Anaemia

Question 1

Symptoms of anaemia

Answer 1

Lethargy
SOB
Palpitations
Headache
Koilonychia

Question 2

Koilonychia

Answer 2

Spoon shaped nails

A sign of iron deficiency anaemia.

Question 3

5 broad causes of anaemia

Answer 3

Bleeding

Deficiencies: Iron, B12, folic acid.

Haemolytic: Short RBC lifespan, increase in RBC destruction.

BM dysfunction

Poor O2 utilisation or carriage.

Question 4

Daily requirement for iron

Answer 4

1-3 mg/day

Question 5

Tests for iron

Answer 5

Serum iron

Total iron binding capacity

Serum transferrin

% Transferrin saturation

Serum ferritin

Question 6

Total iron binding capacity (TIBC)

Answer 6

This is an alternative measure of serum transferrin.

When there is an increase in iron loss, TIBC increases.

Question 7

Ferritin

Answer 7

Protein that stores intracellular iron.

Question 8

% transferrin saturation

Answer 8

The ratio between iron and transferrin. Will detect iron loss of transferrin:iron ratio is very high.

Question 9

Causes of iron deficiency

Answer 9

Bleeding: menorrhagia, occult GI malignancy, GI ulceration.

Coeliac disease

Crohn’s disease

Pregnancy

Question 10

Vitamin B12 requirement

Answer 10

1-3 mcg / day

Question 11

Folic acid requirement

Answer 11

100 mcg/ day

Question 12

Microcytic hypochromic anaemia

Answer 12

Anaemia that shows small red blood cells.

Causes:
Iron deficiency
Thalassaemia

Question 13

Macrocytic anaemia

Answer 13

Anaemia characterised by large red blood cells.

Causes:
B12/ folate deficiency
Myelodysplasia.

Question 14

MCV

Answer 14

Mean corpuscular volume-

Average volume of red blood cells.

Average-: 80-100 fL

Question 15

Megaloblastic anaemia

Answer 15

Macrocytic anaemia due to Vit B12 or folate deficiency. MCV is too high.

Features:
There is sufficient iron and precursors for cell growth.

BUT there is insufficient supply of precursors for cell division.

Question 16

B12 deficiency

Answer 16

Vitamin B12 is required for precursors in cell divisions.

Causes:
Pernicious anaemia- autoimmune disease that destroys parietal cells, leads to loss of intrinsic factor.

Post gastric/ Ileal surgery

Crohn’s disease

Parasitic infection- fish tapeworm.

Question 17

Folate deficiency

Answer 17

Causes megaloblastic anaemia.

Causes:
Dietary- lack of intake

Coeliac and Crohn’s disease

Excess utilisation: chronic haemolysis and pregnancy.

Alcohol

Drugs: phenytoin, methotrexate.

Question 18

Poor utilisation of iron in the body

Answer 18

Iron can become stuck in macrophages.

This prevents it from being mobilised to early erythroblasts.

Question 19

Causes for impaired proliferation of erythroid progenitors

Answer 19

Poor response to erythropoietin.

Unavailable iron prevents erythrocyte development.

Question 20

Sickle cell anaemia

Answer 20

Autosomal recessive genetic condition.

Point mutation in beta-globin gene- HbS, abnormal haemoglobin.

RBC have very short lifespan- 20 days, compared to 100-120.

Episodes of sick cell crisis

Question 21

Management of sickle cell anaemia

Answer 21

Analgesics

Hydration

Exchange transfusion for blood cells

Question 22

Thalassaemia

Answer 22

Inherited autosomal recessive genetic condition that alters Hb gene expression.

Features:
Large spleen, liver, heart.
Misshapen bones.
Microcytic, hypochromic cells.

Distributed similarly to incidence of malaria

Question 23

Bone marrow infiltration

Answer 23

Bone marrow malignancy.

Leukaemia
Lymphoma
Myeloma

Question 24

Management of chronic anaemia

Answer 24

If iron deficient- oral ferrous sulphate for 3 months

If folate deficient- oral forate for 3 months

If B12 deficient- B12 injections for 3 months

Kidney failure- EPO

Question 25

Complications of long term transfusion

Answer 25

Iron overload- haemochromatosis

Creation of allo-antibodies: antibodies created to target blood group antigen on a person’s red blood cell.

Question 26

Hereditary spherocytosis

Answer 26

Genetic condition that causes dysfunctional membranes in RBCs.

Causes RBCs to be sphere shaped instead of biconcave.

This structure is more likely to lyse and cannot flex through small blood vessels.

These cells are broken down rapidly in the spleen due to abnormal proteins present- leads to splenomegaly and aplastic anaemia

Question 27

Hereditary elliptocytosis

Answer 27

Genetic blood disorder of RBC membrane causing the shape to be ‘elliptical’.

This makes individuals more susceptible to haemolytic anaemia.

Question 28

Haemoglobin

• Structure
• Gene

Answer 28

Protein that transports O2 in the blood.

Structure: 4 globin chains in HbA

• 2 alpha
• 2 beta

Genes:

• 4 alpha genes
• 2 beta genes

Question 29

Beta thalassemia

Answer 29

Genetic condition that affects the expression of beta-globin in haemoglobin.
- 2 genes code for beta-globin.

Inherited in a autosomal recessive fashion.

Thalassemia trait- single gene defect
Major= both globin genes defect

Question 30

Beta-thalassemia blood film

Answer 30

Will show hypochromic, microcytic red blood cells

Question 31

Symptoms of beta-thalassemia

Answer 31

B-thalassemia trait- no sever clinical consequences.

Major:

• Severe anaemia
• Transfusion dependency can cause iron overload and organ failure.

Question 32

Haemolysis screen

Answer 32

Diagnoses the following factors:

• Coomb’s test (positive)
• Bilirubin level (increases)
• Presence of spherocytes
• LDH level (increases)
• Reticulocyte count (increases)

Question 33

Main causes of bleeding that causes anaemia

Answer 33

Internal bowel bleed

Menorrhagia

Bleed in the bladder