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A. MLA Map Paediatrics > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Anaemia is when the body has insufficient RBCs to circulate oxygen around the body. Which of the following is NOT a common presentation of anaemia?

1 - dyspnea upon exertion and rest
2 - fatigue
3 - pallor
4 - hypodynamic state (slow HR and weak pulse)

A

4 - hypodynamic state (slow HR and weak pulse)
- patients are in a hyperdynamic state and have palpitations and a bounding pulse to try to compensate for low RBCs and oxygen

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2
Q

Myeloid progenitor cells will be stimulated to become reticulocytes, which is an immature RBC. What is the main hormone is responsible for maturing myeloid progenitor cells into reticulocytes?

1 - calcitriol
2 - erythropoietin
3 - androgen
4 - T3 and T4

A

2 - erythropoietin

  • reticulocytes enter the blood stream after 3 days and mature into RBCs
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3
Q

Anaemia is the a condition in which the body does not have enough healthy erythrocytes, which are immature RBCs. To stimulate proerythroblast in the bone marrow, which organ secretes most of the erythropoietin in the body?

1 - heart
2 - bone
3 - liver
4 - kidney

A

4 - kidney

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4
Q

RBCs contain a protein called haemoglobin. Each haemoglobin contains 4 heme molecules. What is contained at the centre of the heme molecules?

1 - Ca2+
2 - Mg2+
3 - iron
4 - vitamin B1

A

3 - iron
- important for binding to O2
- each haemoglobin can bind 4 molecules of O2

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5
Q

When trying to determine if a patient has anaemia we need to measure mean corpuscular volume (MCV). What is this a measure of?

1 - average concentration of Hb
2 - average size of RBCs
3 - average size of WBCs
4 - concentration of platelets

A

2 - average size of RBCs

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6
Q

What is the definition of anaemia in men?

1 - <220 g/L Haemoglobin (Hb)
2 - <180 g/L Haemoglobin (Hb)
3 - <140 g/L Haemoglobin (Hb)
4 - <100 g/L Haemoglobin (Hb)

A

3 - <140 g/L Haemoglobin (Hb)

This is 2 x SD below the normal level adjusted for age

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7
Q

What is the definition of anaemia in women?

1 - <200 g/L Haemoglobin (Hb)
2 - <180 g/L Haemoglobin (Hb)
3 - <120 g/L Haemoglobin (Hb)
4 - <100 g/L Haemoglobin (Hb)

A

3 - <120 g/L Haemoglobin (Hb)

This is 2 x SD below the normal level adjusted for age

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8
Q

The average life of an RBC is 120 days. Which organ is responsible for removing RBCs ponce they are old and need removing?

1 - spleen
2 - kidney
3 - liver
4 - lungs

A

1 - spleen

  • also able to remove abnormal RBCs
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9
Q

Generally, if we suspect a patient has anaemia, we may perform all of the following, EXCEPT which one?

1 - FBC
2 - Iron studies
3 - Ferritin
4 - Blood Film
5 - Imaging
6 - B12 and Folate

A

5 - Imaging

May be used once a diagnosis is reached, depending on the suspicioun, but not routinely

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10
Q

When trying to diagnose anaemia we use the Mean corpuscular volume (MCV). What is the diagnosis of microcytic anaemia (small RBCs) based on MCV?

1 - <80fl
2 - <100fl
3 - <120fl
4 - <150fl

A

1 - <80fl

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11
Q

When trying to diagnose anaemia we use the Mean corpuscular volume (MCV). What is the diagnosis of normocytic anaemia (normal size RBCs) based on MCV?

1 - 60-80fl
2 - 80-100fl
3 - 100-120fl
4 - 120-150fl

A

2 - 80-100fl

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12
Q

When trying to diagnose anaemia we use the Mean corpuscular volume (MCV). What is the diagnosis of macrocytic anaemia (normal size RBCs) based on MCV?

1 - >80fl
2 - >90fl
3 - >100fl
4 - >120fl

A

3 - >100fl

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13
Q

Which of the following is NOT a cause of normoocytic anaemia (normal size RBCs) with a value 80-100fl?

1 - thalassaemia
2 - renal failure
3 - blood loss
4 - bone marrow disorder

A

1 - thalassaemia
- this causes microcytic anaemia

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14
Q

Which of the following is NOT a cause of microcytic anaemia (small RBCs) with a value <80fl?

1 - thalassaemia
2 - iron deficiency anaemia
3 - haemolytic anaemia
4 - anaemia of chronic disease

A

3 - haemolytic anaemia
- typically causes normocytic anaemia

Thalassaemia = low Hb
- type A = alpha globin deficiency
- type B = beta globin deficiency

  • alpha is more common
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15
Q

Which of the following is NOT a cause of macrocytic anaemia (small RBCs) with a value >100fl?

1 - B12/Folate deficiency
2 - iron deficiency anaemia
3 - thyroid dysfunction
4 - myelodysplasia

A

2 - iron deficiency anaemia

myelodysplasia = rare blood cancer

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16
Q

Normoocytic anaemia (normal size RBCs) is when there is a value 80-100fl. What is used to identify the cause the normocytic anaemia?

1 - Hb
2 - WBCs
3 - platelet count
4 - reticulocyte count

A

4 - reticulocyte count

  • high = haemolytic anaemia and blood loss
  • low = bone marrow disorder
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17
Q

Macrocytic anaemia (normal size RBCs) is when the MCV is >100fl. What is used to identify the cause the macrocytic anaemia?

1 - blood film
2 - WBCs
3 - platelet count
4 - reticulocyte count

A

1 - blood film
Distinguish between:

  • megaloblastic anaemia = large immature RBCs
  • non-megaloblastic anaemia = large mature RBCs
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18
Q

Macrocytic anaemia (normal size RBCs) is when the MCV is >100fl. Usinga. blood film we can distinguish between megaloblastic anaemia (large immature RBCs) and non-megaloblastic anaemia (large mature RBCs). Which of the following is NOT a cause of megaloblastic anaemia?

1 - vitamin B12 deficiency
2 - chronic inflammatory disease
3 - folic acid deficiency
4 - drug induced toxicity (methotrexate)

A

2 - chronic inflammatory disease

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19
Q

Macrocytic anaemia (normal size RBCs) is when the MCV is >100fl. Using a blood film we can distinguish between megaloblastic anaemia (large immature RBCs) and non-megaloblastic anaemia (large mature RBCs). Which of the following is NOT a cause of non-megaloblastic anaemia?

1 - alcohol abuse
2 - pregnancy
3 - hypothyroidism
4 - drug induced toxicity (methotrexate)

A

4 - drug induced toxicity (methotrexate)

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20
Q

There are a number of mechanisms that can lead to anaemia. One of these is a reduction in erythropoiesis, RNC production. Which of the following is NOT a cause of reduced erythropoiesis?

1 - CKD
2 - bone marrow disorder
3 - hypothyroidism
4 - vit B12 and iron deficiency
5 - blood loss
5 - chronic inflammatory disease

A

5 - blood loss

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21
Q

There are a number of mechanisms that can lead to anaemia. One of these is blood loss. Which of the following is NOT a cause blood loss?

1 - menorrhagia
2 - trauma / accidents
3 - hypothyroidism
4 - GI bleed

A

3 - hypothyroidism

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22
Q

There are a number of mechanisms that can lead to anaemia. One of these is increased destruction (haemolysis) of RBCs. This can be divided intravascular and extravascular. Which of the following is NOT a cause intravascular haemolysis?

1 - Disseminated Intravascular Coagulation
2 - Type 1 diabetes
3 - Thrombotic Thrombocytopenic Purpura
4 - Hemolytic uremic syndrome
5 - Mechanical heart valves

A

2 - Type 1 diabetes

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23
Q

There are a number of mechanisms that can lead to anaemia. One of these is increased destruction (haemolysis) of RBCs. This can be divided intravascular and extravascular. Which of the following is NOT a cause extravascular haemolysis?

1 - liver cirrhosis
2 - hypersplenism
3 - inherited haemolytic anaemia (sickle cell disease)
4 - acquired haemolytic anaemia (malaria)

A

1 - liver cirrhosis

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24
Q

To determine if a patient has a haemolysis cause of anaemia we can measure the blood. Which of the following is NOT one of these measures?

1 - lactate dehydrogenase
2 - iron
3 - unconjugated bilirubin
4 - haemoglobin
5 - globin
6 - creatine kinase

A

6 - creatine kinase

  • all the others are contained within RBCs, so if there is haemolysis then this may be raised
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25
Q

Which of the following is NOT a typical laboratory investigation performed if we suspect haeolysis?

1 - lactate dehydrogenase
2 - creatine kinase
3 - bilirubin
4 - haptoglobin

A

4 - haptoglobin
- this binds with free haemoglobin if haemolysis occurs, so this would be low

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26
Q

Which of the following is NOT a typical presentation of anaemia?

1 - pallor / conjunctive pallor
2 - fatigue
3 - scleral icterus (jaundice)
4 - ascites
5 - bony tenderness
6 - lymphadenopathy
7 - dyspnea upon exertion /rest
8 - splenomegaly

A

4 - ascites

27
Q

In paediatrics, what is the most common cause of anaemia?

1 - leukaemia
2 - lymphoma
3 - iron deficiency
4 - excess milk
5 - renal failure

A

3 - iron deficiency

Can be treated with iron supplements for 3 months

28
Q

A 36 year old woman presents, stating she is unusually tired and has recently become quite pale. She also has numb feet, pins and needles. She has vitiligo and hypothyroidismon, for which she takes thyroxine. Based on the presentation and blood results (in the image), what is the most likely diagnosis?

1 - gastric malignancy
2 - helicobacter pylori infection
3 - pernicious anaemia
4 - iron deficiency anaemia

A

3 - pernicious anaemia

Macrocytic anaemia
Pins and needles due to B12 deficiency
Autoimmune conditions

29
Q

B12 binds with intrinsic factor (IF) in the stomach. Which cells produce IF?

1 - surface mucous cells (foveolar cells)
2 - parietal cells.
3 - chief cells.
4 - neuroendocrine cells

A

2 - parietal cells.

In autoimmune condition these can be damaged causing pernicious anaemia

30
Q

When giving folate, which vitamin must be given at least 24h before?

1 - vitamin A
2 - vitamin D
3 - B12
4 - calcium

A

3 - B12

Can cause neurological damage if this is not done

31
Q

25 year old male student from Nigeria presents with hip pain following a recent viral illness with fever, breathless and abdominal pain. Bloods can be seen in the image. Which of the following is the most likely diagnosis?

1 - gastric malignancy
2 - helicobacter pylori infection
3 - pernicious anaemia
4 - iron deficiency anaemia
5 - sickle cell disease

A

5 - sickle cell disease

HbS is most common

Blood results:
- high bilirubin = haemolysis
- high LDH = haemolysis and cell turnover
- abdominal pain = splenomegaly
- SOB = acute chest syndrome

32
Q

Which of the following would NOT be seen on a blood film in a patient with sickle cell disease?

1 - crescent shaped RBCs
2 - target cells
3 - polychromatic
4 - reed-sternberg cells
5 - Howell-Jolly bodies

A

4 - reed-sternberg cells
These are in Hodkings Lymphoma

33
Q

A sickle cell presents with acute chest syndrome with a haemoglobin of 65g/L, which of the following should be performed?

1 - 1 unit of blood
2 - Analgesia for pain
3 - Antibiotics
4 - IV fluids
5 - life-long penicillin V (500mg bd)
Immunisations (against pneumococcus/meningococcus/HiB)
6 - Folic acid
7 - all of the above

A

7 - all of the above

34
Q

What does B12 need to bind with in the stomach so that it can pass through the small intestines and be absorbed in the terminal ileum?

1 - tissue factor
2 - von willebrands factor
3 - intrinsic factor
4 - all of the above

A

3 - intrinsic factor

IM junctions of B12 are typically given as treatment

35
Q

Anaemia is the a condition in which the body does not have enough healthy erythrocytes, which are immature RBCs. To stimulate proerythroblast in the bone marrow, which organ secretes most of the erythropoietin in the body?

1 - heart
2 - bone
3 - liver
4 - kidney

A

4 - kidney

36
Q

RBCs contain a protein called haemoglobin. Each haemoglobin contains 4 heme molecules. What is contained at the centre of the heme molecules?

1 - Ca2+
2 - Mg2+
3 - iron
4 - vitamin B1

A

3 - iron
- important for binding to O2
- each haemoglobin can bind 4 molecules of O2

37
Q

The state of iron when it binds with and without O2 changes. Match the iron state when O2 is and is not bound?

  • Fe3+
  • Fe2+
A
  • bound O2 = Fe3+
  • unbound O2 = Fe2+
38
Q

How many molecules of oxygen can each haemoglobin molecule bind with?

1 - 8
2 - 6
3 - 4
4 - 2

A

3 - 4

39
Q

Our diets contain 2 forms of iron,

  • heme iron (meats) = Fe2+ iron is already bound to haemoglobin
  • non-heme iron (vegetables) = Fe3+ as not bound to haemoglobin

When we eat and the foods get digested, is all iron converted into Fe2+ or Fe3+?

A
  • Fe2+
40
Q

Our diets contain 2 forms of iron,

  • heme iron (meats) = Fe2+ iron is already bound to haemoglobin
  • non-heme iron (vegetables) = Fe3+ as not bound to haemoglobin

Once digested, all iron is converted into Fe2+ in the duodenal cells. Iron then binds to what?

1 - transferrin
2 - ferritin
3 - feroportin
4 - hepcidin

A

2 - ferritin
- if needed Fe2+ iron is released into the blood
- hepastin converts Fe2+ into Fe3+ in the blood

41
Q

Once release from ferritin into the blood, Fe2+ iron is converted into Fe3+ by hephaestin. The Fe3+ then binds to what iron transporter to be transported to tissues in the body?

1 - transferrin
2 - ferritin
3 - feroportin
4 - hepcidin

A

1 - transferrin
- ferritin is present in tissues to store the Fe3+

42
Q

There are lots of causes of anaemia, which is the most common?

1 - B12 deficiency
2 - anaemia of chronic disease
3 - iron deficiency anaemia
4 - sickle cell anaemia

A

3 - iron deficiency anaemia

43
Q

Mean corpuscular volume (MCV) is a test to measures the average size of RBCs. This can be:

  • microcytic = small (<75fl)
  • macrocytic = large (>96fl)
  • normacytic = 80-96fL

Which of the above does iron deficiency anaemia lead to?

A
  • microcytic = small (<75fl)
44
Q

Which of the following are causes of iron deficiency anaemia?

1 - low iron intake
2 - reduced iron absorption
3 - iron loss
4 - increased iron demand
5 - all of the above

A

5 - all of the above
- low iron intake is the most common cause

45
Q

Which of the following can lead to low iron intake, which is the most common cause of iron deficiency anaemia?

1 - vegetarian diets
2 - GIT disorders (coeliac diseases, IBD)
3 - reduced gastric acid secretions
4 - pregnancy
5 - menorrhagia
6 - malignancy
7 - urological
8 - helicobacteria pylori infection
9 - all of the above

A

9 - all of the above

  • helicobacteria pylori = eats irons before we can absorb it
  • vegetarian diets = FE3+ is harder to digest and absorb
  • urological = CKD where we can lose blood or malignancy
46
Q

There are 3 main causes of microcytic anaemia. Which of the following is NOT one of these?

1 - iron deficiency
2 - Haemoglobinopathies – thalassaemia, sickle cell
3 - Sideroblastic anaemia
4 - B12 deficiency

A

4 - B12 deficiency
- B12 deficiency would cause megablastic anaemia

47
Q

Sideroblastic anaemia is one of the 3 causes of microcytic anaemia. What is Sideroblastic anaemia?

1 - low levels of iron in RBCs
2 - RBCs with altered globulins
3 - high iron levels in RBCs
4 - all of the above

A

3 - high iron levels in RBCs
- iron cannot be incorporated into heme or carry O2

48
Q

We typically lose around 1mg of iron everyday. Why is this?

1 - RBCs undergoing programmed cell death in spleen
2 - iron lost in sweat
3 - iron excreted into stool
4 - all of the above

A

4 - all of the above

  • but we can eat iron to account for the lost iron
49
Q

Why does iron deficiency anaemia lead to microcytic anaemia (<75fl, normal is 79-96)?

1 - low erythropoietin
2 - low haemoglobin
3 - high haemoglobin
4 - high ferritin

A

2 - low haemoglobin
- normal haemoglobin:
males = 130-180
female = 115-165

  • not enough haemoglobin means bone marrow jus makes small RBCs
  • microcytic RBCs are pale as well called hypochromic RBCs
50
Q

One of the key signs of iron deficiency anaemia is koilonychia, why does iron deficiency anaemia cause koilonychia?

1 - microcytic RBCs impairs nail growth
2 - microcytic RBCs breakdown reduces keratin levels
3 - low iron causes defects in mitochondrial enzymes
4 - low iron reduces epithelial cell number

A

3 - low iron causes defects in mitochondrial enzymes
- affects ATP levels and fast growing tissue, such as epithelial cells
- hence nails and hair are affected

51
Q

Which of the following is NOT a typical symptoms patients with iron deficiency anaemia present with?

1 - pallor
2 - constipation
3 - SOB
4 - fatigued
5 - palpitations

A

2 - constipation

  • palpitations are because there is low RBCs and less O2, therefore the heart has to work harder to pump blood effectively
52
Q

Which of the following is NOT a typical clinical sign of iron deficiency anaemia?

1 - icterus
2 - koilonychia
3 - hair loss
4 - glossitis
5 - oesophageal webs

A

1 - icterus
- medical term for jaundice

  • plummer vinson syndrome includes glossitis and oesophageal webs
53
Q

When trying to diagnose iron deficiency anaemia, all of the following can typically be seen, EXCEPT which one?

1 - low Hb
2 - low MCV
3 - high ferritin
4 - low serum iron
5 - high total iron binding capacity (unbound transferritin)
6 - variety of RBC sizes

A

3 - high ferritin
- ferritin is typically low because it is only released from cells when iron is present or needed. So no iron to release means ferritin will be low

54
Q

In addition to measuring ferritin and high total iron binding capacity (unbound transferritin), which of the following is NOT a common indicator of iron deficiency anaemia?

1 - serum iron
2 - WCC
3 - folate
4 - B12 (cobalamin)

A

2 - WCC

55
Q

What is a common cause for ferritin (what iron binds to in cells) to be raised?

1 - infection
2 - tissue damage
3 - inflammation
4 - all of the above

A

4 - all of the above
- essentially anything causing inflammation can raise ferritin levels

56
Q

Which of the following is given to patients with iron deficiency anaemia?

1 - ferrous sulphate
2 - thiamine
3 - folic acid
4 - vitamin B12

A

1 - ferrous sulphate

57
Q

What is the indication for ferrous sulphate?

1 - vitamin K deficiency
2 - normocytic anaemia
3 - iron deficiency anaemia
4 - megablastic anaemia

A

3 - iron deficiency anaemia
- prophylactic and therapeutic

58
Q

Ferrous sulphate is given to patients with iron deficiency anaemia. Which of the following can help with the absorption of ferrous sulphate?

1 - alcohol
2 - grapefruit juice
3 - wine
4 - orange juice

A

4 - orange juice
- acidity increases absorption
- hydrochloric acid is the normal way iron is digested

59
Q

All of the following are adverse events of ferrous sulphate. Which is the most common?

1 - nausea
2 - constipation
3 - diarrhoea
4 - epigastric pain
5 - injection site irritation and hypersensitivity if given via IV

A

2 - constipation

in atopic patients, caution should be used when prescribing ferrous sulphate

60
Q

Ferrous sulphate may exacerbate which of the following symptoms?

1 - IBD
2 - IBS
3 - coeliac disease
4 - diverticular disease
5 - intestinal stricture
6 - all of the above

A

6 - all of the above

61
Q

Ferrous sulphate can affect the absorption of drugs. Which 2 of the following are commonly affected?

1 - warfarin
2 - bumetanide
3 - levothyroxine
4 - bisphosphonates

A

3 - levothyroxine
4 - bisphosphonates

  • take these drugs at least 2 hours before taking ferrous sulphate
62
Q

Iron can be prescribed orally (more common) or IV depending on the patients needs. Which of these increases haemoglobin the quickest?

A
  • neither they are the same
  • 100-200mg is normal oral prescription
63
Q

Does ferrous sulphate have to be taken on an empty stomach?

A
  • best for absorption
  • BUT food can reduce GIT symptoms

A. MLA Map Paediatrics (60 decks)

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