Anaemia

Question 1

What is the normal range for haemoglobin?

Answer 1

115 - 160 g/L

Question 2

What is the normal range for Serum iron?

Answer 2

14 - 32 micromol/L

Question 3

After insufficient iron, what is the second most common nutritional deficiency that can cause aneaemia?

Answer 3

Low levels of B12 and Folic acid (folate)

Question 4

Which drugs may cause gastrointestinal bleeding?

Answer 4

NSAIDs
Low dose aspirin
Warfarin

Question 5

Which drug can reduce absorption of iron?

Answer 5

Tetracycline

Question 6

Which vitamin improves the absorption of iron?

Answer 6

Vitamin C

Question 7

What are the roles of B12?

Answer 7

Erythropoiesis and Neuronal function

Question 8

Why are iron tablets taken an hour before food?

Answer 8

Because iron is absorbed better on an empty stomach

Question 9

With what combination of vitamins would you treat a patient with iron deficiency anaemia secondary to menorrhagia?

Answer 9

ferrous fumarate/ folic acid (Ferro-F) combination.

Question 10

Why do you combine folic acid and ferrous fumarate in the initial treatment of iron deficiency anaemia?

Answer 10

A combination with folate is useful in the initial period when folate requirements will be increased as the bone marrow responds. A change to an iron only preparation may be made in a few months time when the haemoglobin is normal.

Question 11

What is the treatment for macrocytic anaemia secondary to vitamin B12 deficiency?

Answer 11

Vitamin B12 MUST be given before folate to avoid precipitating subacute combined degeneration of the spinal cord.

Question 12

For which patients would a blood transfusion be indicated?

Answer 12

Patients needing urgent surgery or with heavy acute bleeding, angina or heart failure.

Question 13

What is the use of measuring ferritin concentrations?

Answer 13

Ferritin is a measure of long-term stores and is an appropriate way to monitor progress, but not in the short term.

Question 14

After prescribing oral iron to a woman with microcytic hypochromic anaemia, how long would you wait before doing a full blood count?

Answer 14

2 to 3 weeks

Question 15

What are three ways of monitoring the effectiveness of treatment for anaemia in the short term?

Answer 15

• Full blood count (after 2-3 weeks)
• Monitor exercise tolerance
• Check iron and haemoglobin after a month

Question 16

What is the best measure of whether iron stores have been repleted by therapy?

Answer 16

Ferritin.

Question 17

what are the common side-effects of oral iron treatment?

Answer 17

Nausea and black stools

Question 18

In which part of the intestine are B12 and folate absorbed?

Answer 18

Jejunum

Question 19

Which part of the gut is most affected by coeliac disease?

Answer 19

Jejunum

Question 20

Which medication could interfere with iron absorption?

Answer 20

Antacids (by increasing pH of stomach or by forming complexes with iron)

Question 21

Why (other than there being adequate iron stores in the body) might ferritin be elevated?

Answer 21

It is an acute phase reactant, so might be elevated by inflammation.

Question 22

What is the most widely used marker of folate stores in the body?

Answer 22

Red cell folate

Question 23

Under which circumstances would you give an iron infusion?

Answer 23

If they are losing iron at a rate that is greater than the rate at which they can absorb iron from the gut.