Anaemia

Question 1

Define Anaemia. Give Reference ranges.

Answer 1

Haemoglobin concentration below normal range.

• males <125
• females <115

Question 2

What are symptoms of Anaemia?

Answer 2

• Fatigue
• reduced exercise tolerance
• SOB: on exertion + at rest
• Angina
• HF

Question 3

What are signs of anaemia?

Answer 3

• Palor
• Tachycardia
• Heart Murmurs
• Koilonychia (spoon finger nails (Fe deficiency)
• Angular stomatitis
• Glossitis (B12/Folate)

Question 4

Define + give 3 examples of microcytic anaemia.

Answer 4

Low MCV (less than 82)

• Iron deficiency (Micro + Iron both have I in)
• Thalassaemia
• RARE - chronic disease (give iron or EPO and achieve optimum disease management)

Question 5

Define Macrocytic anaemia + give 2 examples.

Answer 5

high MCV.

megaloblastic causes:
Vit B12 deficiency
Folate deficiency

Non-megaloblastic causes:
alcohol
hypothyroidism

Question 6

Give 4 examples of normocytic anaemia ya need to know.

Answer 6

• Acute bleeding
• Haemolysis congenitally acquired
• Aplastic anaemia
• Anaemia of chronic disease
• pregnancy
• bone marrow failure
• hypothyroidism

Question 7

How does the body adapt to being anaemic?

Answer 7

• increased heart rate
• Cardiomegaly
• Increased cardiac output
• Right shift oxygen dissociation

Question 8

What are the 3 main causes of iron deficiency anaemia?

Answer 8

• Reduced intake (unlikely in the UK)
• Increased requirement - pregnancy, malabsorption, coeliac disease
• Chronic blood loss - menorrhagia, Upper or Lower GI

Question 9

How does one diagnose Fe deficiency anaemia?

Answer 9

• Bloods (see other Flashie)
• Hx
• Examination
• Ferritin
• Gastroscopy + colonoscopy

Question 10

what bloods do you do to investigate Fe deficiency anaemia?

Answer 10

• FBC- Hb, MCV, MCHC
• Serum Ferritin
• Fe + TIBC (total Iron binding capacity)

Question 11

When microcytic anaemia doesn’t respond to iron what is the likely cause? How does it happen?

Answer 11

• sideroblastic anaemia an incomplete formation of red blood cells
• can be congenital or acquired
• hypochromic microcytic on film
• sideroblasts in bone marrow + increased Fe+ stores
• treat with Pyridoxine (vitamin B6)

Question 12

How do you treat folate deficiency?

Answer 12

• 5mg colic acid/day
• 400mcg pregnancy prophylaxis
• 5mg/day in pregnancy if at risk

Question 13

What causesB12 deficiency?

What are it’s symptoms?

Answer 13

• poor dietay intake (vegan/veggie because found in milk/meat)
• malabsorption - pernicious anaemia, coeliac, tape worms

Sx - neuropsychiatric from irritability to psychosis
-neurological - parasthesia, neuropathy spinal cord degeneration

Question 14

Tell me about pernicious anaemia?

Answer 14

• autoimmune atrophic gastritis
• more common in females
• leads to a lack of intrinsic factor secretion and therefore B12/folate deficiency
• associated with other AI disease

Question 15

Specific investigations for pernicious anaemia?

Answer 15

• IF antibodies

- parietal cell antibodies

Question 16

Treatment for pernicious anaemia?

Answer 16

• IM hydroxycobalamin (B12)
• 1mg every other day til neuro signs stop
• 1mg every 3/12 for life

Question 17

What drugs can cause aplastic anaemia?

Answer 17

• phenytonin
• cytotoxics
• chloramphenicol
• suphonamides

IF THEYRE BEEN PRESCRIBED IT ONCE AND CAUSED APLASTIC ANAEMIA DONT DO IT AGAIN

Question 18

3 broad sweeps of haemolytic anaemia?

Answer 18

• membrane -spherocytosis
• metabolic -GDP6 deficiency
• haemoglobinopathies - thalassaemia + sickle cell
• ACQUIRED (there’s bare)

Question 19

Acquired causes of haemolytic anaemia?

Answer 19

-immune:
-autoimmune
-allo-immune - transfusion reaction + newborn haemolytic ting
drugs - methlydopa, penicillin

• Non-immune
  
  • TTP/HUS, DIC, malignancy, pre-elampsia
  • prosthetic heart valves
  • malaria

Question 20

Tell me about G6PD deficiency

Answer 20

• most common in people from the med and africa
• X-linked recessive (only affects males)
• drugs and fava beans precipitate crisis
• HEINZ bodies on film
• G6PD enzyme assay to diagnose

Question 21

Tell me about thalassaemia.

Answer 21

-under/no production of one of the globin chains
-alpha = Cr 16, Beta = Cr 11 (chain affected)
-FBC, blood film, Hb electrophoresis to Ix
-regular blood transfuions hb >90
&therefore iron chelation w/ deferiprone (feri off de prone iron)
-stages = major, intermedia, carrier (need transfusion, jsut anaemia, fine)

Question 22

Tell me about sickle cell.

Answer 22

• autosomal recessive affected beta-globulin production
• common in africa
• carrier = protection from falciparum malaria
• Tx w/ hydoxycarbamide (stimulates feotal Hb = reduces sickling)
• abx + imms for prophylaxis for splenic infarct