Anaemia

Question 1

Decribe the creation of an erythrocyte

Answer 1

hemocytoblast –> proerythroblast –> normoblast –> reticulocyte –> erythrocyte

Question 2

How do the kidneys regulate erythropoeisis?

Answer 2

erythropoeitin released in hypoxic conditions. eyrhtropoietin acts on bone marrow to increase number of erythrocyte progenitor cells.

Question 3

What 2 metabolic pathways are found in the RBC? What can abnormalities in these pathways lead to?

Answer 3

Embden-Meyerhof Pathway - glucose metabolised to lactate to produce ATP. Used to maintain membrane pumps.

Hexose monophosphate pathway - G6P used to generate NADPH.

abnormalities lead to anaemia

Question 4

define anemia in adult men and women

Answer 4

men -

Question 5

How does the body respond to anemia?

Answer 5

Increasing CO, produce more 2,3-BPG, increasing erythropoeisis,

Question 6

What are the symptoms of anemia?

Answer 6

dyspnoea, weakness and lethargy, palpitations, headaches, tachycardia, pallor

Question 7

What are the 2 ways anaemia can occur?

Answer 7

reduced production or increased removal

Question 8

how can anemia be classified?

Answer 8

High (due to hemorrhage or hemolysis) and low reticulocytes (reduced production)

Question 9

How would you test for hemolysis? What would each test show?

Answer 9

Blood films - show spherocytosis, red cell fragments etc
Direct coombs test - tests for autoimmune hemolysis
Bilirubin levels or LDH levels
haptoglobin - used to remove Hb from blood by spleen
Reticulocyte count

Question 10

How can low reticulocyte anemia be further subclassified?

Answer 10

microcytic, normocytic, macrocytic

Question 11

Name 5 main causes of microcytic anemia

Answer 11

TAILS

Thalassemia, anaemia of chronic disease, iron deficiency, lead, sideoblastic anemia

Question 12

How would you confirm iron deficiency anemia

Answer 12

ferritin and transferrin % saturation tested.

Question 13

Name causes of normocytic anemia

Answer 13

anaemia of chronic disease, renal failure, bone marrow failure

Question 14

Explain the pathogenesis of anemia of chronic disease

Answer 14

In chronic disease there is chronic inflammation. Inflammation produces IL-6 which stimulates increased hepcidin which reduces amount of ferroportin in blood.
Hepcidin reduces iron absorption in gut.

Question 15

name causes of macrocytic anemia

Answer 15

b12 or folate deficiency, hypothyroidism, alcoholism.

Question 16

When would b12 deficiency be seen?

Answer 16

vegetarians, pernicious anemia, iliac disease or surgery

Question 17

when would folate deficiency be seen?

Answer 17

poor diet, malabsorption, drugs

Question 18

What would anaemia of chronic disease show during investigations which are different to iron deficiency anaemia?

Answer 18

Increased ferritin levels, raised inflammatory markers, low % transferrin saturation

Question 19

How would you treat Anemia of chronic disease?

Answer 19

EPO, transfusion, treat underlying disease