Anaemia

Question 1

Define anaemia

Answer 1

Low Hb concentration due to either:

• low red cell mass
• increased plasma volume (e.g. in pregnancy)

Question 2

Two general ways of decreased RBCs?

Answer 2

Increased loss of RBCs

Decreased production of RBCs

Question 3

What are the Sx of anaemia?

Answer 3

May be asymptomatic if slow onset

Generalised:
- Fatigue, Dyspnoea, Headache and faintness, Palpitation, Tinnitus, Anorexia, Angina (if pre-existing CV disease)

Question 4

What are the general signs of anaemia?

Answer 4

Pallor / pale conjunctiva

Hyperdynamic circulation - tachycardia, ejectin systolic murmur, cardiac enlargement

Retinal haemorrhages (rare)

Heart failure => peripheral oedema

Question 5

What are the causes of microcytic anaemia?

Answer 5

Iron deficiency anaemia
Thalassaemia
Sideroblastic anaemia
Anaemia of chronic disease

Question 6

What are the causes of normocytic anaemia?

Answer 6

Acute blood loss
Anaemia of chronic disease
Bone marrow failure (suspect if pancytopaenia)
Renal failure
Hypothyroidism
Haemolysis
Pregnancy

Question 7

What are the causes of macrocytic anaemia?

Answer 7

Vit-B12/folate deficiency
Alcohol excess/liver disease
Hypothyroidism
Antifolate drugs, e.g. phenytoin
Reticulocytosis
Cytotoxics
Myelodysplastic syndrome
Marrow inflitration

Question 8

Describe haemolytic anaemia

Answer 8

May be normocytic or macrocytic

Question 9

When should haemolytic anaemia be suspected?

Answer 9

Reticulocytosis
Macrocytosis
Haptoglobin decreased
Raised bilirubin and urobilinogen
Mild jaundice

Question 10

What is haptoglobin?

Answer 10

Protein that binds to Hb to remove it

Question 11

What are the causes of decreased red cell (marrow) production?

Answer 11

Stem cell defects/dysfunction

Hypoproliferation

Marrow infiltration

Nutrutional deficiencies

Question 12

What are the causes of stem cell defects?

Answer 12

Intrinsic = stem cell aplasia/abnormalities e.g. leukaemia

Extrinsic = killed/impaired stem cell function
- drugs, viruses, chemicals, radiation

Question 13

What can cause hypoproliferation of marrow?

Answer 13

Hypostimulation
- i.e. in renal insufficiency, endocrinopathies

Exrinsic inhibition of proliferation
- cytokines, viral infections, autoimmune disease

Question 14

What can cause marrow infiltration?

Answer 14

Cancers (Metastases, lymphomas, myelomas, leukaemias)

Fibrosis

Question 15

Nutritional deficiencies that can cause reduced marrow production?

Answer 15

Iron
Folate / Vit-B12
Protein malabsorption

Question 16

What can cause excess peripheral loss of RBCs?

Answer 16

Bleeding

Haemolysis

Question 17

List the causes of haemolysis

Answer 17

Intrinsic

• abnormal Haemoglobins (sickle, beta-thalassaemia)
• membrane protein defects

Extrinsic

• autoimmune reactions
• hypersplenism - increased RBC lysis
• microangiopathic disorders - e.g. TTP, DIC
• Infections - malaria, clostridia

Question 18

What are the causes of iron deficiency anaemia?

Answer 18

Blood loss - Menorrhagia

Poor diet - poverty

Malabsorption - e.g. coeliac disease

GI blood loss due to parasites such as hookworm

Question 19

Specific signs of chronic iron deficiency anaemia?

Answer 19

Koilonychia
Angular stomatitis/cheilosis
Atrophic glossitis
Post-cricoid webs

Question 20

What will Ix show in iron-def anaemia?

Answer 20

Microcytic hypochromic anaemia
Ferritin decrease (increased in inflammation)
Decreased serum iron
Increased TIBC

Question 21

How should iron deficiency anaemia be treated?

Answer 21

Treat the underlying cause

Oral Iron e.g. ferrous sulfate 200 mg/8H

Question 22

What are the SEs of oral iron?

Answer 22

Nausea, abdo discomfort, diarrhoea, constipation, black stools

Question 23

What will Ix show in anaemia of chronic disease?

Answer 23

Mild, normocytic anaemia

Normal increased ferritin