Anaemia ✅

Question 1

What is anaemia defined as?

Answer 1

A haemoglobin level below the normal range

Question 2

What does the normal range of haemoglobin level vary with?

Answer 2

Age

Question 3

Why are Hb levels higher in utero?

Answer 3

Mainly due to the higher oxygen affinity of HbF

Question 4

What happens to Hb levels during the first few months of life?

Answer 4

They fall due to reduced red cell production

Question 5

What happens to Hb after the first few months of life?

Answer 5

Levels stabilise until puberty

Question 6

What might happen to Hb levels during puberty?

Answer 6

Growth leads to an increased demand for iron, and iron deficiency may develop, particularly in girls

Question 7

What Hb level is considered anaemia in neonates?

Answer 7

<130g/L

Question 8

What Hb level is considered anaemia in 1-12 months?

Answer 8

<100g/L

Question 9

What Hb level is considered anaemia in 1-12 years?

Answer 9

<110g/L

Question 10

What are the main mechanisms anaemia occurs through?

Answer 10

• Insufficient red cell production
• Excessive red cell destruction (haemolysis)
• Increased red cell loss (bleeding)

Question 11

What should the investigation of anaemia start with?

Answer 11

A full blood count and blood film

Question 12

What should be suspected if anaemia is associated with abnormalities in the white cell and platelet counts?

Answer 12

A bone marrow disorder, such as leukaemia, should be suspected

Question 13

What provides the most useful information about the likely aetiology of anaemia if WCC and platelets are normal?

Answer 13

MCV and MCH

Question 14

What kind of anaemia does iron deficiency result in?

Answer 14

Microcytic hypochromic anaemia (low MCV, low MCH)

Question 15

What is an important differential for microcytic hypochromic anaemia?

Answer 15

ß-thalassaemia

Question 16

When in particular is ß-thalassaemia an important differential for microcytic hypo chromic anaemia?

Answer 16

In children from the Indian subcontinent

Question 17

What is found on investigation in ß-thalassaemia carriers?

Answer 17

MCH and MCV are low, but Hb only slightly reduced (80-100g/L)

Question 18

What should be done when iron deficiency anaemia is suspected, in terms of testing?

Answer 18

Further test should be performed to confirm iron deficiency and rule out less common causes, such as thalassaemia and anaemia of chronic disease

Question 19

What are the causes of microcytosis?

Answer 19

• iron deficiency
• Thalassaemia major or trait
• Anaemia of chronic disease

Question 20

What are the causes of macrocytosis?

Answer 20

• Folate deficiency
• Vitamin B12 deficiency
• Diamond-Blackfan anaemia
• Liver disease
• Hypothyroidism

Question 21

What happens to; 
a. Hb level
b. MCV/MCH
c. Serum ferritin
d. TIBC
e. Serum transferrin receptor
f. Iron saturation 
in iron deficiency

Answer 21

a. Hb level <100
b. MCV/MCH reduced
c. Serum ferritin reduced
d. TIBC increased
e. Serum transferrin receptor increased
f. Iron saturation reduced

Question 22

What happens to; 
a. Hb level
b. MCV/MCH
c. Serum ferritin
d. TIBC
e. Serum transferrin receptor
f. Iron saturation 
in anaemia of chronic disease

Answer 22

a. Hb level 80-100
b. MCV/MCH normal or slightly reduced
c. Serum ferritin normal or increased
d. TIBC normal
e. Serum transferrin receptor normal
f. Iron saturation normal

Question 23

What happens to; 
a. Hb level
b. MCV/MCH
c. Serum ferritin
d. TIBC
e. Serum transferrin receptor
f. Iron saturation 
in ß-thalassaemia major

Answer 23

a. Hb level <60
b. MCV/MCH very low
c. Serum ferritin normal
d. TIBC normal
e. Serum transferrin receptor normal
f. Iron saturation normal

Question 24

What happens to; 
a. Hb level
b. MCV/MCH
c. Serum ferritin
d. TIBC
e. Serum transferrin receptor
f. Iron saturation i
in ß-thalassaemia trait?

Answer 24

a. Hb level 80-100
b. MCV/MCH reduced
c. Serum ferritin normal
d. TIBC normal
e. Serum transferrin receptor normal
f. Iron saturation normal