Anaemia

Question 1

What are the 3 possible mechanisms that leads to anaemia?

Answer 1

1. Bleeding
2. Production problems
3. Haemolysis

Question 2

What is microcytic anaemia and what are the causes of microcytic anaemia?

Answer 2

Microcytic anaemia = <80fL
Possible causes:
1. Iron deficiency anaemia
2. Anaemia of chronic diseases
3. Thalassaemia
4. Lead toxicity
5. Sideroblastic anaemia

Question 3

What is the normal cell size of red blood cells?

Answer 3

80-100fL

Question 4

What are the causes of normocytic anaemia?

Answer 4

Acute blood loss
Anaemia of inflammation/ Anaemia of chronic inflammatory condition.
Multiple myeloma - must always rule this out

Question 5

What are the causes of macrocytic anaemia?

Answer 5

Folate or vitamin B12 deficiency.
Pregnancy
Thyroid problems
Myelodysplastic syndrome
Post-splenectomy
Alcohol excess - think of this when blood tests are otherwise normal
Drugs, such as Methotrexate
Liver diseases (Cirrhosis)

Question 6

What are the signs of iron-deficiency anaemia?

Answer 6

Fatigue
Dyspnoea
Headache
Pallor
Atrophic glossitis
However, some may be asymptomatic, even in severe anaemia.

Question 7

Who should be referred via the urgent 2-week referral pathway - if iron-deficiency anaemia is detected?

Answer 7

All males aged above 60 and all females above 55.

Anyone less than 50yo but has rectal bleeding should be considered to be referred urgently.

Question 8

What are the common causes of GI tract blood loss?

Answer 8

Aspirin and NSAIDs
Gastric carcinoma
Colonic carcinoma
Benign gastric ulceration
Angiodysplasia

Question 9

What are the malabsorption causes of iron-deficiency anaemia?

Answer 9

Coeliac disease, Gastrectomy, H. Pylori infection.

Or less commonly, Schistosomiasis and Hookworm, or IBD.

Question 10

What biochemical test is used to confirm iron deficiency?

What value confirms this?

Answer 10

Serum Ferritin levels.

<15micrograms/L confirms iron deficiency.

Question 11

Ileal resection can put someone at risk of which type of anaemia?

Answer 11

Vitamin B12 deficiency anaemia - becuase vitamin B12 is absorbed in the terminal ileum.

Question 12

What are the features of B12 deficiency anaemia?

Answer 12

• All symptoms of anaemia, such as fatigue, dyspnoea and headache.
• “lemon tinge” in the skin due to combined effect of pallor and mild jaundice (due to haemolysis),
• Glossitis - beefy-red, sore tongue.
• Angular cheilosis - a.k.a. stomatitis - ulcerations at the corner of mouth.

Question 13

What is pernicious anaemia?

Answer 13

Pernicious anaemia is an autoimmune disorder in which there is atrophic gastritis, leading to achlorhydria and a lack of gastric intrinsic factor secretion.

Question 14

Why is there a lower threshold for upper GI endoscopy in those with pernicious anaemia?

Answer 14

Pernicious anaemia increases risk of gastric carcinoma by 3-fold.

Question 15

What are the specific tests for Pernicious Anaemia?

Answer 15

Parietal cell antibodies and Intrinsic Factor antibodies.

Question 16

Which group of individuals are prone to VitB12 deficiency anaemia? Why?

Answer 16

Vegans are prone to Vitamin B12 deficiency anaemia.

because VitB12 is found in meat, fish and diary products.

Question 17

In patients with normocytic anaemia, how is multiple myeloma diagnosed? (i.e. what are the features of Multiple Myeloma)

Answer 17

CRAB
C - HyperCalcaemia
R - Renal failure
A - Anaemia (due to infiltration of the bone marrow, causing decreased ability of the BM to make RBC)
B - lytic Bone lesions