Anaemia

Question 1

What does spherocytes on the blood film mean possibly?

Answer 1

Warm haemolytic anaemia

Hereditary spherocytosis

Question 2

Which part of the Hb is affected in thalessemia?

Answer 2

Globin

Question 3

What are pencil cells?

Answer 3

A feature of iron deficiency anaemia

(Not in thalessemia)

Question 4

Will an upper GI bleed cause a positive faecal occult blood test?

Answer 4

Yes

Question 5

What is diagnostic test for thalassemia?

Answer 5

Haemoglobin electrophoresis

Question 6

What are some causes of microcytic anaemia?

Answer 6

Fe deficiency

Thalassemia

Chronic disease

Inherited spherocytic

Lead poisoning

Question 7

What is the RDW in Fe deficiency and thal minor?

Answer 7

Fe - elevated

Thal - normal

Question 8

What is a systematic way to classify causes of anaemia?

Answer 8

Blood loss

Decreased production

Increased destruction

Question 9

How long do B12 stores last?

Answer 9

18 months

Question 10

In terms of the classification of anaemia’s, what types of anaemia is Fe deficiency anaemia?

Answer 10

Blood loss

Decreased production

Question 11

Does the urine go dark in haemolysis?

Answer 11

Generally no as it won’t pass through the glomerulus

Question 12

How long does the folate stores last?

Answer 12

3 months

Question 13

What is the next test to be performed with spherocytes are seen? How is it interrupted?

Answer 13

Direct combs test

• Positive: warm haemolytic anaemia
• Negative: hereditary spherocytosis

Question 14

What is the Ix reticulocyte count useful for?

Answer 14

Determining the function of the bone marrow

Question 15

Where is Fe absorbed? How much can be absorbed per day?

Answer 15

Duodenum

1mg per day

Question 16

What is the size of cells in folate and B12 deficiency?

Answer 16

Macrocytic

Question 17

What is the most common cause of Fe deficiency in Australia?

Answer 17

Occult blood loss from the GIT

Question 18

In haemolysis, is the bilirubin conjugated or unconjugated?

Answer 18

Unconjugated

Question 19

Why might the platelets be up in a patient with fatigue?

Answer 19

Platelets can be elevated in Fe deficiency anaemia

A inflammatory process might be elevating the platelets

Question 20

What abnormal cells might be seen in thalassemia?

Answer 20

Target cells

Question 21

What does a leukoerythroblastic picture in peripheral blood reflect?

Answer 21

Bone marrow invasion pushing bone marrow precursors into the peripheral blood

Question 22

What do you look for on blood film in haemolysis?

Answer 22

Spherocytes = warm autoimmune anaemia or hereditary spherocytosis

Fragments + Schistocytes = microangiopathy

Bite cells + blisters = oxidative damage

Question 23

What is the red cell distribution width (RDW)?

Answer 23

The width of the peak of the standard deviation of the RBC number and MCV

Question 24

What are the five signs of haemolytic anaemia

Answer 24

Abnormal blood film

Raised lactate dehydrogenase

Raised reticulocyte counts

Raised unconjugated bilirubin

Reduced haptoglobin

Question 25

What must you be wary of when looking at the ferritin in iron studies?

Answer 25

It’s an acute phase reactant therefore may be inappropriately normal

Question 26

What test will measure long term folate levels?

Answer 26

Red cell folate

Question 27

What causes decreased RBC production?

Answer 27

Anaemia of chronic disease

Low haematinitcs - Folate, B12, iron

Bone marrow failure

Endocrine disorders - Thyroid, low EPO

Infectious eg TB, HIV