Anaemia

Question 1

What does a macrocytosis imply?

Answer 1

Liver disease
Alcoholism
Megaloblastic anaemia (oval macrocytes)

Question 2

What do target cells imply?

Answer 2

Iron deficiency
Liver disease
Haemoglobinopathies
Post-splenectomy

Question 3

What is sideroblastic anaemia and what is it characterised by on a blood film?

Answer 3

This is a refractory anaemia defined by the presence if ring sideroblasts: erythrocytes containing a ring of iron granules around the nucleus. Cells are hypochromic and microcytic.

Question 4

What are the causes of sideroblastic anaemia?

Answer 4

Hereditary: X chromosome linked ALA-S mutation
Acquired
- Primary: myelodysplasia (refractory anaemia)
Malignant myelodysplasia
Other: isoniazid, alcohol, lead

Question 5

What do leukocyte and platelet counts help distinguish in anaemia?

Answer 5

Pancytopenia (bone marrow or hypersplenism)
Platelets raised - haemolysis or haemorrhage
Leukocyte raised - leukaemia or infection

Question 6

What are the causes of iron overload?

Answer 6

Increased iron absorption: haemochromatosis, thalassaemia, sideroblastic anaemia, chronic liver disease
Increased iron intake: African siderosis
Repeated red cell transfusions: transfusional siderosis

Question 7

What type of anaemia does a deficiency in B12 or folate produce

Answer 7

Megaloblastic macrocytic anaemia
Clinical features are: 
- jaundice
- glossitis
- angular stomatitis
- pupura as a result of thrombocytopenia 
- malabsorption symptoms

Question 8

What are the causes of microcytic anaemia?

Answer 8

Iron deficiency
Anaemia of chronic disease
Thalassaemia (alpha and beta)
Sideroblastic anaemia (least common)

Question 9

What are the causes of iron deficiency?

Answer 9

1. Blood loss: menorrhagia or GI loss (Meckel’s diverticulum, PUD, gastritis, hookworm, colorectal Ca)
2. Increased utilisation: pregnancy or infants/children/elderly
3. Decreased absorption
4. Intravascular haemolysis: microangiopathic haemolytic anaemia or PNH

Question 10

What is characteristic of thalassaemia trait alpha?

Answer 10

Tear dropped RBCS due to damage to membrane from removal of excess globin chains