g. pencil &
  cigar cells
• Features of infection, e.g. activated
  lymphocytes, toxic granulation, etc.
• Features of disseminated intravascular
  coagulation
• Blasts – acute leukaemia

Question 10

Step 6: Use clinical information to compile a differential diagnosis:

Examples of Q’s to answer after a complete history taking and physical exam:

Answer 10

Is the patient fairly well or sick?
* How symptomatic is the patient of the anaemia?
* Will help determine the urgency of management & need for
blood transfusion
* Are there any red flags in the history or examination?
* E.g. haematological malignancy or bone marrow failure
* Sepsis
* Chronic blood loss
* Progressive or unresolving symptoms, etc.
* Existing medical problem or medication?
* Physical abnormalities found
* Nutritional cause, acute or chronic disease, pure
haematological disorder or multi-system disease
etc.

Question 11

Anaemia

Answer 11

Reduction in hemoglobin below the normal ranges for age and sex

Question 12

True or false: Anaemia is the most common haematological abnormality.

Answer 12

True

Question 13

True or false: Anaemia is a manifestation of a disease not a disease itself.

Answer 13

True: Making a diagnosis for “anaemia” is never sufficient.
NB: Identify the type of anaemia and find the cause .

Question 14

True or False: Full blood count (FBC) is one of the most commonly performed blood tests.

Answer 14

True: Know the normal values later on.

Question 15

True or False: there are 7 steps for finding the cause.

Answer 15

True

Question 16

Step 1: Diagnose anaemia
What is anaemia?

Answer 16

3 aspects:
1. Quantitative: Decrease in the no. of RBC.
2. Functional: Circulating RBCs cannot carry enough oxygenated blood to meet the metabolic demand.
3. Age and sex-Reduced haemoglobin and haematocrit levels below normal range

Question 17

Haemoglobin

Answer 17

Iron-containing protein in RBCs

Question 18

Hematocritic

Answer 18

The ratio V(RBC: V (Total blood-RBCs and plasma)

Question 19

What is the normal Hb level according to age group and sex.

Answer 19

Adults:
- Men: 14-18 g/dL
-Women: 12-16 g/dL
Pregnant women: >11-12g/dL

Babies and children: 7-16 g/dL depending on the age.

Question 20

Regarding normal Hb levels in the South African context, is the following statement true or false:

Altitude also has an effect

Answer 20

False, but according to WHO…

Question 21

Physiological anaemia of the infant

Answer 21

Normal decrease in haemoglobin during the first 2-3 months of life.