Anaemia

Question 1

Anaemia

• definition
• categorize causes
• symptoms (4)
• signs (3)

Answer 1

Hb < 135g/l (M) < 115g/l (F)

• can be due to reduced production, increased breakdown, or increased plasma vol (pregnancy)
• Symptoms - SOB, fatigue, pallor, tinnitus, palpitations
• Signs - severe anaemia: hyperdynamic circ e.g. flow murmurs, tachycardia > HF

Question 2

Causes of Microcytic anaemia (FAST)

Answer 2

• Fe-def anaemia
• anaemia of chronic disease
• Sideroblastic anaemia
• thalassemia

Question 3

Causes of normocytic anaemia (5)

Answer 3

• Anaemia of chronic disease
• hypothyroidism
• blood loss
• pregnancy
• haemolysis
• BM failure

Question 4

Causes of High MCV (FATRBC)

Answer 4

• Fetus (pregnancy)
• Antifolates (e.g. phenytoin)
• Thyroid (hypothyroid)
• Reticulocytosis
• B12/folate def
• Cirrhosis
• also myelodysplastic syndromes

Question 5

Signs of IDA (4)

Answer 5

• Koilonychia
• Angular stomatitis
• atrophic glossitis
• brittle hair
• post-cricoid webs (Plummer vinson syndrome)

Question 6

Blood film features of IDA (3)

Answer 6

1. microcytic, hypochromic
2. aniocystosis (varying size)
3. Poikilocytosis (varying shape)
4. Pencil cells

Question 7

Causes of Fe def anaemia - bleeding until proven otherwise

Classified into:

• Blood loss - give some causes (3)
• increased utilization (2)
• Decreased intake (2)
• Decreased absorption (2)
• Intravascular haemolysis (2)

Answer 7

Blood loss - GI losses

• ​Meckel’s diverticulum (older children)
• Peptic ulcer/gastritis (chronic NSAID) use
• Colonic polyps/cancer (most common > 50yrs)
• Menorrhagia
• hookworm infestation

Increased utilization - pregnancy/childhood; for growth

Decreased intake - prematurity, suboptimal diet

Decreased absorption - Coeliacs, post surgical (absence of villi, rapid transit)

Intravascular haemolysis - Microangiopathic haemolytic anaemia, PNH; chronic loss of Hb in urine

Question 8

Management of IDA (2)

Answer 8

• treat the cause
• oral iron - AEs; abdo discomfort, black stools, constipation/diarrhoea

Question 9

Anaemia of Chronic disease (ACD): causes (4)

Answer 9

ACD is a cytokine driven inhibition of RBC production

Causes:

• chronic Infection e.g. TB
• inflammation e.g. RA
• malignancy
• vasculitis

(Inflammotry markers e.g. IFNs & IL-1 reduce EPO receptor production in kidneys. Also LPS & IL-6 stimulate liver to make hepcidin which reduces Fe absorption from the gut by inhibiting transferin)

Question 10

ACD - is ferritin high or low?

Answer 10

HIgh - it is an acute phase protein (also fe is sequestered and acumulated in macrophages - to deprive invading bacteria of Fe)

Question 11

Sideroblastic anaemia:

• why does it cause haemosiderosis?
• Dx (1)
• causes (4)
• rx (2)

Answer 11

• ineffective erythopoiesis - cannot add fe to Hb > accumulates and causes haemosiderosis - depositing on liver/ heart etc
• dx - ring sideroblasts; these are erythoid precursoirs with Fe deposited in mitochondria in a ring around the nucleus
• Causes
  
  • myelodysplastic disorders
  • chemo
  • alcohol excess
  • lead excess, anti-TB drugs
• Rx - remove the cause & give vit B6 (promotes RBC synth)

Question 12

Say whether the Fe, TIBC & ferritin will be High (H) or Low (L) in following diseases:

1. IDA
2. ACD
3. Chronic haemolysis
4. haemochromatosis
5. pregnancy
6. sideroblastic anaemia

Answer 12

Disease

Fe

TIBC

Ferritin

Fe def

L

H

L

ACD

L

L

H

Chronic haemolysis

H

L

H

Haemochromatosis

H

L/N

H

Pregnancy

H

H

N

Sideroblastic anaemia

H

N

H