Anaemia

Question 1

What colour do reticulocytes stain?

Answer 1

deep red/purple

Question 2

If MCV low (microcytic) what should be considered as the problem?

Answer 2

haemoglobinisation - Cytoplasm defect

Question 3

If MCV high (macrocytic) what should be considered as the problem?

Answer 3

maturation

Question 4

In which type of anaemia are the RBCs hypochromic (lacking in colour)?

Answer 4

Microcytic

Question 5

2 main types of microcytic anaemia?

Answer 5

iron deficiency
globin deficiency (thalassemia)

Question 6

What 2 things is iron essential for?

Answer 6

O2 transport

Electron transport

Question 7

In what way is iron potentially toxic to the body?

Answer 7

produces free radicals

Question 8

Describe the structure of adult haemoglobin.

Answer 8

4 globulin molecules (2 alpha, 2 beta)

I haem subunit attached, which contains an iron ion (Fe2+)

Question 9

How many O2 molecules can one haem group bind to?

Answer 9

1

Question 10

Where is most of the iron in the body?

Answer 10

in the haemoglobin

Question 11

Is the iron cycle an open or closed system?

Answer 11

closed

Question 12

Is the iron turnover in the plasma pool fast or slow?

Answer 12

fast

Question 13

Circulating iron is bound to what?

Answer 13

transferrin

Question 14

Where is iron transferred to?

Answer 14

bone marrow macrophages, which feed it to the red cell precursors

Question 15

Where is iron mainly stored as ferritin?

Answer 15

liver

Question 16

What is the name of the protein which has two binding sites for iron?

Answer 16

transferrin

Question 17

In what situation is transferrin increased?

Answer 17

genetic haeomochromatosis

Question 18

What does low ferritin mean?

Answer 18

iron deficiency

Question 19

3 general caused of iron deficiency?

Answer 19

not getting enough iron i.e. diet
losing it through bleeding
not absorbing it

Question 20

Examples of malabsorption of iron?

Answer 20

coeliac disease

Achlorydia (absence of HCl in gastric secretions)

Question 21

What are the two general causes of macrocytic anaemia?

Answer 21

genuine (megaloblastic/nonmegaloblastic)

spurious

Question 22

What is an erythroblast?

Answer 22

Erythroblast: A normal red cell precursor with a nucleus

Question 23

What is a megaloblast?

Answer 23

An abnormally large nucleated red cell precursor with an immature nucleus.

Question 24

Megaloblastic anaemias are characterised by what?

Answer 24

defects in DNA synthesis and nuclear maturation

Question 25

What happens to RNA and haemoglobin synthesis in megaloblastic anaemias?

Answer 25

relative preservation of RNA and haemoglobin synthesis

Question 26

The larger cell size in megaloblastic anaemia is not due to an increase in the size of the developing cell, but what?

Answer 26

a failure to become smaller

Question 27

Causes of Megaloblastic Anaemia?

Answer 27

``` B12 deficiency Folate deficiency Others Drugs Rare inherited abnormalities ```

Question 28

Why does lack of B12 or folate cause megaloblastic anaemia?

Answer 28

B12 and folate are essential co-factors for nuclear maturation. They enable chemical reactions that provide enough nucleosides for DNA synthesis

Question 29

Are B12 and folate biochemical reactions interlinked?

Answer 29

yes - Methionine cycle and folate cycle

Question 30

Dietary folates are converted to what, and absorbed where?

Answer 30

monoglutamate, absorbed in jejenum

Question 31

Give 4 causes of folate deficiency.

Answer 31

- drugs - malabsorption - excess utilization - inadequate intake

Question 32

List symptoms of folate and B12 deficiency which are common to both.

Answer 32

Symptoms/signs of anaemia weight loss, diarrhoea, infertility Sore tongue, jaundice Developmental problems

Question 33

In which deficiency may problems occur to myelin sheath?

Answer 33

b12

Question 34

Name the autoimmune condition with resulting destruction of gastric parietal cells.

Answer 34

Pernicious anaemia

Question 35

Give an example of some autoimmune conditions which pernicious anaemia may be associated with.

Answer 35

Hypothyroidism, vitiligo, Addison’s disease

Question 36

Blood film shows what in pernicious anaemia?

Answer 36

macrovalocytes and hypersegmented neutrophils

Question 37

Is pernicious anaemia micro or macro?

Answer 37

macrocytic, and there may be pancytopenia

Question 38

Are Assay B12 and folate levels in serum always reliable?

Answer 38

no

Question 39

Which antibodies are tested for in B12 and folate defiency?

Answer 39

anti gastric-parietal cell (GPC) and anti-intrinsic factor (IF)

Question 40

Is bone marrow examination usually required for b12/folate deficiency?

Answer 40

no

Question 41

Treatment for pernicious anaemia?

Answer 41

vitamin b12 injections for life

Question 42

In what type of anaemia would red blood cell transfusion be given?

Answer 42

life threatening

Question 43

Causes of non megaloblastic macrocytosis?

Answer 43

Alcohol Liver disease Hypothyroidism Marrow failure (this is the only one of the 4 which is most likely to be ass. with anaemia)

Question 44

Two types of spurious macrocytosis?

Answer 44

Reticulocytosis | Cold agglutinins disease

Question 45

What does reticulocytosis indicate?

Answer 45

indicates a marrow response to ‘loss’ of red cells either through acute bleeding or haemolysis

Question 46

What happens in Cold Agglutinins disease?

Answer 46

"analyser" gets confused as clumps of ‘agglutinated’ red cells go through and are registered as 1 big cell

Question 47

Why may patients with pernicious anaemia appear mildly jaundiced?

Answer 47

intramedullary haemolysis

Question 48

What does this describe: Red cells die prematurely in the marrow Haemoglobin and lactate dehydrogenase (LDH) are released from dead red cells Haemoglobin converted to bilirubin

Answer 48

ineffective erythropoiesis

Question 49

What can complicate severe megaloblastic anaemia?

Answer 49

pancytopenia

Question 50

Can nuclear maturation defects affect all lineages?

Answer 50

yes

Question 51

What is the most useful classification of anaemia?

Answer 51

MCV