Anaemia

Question 1

When would you see high reticulocytes in anaemia?

Answer 1

When the anaemia is due to increased removal of Hb:

• Haemorrhage
• Haemolysis eg. Sickle cell, hereditary sherocytosis/eliptocytosis, pyruvate kinase deficiency, G6PD deficiency
• Splenic sequestration (splenomegaly)

Question 2

When would you see low reticulocytes in anaemia?

Answer 2

When the anaemia is due to decreased Hb production

Question 3

Give some causes of microcytic anaemia

Answer 3

Thalasaemia
Anaemia of chronic disease
Iron deficiency 
Lead
Sideroblastic anaemia

Question 4

Give some causes of iron deficiency anaemia

Answer 4

Reduced intake - vegetarians
Increased loss - GI bleed, heavy periods
Excessive use - pregnancy

Question 5

Give causes of macrocytic anaemia

Answer 5

Vitamin B12 deficiency
Folate deficiency
Alcoholism
Hypothyroidism

Question 6

Give causes of vitamin B12 deficiency

Answer 6

Low intake - vegans
Pernicious anaemia (low intrinsic factor)
GI surgery

Question 7

Give causes of folate deficiency

Answer 7

Poor diet
Malabsorption
Drugs (anticonvulsants)

Question 8

Give causes of normocytic anaemia

Answer 8

Anaemia of chronic disease
Renal failure
Mixed deficiency (ie. Iron and vitamin B12)
Bone marrow failure

Question 9

Pathophysiology of anaemia of chronic disease

Answer 9

In chronic inflammation cytokines are released, stimulate excess HEPCIDIN.
This reduces gut iron absorption and reduces iron release by macrophages

Question 10

Symptoms of anaemia

Answer 10

Fatigue & lethargy
Weakness
Shortness of breath
Palpitations
Headaches 

Severe: angina, HF, claudication, confusion, dizziness

Question 11

Signs of anaemia

Answer 11

Pallor
Tachycardia
Systolic flow murmur
Glossitis
Angular stomatitis
Leg ulceration
Koilonychia 
Pale conjunctiva

Question 12

Questions to ask in anaemia history

Answer 12

Diet: vegan/vegetarian?
Past surgery?
Family history?
Past medical history?

Question 13

Investigations in anaemia

Answer 13

Blood film: spherocytosis? Mean cell volume? Reticulocytes?

Blood test: ferritin levels, transferrin saturation, VitB12 and folate levels, EPO, bilirubin, LFTs, Direct Coombs test

Question 14

Management of anaemia

Answer 14

Treat underlying cause

• Iron deficiency: give dietary advice and oral iron supplements
• ACD: EPO, transfusion

Question 15

Define anaemia

Answer 15

Reduced haemoglobin concentration in the blood <130g/L, leading to reduced O2 delivery to cells