Anaemia

Question 1

Warm AIHA

Answer 1

IgG mediated
Phagocytosis - no complement - occurs in spleen - steroids effective
Lymphoproliferative disease, drugs (penicillin), AI disease (SLE, Crohn’s, RA, UC)

Question 2

Cold AIHA

Answer 2

IgM mediated
Opsonisation - complement - occurs in liver Kupffer cells - steroids ineffective
Mycoplasma, EBV infections, mono

Question 3

Schistocytes

Jaundice, uraemia, thrombocytopenia

Answer 3

MAHA

Question 4

Abdominal pain

Dactylitis

Answer 4

Sickle cell anaemia

Question 5

Fava beans
Heinz bodies
Bite cells

Answer 5

Think ‘Heinz beans’
G6PD deficiency
ROS = denatured Hb inclusion bodies (Heinz bodies). Bite cells = bites out of RBC where spleen tries to remove Heinz

Question 6

DAAT positive

Answer 6

AI haemolytic anaemia

Question 7

Microcytic anaemia

RA

Answer 7

Anaemia of chronic disease

Question 8

Mediterranean

Microcytic anaemia

Answer 8

B-thalassaemia

Question 9

Microcytic anaemia
Anisocytosis
Low serum iron + ferritin, high TIBC

Answer 9

Iron deficiency anaemia

Question 10

Macrocytic anaemia

Pancytopenia + hypocellular BM (ptechiae, high reticulocytes, low WBCs and platelets)

Answer 10

Aplastic anaemia

Failure of BM - macrocytosis as release of fetal Hb to make up for anaemia

Question 11

Hyper-segmented neutrophils

Cabot rings

Answer 11

Megaloblastic anaemia (folate / B12)

Question 12

Anisocytosis

Answer 12

Variation in RBC size

Usually due to ID

Question 13

Donath Landsteiner test

Cold AIHA

Answer 13

Paroxysmal cold haemoglobinuria

Question 14

Warm vs. cold AIHA

Answer 14

DAAT performed at low and high temperatures - when antibodies bind

Question 15

Osmotic fragility test

Answer 15

Hereditary spherocytosis

Question 16

Kleihauer test

Answer 16

Rhesus disease

Looks for fetal Hb containg cells

Question 17

Teardrop poikilocytes (dacrocytes)
Hypocellular BM
Dry tap

Answer 17

Myelofibrosis

Question 18

Hamm’s test

Answer 18

Paroxysmal nocturnal haemoglobinuria

Mild acid - RBCs have increased fragility

Question 19

IDA + Post-cricoid webs

Difficulty swallowing

Answer 19

Plummer-Vinson syndrome

Question 20

Pencil cells, anisocytosis, hypochromia, poikilocytosis

Answer 20

IDA

Question 21

How does chronic disease cause anaemia?

Answer 21

• Inflammatory markers reduce EPO receptor production by kidneys (or in renal disease there is just EPO deficiency)
• Dysregulated iron metabolism - IL6 + LPS stimulate liver to make hepcidin - decreases iron absorption from gut

Question 22

Ring sideroblasts

Alcohol excess

Answer 22

Sideroblastic anaemia
(Pyridoxine (vitamin B6) given to promote RBC production)

Question 23

Megaloblastic macrocytic anaemia

Answer 23

B12 / folate deficiency

Cytotoxic drugs

Question 24

Non-megaloblastic macrocytic anaemia

Answer 24

Alcohol, reticulocytosis (e.g. in haemolysis), hypothyroidism, pregnancy

Question 25

Hypersegmented neutrophils

Answer 25

Megaloblastic anaemia

Question 26

Meat + dairy products (vegans)
Malabsorption (PA or ileal resection)
Glossitis, angular cheilosis, neuropathy

Answer 26

B12 deficiency
(Replenish with IM B12)

Question 27

Diagnostic test pernicious anaemia

Answer 27

Parietal cell antibodies (IF less specific, Schilling test outdated)

Question 28

Green vegetables

Pregnancy

Answer 28

Folate deficiency