anaemia

Question 1

anaemia?

Answer 1

reduced total red cell mass

Question 2

assuming steady state normal ranges are:

Answer 2

adult males Hb

Question 3

what is haematocrit?

Answer 3

ratio of the whole blood that is red blood cells if it were left to settle

Question 4

ie haematocrit of 0.5 means that half of the whole blood is made up of red blood cells

Answer 4

in some situations, hb/haematocrit is not a good marker of anaemia

Question 5

after a rapid bleed, blood volume could be the same, but plasma expansion has occurred to make up the lost volue i.e. haematocrit would be reduced

Answer 5

also IV fluids results in an increased plasma volume

Question 6

response to anaemia?

Answer 6

increase red cell production, peripheral blood reticulocytosis

Question 7

probapo - o - reticulocyte mature RBC

Answer 7

pronormoblast, basophilic normoblast, polychromatophilic/intermediate normoblast, orthochromatic/late normoblast. retic, RBC

Question 8

reticulocytes

Answer 8

red cells that have just left the bone marrow, larger than average rbcs, have remnants of RNA, stain purple/deep red as a consequence. blood film appears polychromatic

Question 9

up regulation of reticulocytes by the bone marrow in response to anaemia may take?

Answer 9

a few days

Question 10

what does polychromasia result from?

Answer 10

residual rna in the cell which gives the classic blue/grey appearance with classic stains

Question 11

if mcv is low, consider problems with?

Answer 11

haemoglobinisation

Question 12

if mcv is high, consider problems with maturation

Answer 12

haemoglobin synthesis occurs in the cytoplasm. defects result in small cells

Question 13

shortage in globins, haem (porphyrin ring or iron) results in ?

Answer 13

small cels with a low hb content

Question 14

they are small and lacking in colour

Answer 14

y

Question 15

hypochromic, michrocytic anaeia =

Answer 15

defective haeomglobin synthesis:cytoplasmic defect

Question 16

causes of microcytic anaemia?

Answer 16

iron deficiency, thalassaemia (globin defiency). some cases of anaemia from chronic disease

Question 17

iron can exist in what states?

Answer 17

fe2 plus or fe 3 plus

Question 18

in chronic disease, there is enough iron but not enough available iron

Answer 18

y

Question 19

why is iron potentially toxic?

Answer 19

it generates free radicals

Question 20

iron is also essential for electro transport (mitochondrial production of ATP)

Answer 20

u

Question 21

when fully saturated, 1g of Hb will bind ______ml 02?

Answer 21

1.34

Question 22

how much iron is absorbed into body each day?

Answer 22

1mg

Question 23

circulating iron is bound to transferrin, it is transferred to the bone marrow macrophages that feed it to red cell precursors

Answer 23

iron is stored in ferritin mainly in the liver

Question 24

how many binding sites does transferrin have for iron?

Answer 24

2

Question 25

transports iron from donor tissues (macrophages, intestinal cells and hepatocytes) to tissues expressing transferring receptors

Answer 25

y

Question 26

what does percentage saturation of transferrin with iron measure?

Answer 26

iron supply

Question 27

large intracellular protein, store up to 4000 ferric ions

Answer 27

ferritin

Question 28

ferritin in serum?

Answer 28

tiny amount

Question 29

serum ferritin?

Answer 29

reflects intracellular ferritin synthesis in response to the iron status of the host

Question 30

serum ferritin is an easily measured indirect measure of ?

Answer 30

storage iron

Question 31

iron deficiency can be confirmed by a combination of a microcytic, hypo chromic anaemia (decreased functional iron) and reduced storage iron (low serum ferritin)

Answer 31

y

Question 32

causes of iron deficiency?

Answer 32

diet, RELATIVE DEFICIECNY, ABSOLUTE deficiency, bleeding (usually GI), not absorbing enough…relatively uncommon - malabsorption (coeliac and achlorhydria)

Question 33

what is a relative deficiency?

Answer 33

ir pregnant woman

Question 34

absolute?

Answer 34

vegetarian diet

Question 35

causes of chronic blood loss leading to low iron?

Answer 35

monorrhagia, GI (TUMOURS, ULCERS, nsaids)

haematuria

Question 36

sequential consequences of negative iron balance?

Answer 36

exhaustion of iron stories, iron deficient erythropoiesis (falling MCV), anaemia, epithelial changes (skin, koilonychia)

Question 37

remember a small volume of GI blood loss can occur without any symptoms or signs of bleeding

Answer 37

this can outstrip the maximum dietary iron absorption of iron and result in anaemia

Question 38

how can iron absorption be increased?

Answer 38

iron supplements

Question 39

iron deficiency anaemia requires?

Answer 39

investigation for an underlying cause

Question 40

anaemia with high reticulocyte count?

Answer 40

bleeding or haemolysis