Anaemia

Question 1

What is anaemia?

Answer 1

A decrease in the amount of haemoglobin in the blood - <135g/L for men, <115g/L for women.

Question 2

What could cause low Hb concentration?

Answer 2

Low red cell mass

Increased plasma volume

Question 3

What is microcytic anaemia? What are the causes?

Answer 3

Mean cell volume (MCV) <80. Mainly iron-deficiency anaemia but also includes thalassemia and, rarely, sideoblastic anaemia.

Question 4

What defines normocytic anaemia? What are the causes?

Answer 4

MCV 80-100. Acute blood loss, anaemia of chronic disease, combined haematicic deficiency (lecture 19.1.18)

Question 5

What defines macrocytic anaemia? What are the causes?

Answer 5

MCV >100. B12 or folate deficiency (megaloblastic), alcohol excess/liver disease, metabolic disease eg hyperthyroidism.

Question 6

What is thalassaemia?

Answer 6

A group of inherited blood disorders characterised by reduced haemoglobin production. The two main types are alpha and beta thalassaemias. (wiki, lecture)

Question 7

How could chronic kidney disease cause anaemia?

Answer 7

Less EPO so fewer RBCs.

Question 8

What causes iron deficiency?

Answer 8

Bleeding, malabsorption, poor diet, breastfeeding, hookworm. (pts)

Question 9

What is the main diagnostic test for iron deficiency?

Answer 9

Measure serum ferritin. However, ferritin is an acute phase protein, so its concentration will increase in response to inflammation and malignancy, leading to false results.

Question 10

What investigations would you do for suspected anaemia?

Answer 10

An endoscopy can be done to see if anaemia is due to a GI bleed.
Reticulocyte count tells you how quickly RBCs are being made in the bone marrow. Raised = problem with removal, eg bleeding, haemolytic anaemia. Low = problem with production eg iron deficiency anaemia.

Question 11

What are the signs of iron deficiency?

Answer 11

Koilonychia (spoon-shaped nails), angular stomatitsi (ulcer at side of mouth), atrophic glossitis (atrophy of lingual papillae), brittle hair and nails.

Question 12

How is iron deficiency anaemia treated? What are the side-effects?

Answer 12

Ferrous sulphate tablets.

Cause constipation, epigastric pain, diarrhoea, GI irritation.

Question 13

What causes folate deficiency? and would this cause micro, normo or macrocytic anaemia?

Answer 13

Folate deficiency = macrocytic anaemia. Caused by malabsorption, increased demand (eg pregnancy), and poor diet (folate is in green veg, fruit)

Question 14

What mainly causes B12 deficiency?

Answer 14

The most common cause of B12 deficiency is pernicious anaemia, in which autoimmune destruction of parietal cells results in decreased production of intrinsic factor. Since B12 needs to bind to IF to be absorbed, this leads to vitamin B12 malabsorption. (pts)

Question 15

How is B12 deficiency treated?

Answer 15

Vitamin B12 injections or tablets. (pts)

Question 16

How can crohn’s disease, coeliac disease and gastrectomy cause macrocytic anaemia?

Answer 16

B12 deficiency.

Question 17

What are the symptoms of anaemia?

Answer 17

Fatigue
Faintness
Breathlessness
Reduced exercise tolerance

Question 18

What are the signs of anaemia?

Answer 18

Pale skin, pale mucous membranes, tachycardia.

Question 19

What is sickle cell anaemia?

Answer 19

A common type of sickle cell disease, which is a haemoglobinopathy in which the oxygen-carrying capacity of haemoglobin in red blood cells, causing them to become sickle-shaped.

Question 20

Give 3 complications of sickle cell disease.

Answer 20

Chronic haemolytic anaemia
Infections
Painful 'sickle cell' crises
Acute chest syndrome
Ischaemic/haemorrhagic stroke
Ocular disease
(lecture)

Question 21

How is sickle cell trait inherited?

Answer 21

Autosomal recessive inheritance.

Question 22

What is the effect of having sickle cell trait?

Answer 22

Heterozygote advantage. It protects against falciparum malaria. Can also cause symptoms of sickle cell anaemia at high altitude.

Question 23

What is Hbs?

Answer 23

Sickle haemoglobin.

Question 24

Why does sickling occur?

Answer 24

The sickling only occurs in deoxygenated Hbs cells. It occurs more in:
acidosis, which decreases Hb affinity for O2,
low-flow vessels, because Hb has more time to deoxygenate.

Question 25

What can cause low haptoglobin?

Answer 25

Repeated sickling weakens the RBC membrane so it breaks down in the blood. It is recycled by haptoglobin. When this is happening there is less free haptoglobin in the blood so low haptoglobin is a sign of sickle cell anaemia.

Question 26

Why could a patient with sickle cell anaemia have jaundice, scleral icterus and bilirubin gallstones?

Answer 26

Increasing breakdown and recycling of haemoglobin creates lots of haem, which forms unconjugated bilirubin, which causes jaundice, scleral icterus and gallstones.

Question 27

How does glucose-6-phosphate dehydrogenase deficiency cause anaemia and what type?

Answer 27

Inherited condition in which the body doesn’t have enough G6PD, which helps red blood cells (RBCs) function normally. This deficiency can cause haemolytic macrocytic anemia, usually after exposure to certain medications, foods, or infections.