Anaemia

Question 1

Symptoms

Answer 1

Fatigue
SOB
Faint
Headache
Palpitations
Tinnitus
Angina (if CAD)
Anorexia

Question 2

Signs

Answer 2

Pallor (conjunctivae)
Tachycardia, ejection systolic flow murmur, loudest apex + cardiomegaly (hyperdynamic circulation)
Retinal haemorrhage (rare)

HF - later

Question 3

Microcytic Anaemia

Answer 3

MCV <80

Iron deficiency: low HB, low iron, low ferritin, ^TIBC
Sideroblastic: low Hb, ^iron, ^ ferritin, low TIBC
Thalassaemia: ^HbF, low HA, ^ iron, ^ ferritin, low TIBC

Question 4

Normocytic Anaemia

Answer 4

Acute blood loss
Anaemia of chronic disease (or low MCV)
Bone marrow failure (aplastic Anaemia)
Renal failure
Hypothyroidism (or ^MCV)
Haemolysis (or ^MCV)
Pregnancy

Question 5

Macrocyctic Anaemia

Answer 5

MCV >100
B12 deficiency (+pernicious Anaemia)
Folate deficiency
Alcohol excess (liver disease)
Reticulocytosis (with haemolysis)
Myelodysplastic syndromes
Marrow infiltration
Hypothyroidism
Cytotoxics (hydroxycarbamide)
Antifolate drugs (phenytoin)

Question 6

Haemolytic Anaemia

Answer 6

Acquired:

• autoimmune HA, HUS, DIC, TTP, HELLP, malignant HTN, hypersplenism
• burns, trauma

Hereditary:

• Enzyme defect: glucose 6 phosphate dehydrogenase deficiency, pyruvate kinase deficiency
• Membrane defect: hereditary spherocytosis
• Haemoglobinopathy: sickle cell disease, thalassaemia

Question 7

Investigations

Answer 7

Blood: FBC (Hb, haematocrit, MCV, serum ferritin, serum iron, TIBC, transferrin saturation, reticulocyte count, platelet count), haemotinics (iron, B12, folate)
Peripheral smear
Blood film
Bone marrow biopsy
Hb electrophoresis
Direct Coombs test
G6PD
Enzyme assay
B12
Folate
LDH
Unconjuated bilirubin 
Urinalysis