Anaemia

Question 1

What is the definition of anaemia?

Answer 1

low haemoglobin concentration

Question 2

What is the normal haemoglobin levels for males and females?

Answer 2

males - 130-180

females - 120-160

Question 3

What are the pathophysiological classifications of anaemia?

Answer 3

decreased production

increased destruction or loss of red cells

Question 4

What is the practical classifications of anaemia?

Answer 4

microcytic - decreased MCV

macrocytic - increased MCV

Question 5

What are the symptoms of anaemia?

Answer 5

fatigue 
dyspneoa 
faintness
palpitations 
headache 
tinnitus
anorexia

Question 6

What are the causes of microcytic anaemia?

Answer 6

haem deficiency:

• iron deficiency
• anaemia of chronic disease
• problems with porphyrin synthesis (v rare)

globin deficiency:
- thalassaemia

Question 7

What is the most common cause of microcytic anaemia?

Answer 7

iron deficiency

Question 8

What are some causes of iron deficiency?

Answer 8

blood loss e.g. menorrhagia, GI bleeding
poor diet (usually children/babies)
malabsorption e.g. coeliac

Question 9

Describe iron deficient anaemia

Answer 9

microcytic

hypo chromic

Question 10

How is iron deficiency anaemia diagnosed?

Answer 10

decreased ferritin

decreased Hb

Question 11

What is the treatment of IDA?

Answer 11

treat the cause

oral iron e.g. ferrous sulphate

Question 12

What are the side effects of oral iron?

Answer 12

GI disturbance: nausea, abdominal discomfort, diarrhoea/ constipation
black stools

Question 13

By how much should Hb rise per week after starting treatment for IDA?

Answer 13

by 10g/L a week

Question 14

What are the different classifications of macrocytic anaemias?

Answer 14

megaloblastic

nonmegaloblastic

Question 15

What is a megaloblast?

Answer 15

a cell in which nuclear maturation is delayed compared with the cytoplasm

Question 16

Which macrocytic anaemias are megaloblastic?

Answer 16

B12 and folate deficiency

Question 17

Why are B12 and folate deficiencies megaloblastic?

Answer 17

As they are both required for DNA synthesis

Question 18

Where is b12 absorbed?

Answer 18

terminal ileum

Question 19

Describe B12 absorption.

Answer 19

binds to intrinsic factor in the stomach

absorbed into terminal ileum

Question 20

Why is RBC production slow in B12 deficiency?

Answer 20

synthesis of thymidine and hence, DNA is impaired

Question 21

What are causes of B12 deficiency?

Answer 21

dietary e.g. vegans

malabsorption e.g. pernicious anaemia

Question 22

What is pernicious anaemia?

Answer 22

autoimmune condition with resulting destruction of gastric parietal cells
intrinsic factor deficiency resulting in B12 malabsorption and deficiency

Question 23

What are causes of folate deficiency?

Answer 23

poor diet e.g. alcoholics, elderly
increased demand e.g. pregnancy, haemolysis
malabsorption e.g. coeliac
drugs, alcohol, anti epileptics

Question 24

Where is folate absorbed?

Answer 24

jejunum

Question 25

What can folate deficiency cause in pregnancy?

Answer 25

neural tube defects

Question 26

What is the treatment of folate deficiency?

Answer 26

underlying cause
folic acid 5mg/day PO 4 months
never without B12 unless patient has known normal B12 levels (as if low B12 - can cause subacute combined degeneration of the cord)

Question 27

What spinal cord problem can B12 deficiency cause?

Answer 27

subacute combined degeneration of the cord

Question 28

What is the treatment of B12 deficiency?

Answer 28

treat underlying cause
malabsorption/pernicious - lifelong injections
dietary - oral

Question 29

What are the causes of non megaloblastic macrocytic anaemia?

Answer 29

alcohol
liver disease
hypothyroid

Question 30

What autoantibodies can you test for in suspected pernicious anaemia?

Answer 30

anti intrinsic factor (IF)

anti gastric parietal cell (gpc)

Question 31

What neurological symptoms can B12 deficiency cause?

Answer 31

parasthesiae

peripheral neuropathy