Anaemia

Question 1

(think general, heart, neuro, and other)

presenting complain

anaemia

Answer 1

Fatigue, SOB
Palpitations, angina, CCF
Headaches, TIA’s, retinal bleeds
intermittent claudication

Question 2

Observations in someone with Anaemia

what can we see on them which makes us think where is the IRON

Answer 2

pale, (pruritis, koilonychia), (jaundice)

Depends on cause of anaemia

Question 3

Investigations when anaemia is suspected

what tests should we run, what do we need to know

Answer 3

bloods (FBC, U&E, LFT, TFT, ESR/CRP, ferritin)
coombe’s test
Fine needle aspirate - investigate the bone marrow
Ferrokinestics and RBC survival

Question 4

causes of microcytic anaemia

three main groups and then sub causes

Microcytic anaemia

Answer 4

Iron deficiency - decreased supply or increased demand
haemoglobinopathy - thalassaemia or hereditory spherocytosis
bone marrow hypoproduction - chronic disease, sideroblastic, or poisoning

Question 4

causes of normocytic anaemia

THree main areas and acronyms within these areas

Answer 4

acute haemorrhagic
haemolytic - haemoglobinopathy, membrane defects, enzyme defects
cont = SPLITTING
Bone marrow hypoproduction - APLASTIC
cont = bone marrow replacement, chronic disease, diet, endocrine

Question 4

causes of Macrocytic anaemia

8 main causes

Answer 4

megaloblastic - vitamin B 12 deficiency
Folate deficiency.
Alcoholic liver disease
Reticulocytosis
Myelodysplasia
aplastic anaemia
leukaemia
iron disorders
endocrine

Question 4

causes of Haemolytic anaemias

hereditary

Answer 4

Haemoglobinopathy
membrane defects
enzyme defects

Question 4

which hereditary membrane defect causes microcytic haemolytic anaemia?

Answer 4

hereditary spheropcytosis

Question 5

Which hereditary haemoglobinopathy causes microcytic anaemia

haemolytic anaemia

Answer 5

thalassaemia: ineffective erythropoiesis and haemolysis

Question 5

which hereditary membrane defect causes normocytic haemolytic anaemia?

haemolytic anaemia

2

Answer 5

hereditary elliptocytosis
hereditary stomatocytosis

Question 5

Which hereditary haemoglobinopathy causes normocytic anaemia?

haemolytic anaemia

3 of them

Answer 5

Sickle cell, unstable Hb and altered O2 affinity.

altered Hb inlcude koln, seattle, zurich and yakima

Question 6

what hereditary enzyme defect causes normocytic haemolytic anaemia?

honestly this feels stupid by now

2

Answer 6

G6PD
pyruvate kinase deficiency

Question 7

what are the aquired immune causes of haemolytic anaemia?

TAN, NIPPY, A, A

Answer 7

toxins
autoimmune
neoplasia
neoplasia
infection
paroxysmal cold haemoglobinuria,
primary autoimmune measles,
syphillis
allo-immune
antibiotic induced

Question 8

what are the aquired non immune mediated causes of haemolytic anaemia?

MMMM

4

Answer 8

medications
MAHA
Malaria
Membrane disorders

Question 9

presenting complain of haemolytic anaemia sufferers?

what do they present with (which symptoms)

ABCD

Answer 9

Anaemia - due to haemolysis or associated aplastic crises.
Breakdown products - jaundice, pigment stones, haemoglobinuria
Compensation - hepatosplenomegaly, medullary hyperplasia, iron overload
Disease specific - sickle cell, PNH, cold autoimmune

ABCD

Question 10

Investigation to perform on thos with suspect haemolytic anaemia

what should be done

3 main areas

Answer 10

Bloods (reticulocytes >5%)
MCV: normocytic - most haemolytic anaemias
microcytic - thalassaemia, pancytopenia due to myelofibrosis
macrocytic - acute haemolysis due to reticulocytosis

FIlm: polychromasia, due to immature cells
specific red cell forms - spherocytes

Chemistry - LFTs, A2 haptoglobins and plasma haemoglobin

Urine - haemosiderin and haemoglobin

Question 11

Treatment of haemolytic anaemia?

Answer 11

PNH = steroids, androgens and bone marrow transplant
AIHA = immunosupressants, splenectomy, blood transfusions