Anaemia

Question 1

What Hb values indicate an anaemia?

Answer 1

Men: <13.5 (135)
Women: <11.5 (115)

Question 2

How can the causes of anaemia be categorised?

Answer 2

Macro / Normo / Microcytic

Question 3

Causes of macrocytic anaemia?

Answer 3

FAT RBC

Folate/B12
Antifolate drugs
Thyroid disorder (hypo)
Reticulocytosis
Booze
Cirrhosis

Question 4

Causes of normocytic anaemia?

Answer 4

Acute blood loss
Anaemic of chronic disease
Marrow failure
Pregnancy

Question 5

Causes of microcytic anaemia?

Answer 5

Find Those Small Cells

Fe deficiency
Thal
Sideroblastic anaemia (bone marrow produces abnormal red cells)
Chronic disease

Question 6

Which cause of anaemia does not fall into the 3 categories?

Answer 6

Haemolytic anaemia - due to increased RBC breakdown

Question 7

Causes of iron deficiency anaemia?

Answer 7

Blood loss i.e. GI bleed/period
Impaired iron absorption i.e. in coeliacs
Dietary insufficiency

Question 8

Clinical presentation of someone with an IDA

Answer 8

Signs:

• koilonychia
• Angular stomatitis

Symptoms:

• fatigue
• dyspnoea
• tinnitus
• headache
• palpitations
• pre-syncope

Question 9

Investigations to order in suspected IDA

Answer 9

Haematinics: ferritin (low) + total iron binding capacity (inc) + transferrin saturation (low)

FBC: Hb, MCV, MCH (all low)

Film: looking for poikilocytosis + anisocytosis

If Hx does not suggest obvious blood loss site then scope

Question 10

Management of IDA

Answer 10

1. Treat underlying cause

2. Ferrous sulphate

Question 11

Most common cause of B12 def. in UK?

Answer 11

Pernicious anaemia

Question 12

Pathophysiology of pernicious anaemia

Answer 12

B12 requires intrinsic factor to be absorbed
Intrinsic factor secreted by parietal cells of stomach
PA = autoimmune gastritis + Ab against gastric parietal cells = less secretion of intrinsic factor

Question 13

Importance of B12

Answer 13

DNA and myelin synth.

Question 14

other causes of B12 def. excluding pernicious anaemia

Answer 14

Surgery to terminal ileum
Diet low in B12 (vegans)
Chronns

Question 15

Clinical presentation of B12 def.

Answer 15

Symptoms of anaemia
Glossitis
Mild jaundice
Weight loss
Angular stomatitis

Question 16

Which spinal condition can pernicious anaemia lead to?

Answer 16

Subacute Combined Degeneration of the Cord

• results in distal sensory loss
• pain and temperature sensation remains the same

Question 17

Investigations to request in suspected B12 def.

Answer 17

Serum B12
Antibodies against gastric parietal cells
Thyroid antibodies and function
Schilling test (B12 swallow test)

Question 18

Management of B12 deficiency

Answer 18

Replenish B12 stores by IM or oral

Question 19

Which subgroup of people is pernicious anaemia more likely in?

Answer 19

Blood group A

>40 and above

Question 20

Causes of folate deficiency

Answer 20

• Dietary insufficiency
• Malabsorbtion
• Increased requirement in pregnancy
• Folate antagonist drugs like methotrexate

Question 21

Management of folate deficiency anaemia

Answer 21

Folic acid

Treat any underlying cause