Anaemia

Question 1

What are the symptoms of anaemia?

Answer 1

• Tired all the time
• Short of breath
• Muscle pain on exertion
• Dizzy
• Angina

Question 2

What are the clinical signs of anaemia?

Answer 2

• Palor in skin and conjunctiva
• Tachycardia
• Rapid breathing
• Peripheral oedema if severe
• Signs relating to the cause of anaemia

Question 3

What are 4 ways of classifying anaemia?

Answer 3

• Under-production or increased loss of RBC
• Congenital or acquired
• Acute or chronic
• Mean cell volume (microcytic, normocytic and macrocytic)

Question 4

Describe how you can classify anaemia by MCV (Mean Cell Volume)

Answer 4

Microcytic - (60-80fl) caused by Iron def and thalassaemia
Normocytic - (80-100fl) - blood loss, anaemia of chronic disease and renal impairment.
Macrocytic -(100-120) Megaloblastic anaemia caused by B12/folate deficiency, myelodysplasia
Hypochromic - Cells with low colour (iron def and thalassaemia)

Question 5

Describe some of the features of Iron Deficiency Anaemia

Answer 5

• Most common cause of anaemia

- Typically reduction in MCV, low Hb, Low ferritin and low transferrin saturation with iron

Question 6

What is Iron Deficiency anaemia caused by?

Answer 6

Poor intake, Blood loss (menstral, GI), Malabsorption (Coeliac disease), Increased need (growth or pregnancy)

Question 7

What are some clinical features of Iron Deficiency

Answer 7

Pale, Tachycardia, Koilonychia (nails looked spooned), hair loss, Pica (Kids eating metal/soil), Glossitis (inflammation of tounge)/ Angular Stomatitis (red patches at the edge of mouth) and features relating to the cause

Question 8

What are some of the investigations of iron deficiency?

Answer 8

• Taking a history
• Confirm iron def by low ferritin and typical FBC
• Screen for coeliac disease
• Upper and lower endoscopy for all except pre-menopausal women.
• Consider other imaging

Question 9

Describe how you can treat iron deficiency orally.

Answer 9

• Replacement with sufficient iron for long enough period (ferrous sulphate)
• The side effects are naursea, abdo pain, constipation.
• Typically need 3 more months of iron after correction
• Treat the cause

Question 10

What are some of the parental treatments of iron deficiency

Answer 10

Intramuscular injection - No longer used as it was painful and stained the skin
- Intravenous - Ferric Carboxymaltose over 15-30mins or Iron dextran over 4-6 hours. All IV can cause flu like symptoms

Question 11

Describe some of the features of a B12 Deficiency

Answer 11

It is typically a macrocytic anaemia. Can cause peripheral neuropathy. Can result from pregnancy, oral contraception, pernicious anaemia (autoimmune) or strict vegan diets or terminal ileal disease.

Question 12

What are the treatments for B12 Deficiency

Answer 12

Hydrooxocobalamin or Cyanocobalamin

Question 13

Describe some of the features of Folate deficiency

Answer 13

• Limited stores so deficiency can occur in weeks
• Can occur because of poor intake, increased used for example in pregnancy or because of malabsorbtion drugs
• Replacement with oral folic acid (5mg per day)

Question 14

Describe how you can treat anaemia from blood loss

Answer 14

• Blood transfusion to replace loss

Question 15

Describe some of the features anaemia of chronic disease

Answer 15

• It is typically normoctic anaemia associated with chronic inflammatory
• They have plentiful iron stores but poor transfer to RBC due to hepcidin and cytokines
• History of chronic disease, inflammatory markers increase,
• Will respond to treatment of underlying disease

Question 16

Describe some features of anaemia renal failure

Answer 16

• This is mainly due to a lack of erthythopoietin
• Contribution from blood loss at dialysis and inflammatory disease
• Response well to erythropoietin

Question 17

Describe some of the features of anaemia due to haemolysis

Answer 17

• It is increased RBC destruction
• Can be acute or chronic, congenital or acquired.
• It gives issues with RBC membranes, RBC enzymes and globin chains in Hb

Question 18

What are the two types of anaemia haemolysis

Answer 18

Congenital Spherocytosis - Causes spherical cells

Auto-immune haemolysis - Auto immune bodies against RBC surface antigens

Question 19

What are some of the causes of haemolysis?

Answer 19

Prosthetic heart valve, disseminated intravascular coagulation, RBC enzyme deficiency

Question 20

Describe how anaemia is caused by abnormal haemoglobin

Answer 20

Haemoglobinopathy (sickle cell disease where glutamic acid to valine)

• shortened RBC survival and reduced production.
• treated by hydroxycarbamide to increase Hbf production

Question 21

Describe some of the features of thalassaemia

Answer 21

• Inbalance of globin chain production
• Progressive anaemia treated with supportive care or transfusion
• Progressive iron overload

Question 22

How does anaemia arise from marrow infiltration

Answer 22

Myeloma - B cell maligancy of mature plasma cells. It presents as chance finding, anaemia, renal failing, hypercalacaemia, bone pain or fracture. Treatment is supportive care, chemotherapy or radiotherapy.
Haematological malignancy - diagnosed by marrow sampling and treated by chemotherapy/immunotherapy.

Question 23

Describe how anaemia arises from marrow failure

Answer 23

Myelodysplatic disorders - Cancers in which immature blood cells do not mature
Aplastic anaemia - Bone marrow doesn’t produce enough blood cells

Question 24

What does MCV, MCH and MCHC mean?

Answer 24

MCV - Mean Cell Volume
MCH - mean corpuscular hemoglobin (average amount of hemoglobin found in the red blood cells in the body)
MCHC - mean corpuscular hemoglobin concentration (measure of the average concentration of haemoglobin inside a single red blood cell