Anaemia

Question 1

what the symptoms of anaemia?

Answer 1

fatigue 
dyspnoea 
faintness 
palpitations 
headache
tinnitus 
angina

Question 2

whats are the signs of anaemia?

Answer 2

conjunctival and skin pallor 
glossitis 
koilonychia 
stomatitis 
tachycardia 
ES murmur

Question 3

A microcytic anaemia is when there is low MCV. What causes it?

Answer 3

IDA
thalassaemia
sideroblastic anaemia
chronic disease (some)

TICS

Question 4

A normocytic anaemia is when there is a normal MCV. What causes it?

Answer 4

Acute blood loss 
Anaemia of chronic disease 
Bone marrow failure 
renal failure 
hypothyroidism 
haemolysis

Question 5

A macrocytic anaemia is when there is a high MCV. What causes it?

Answer 5

B12 or folate deficiency
Alcohol xs
Reticulocytosis
myelodysplastic syndrome

Question 6

What causes IDA?

Answer 6

GI blood loss (Golden rule IDA in males and postmenopausal women is GI blood loss until proven otherwise)

Menstruation

Malabsorption i.e coeliacs

Question 7

what investigations are done in IDA and what are their results?

Answer 7

Hb, MCV and MCH
- all are low

Blood film

• microcytic, hypochromic RBCS
• Anisocytosis (RBCs of varying size)
• Poikilocytosis (RBCs of varying shape)

Serum ferritin and serum iron
- both low

Total iron binding capacity
- increased

Coeliac serology

OGD and colonoscopy

Question 8

what is the treatment of IDA?

Answer 8

Oral iron replacement

• Ferrous sulphate
• Ferrous Gluconate
• Ferrous fumarate

Ascorbic acid
- increases iron absorption

IV iron replacement

• iron dextron
• sodium ferric gluconate complex

Question 9

what are the side effects of iron replacement?

Answer 9

Nausea, GI upset, diarrhoea/constipation, black stools

Question 10

what is thalassaemia?

Answer 10

a relative lack of globin genes leading to decreased globin production and subsequent low Hb

Question 11

how many alpha globin genes are there and where are they located?

Answer 11

4 located on Ch16

Question 12

how many beta globin genes are there and where are they located?

Answer 12

2 on Ch11

Question 13

how does missing alpha globin genes manifest?

Answer 13

missing 1 gene - mild microcytosis

missing 2 genes = microcytosis, increased red cell count and sometimes very mild anaemia

missing 3 genes = significant anaemia and bizzare small red cells known as HbH disease as the B-chains join together

Missing 4 = not compatible with life

Question 14

how is HbH disease managed?

Answer 14

blood transfusions during periods of stress

Hepatosplenomegaly
lef ulcers
jaundice

Question 15

how does B-thalassaemia major manifest physically and on blood analysis?

Answer 15

skull deformities
hepatosplenomegaly
osteopenia

FBC shows microcytic anaemia and leucocyte and platelet derrangement

blood smear shows microcytic RBCs with irregular teardrop shape

Question 16

how is B-thalassaemia managed? what are the side effects of this management?

Answer 16

life long blood transfusions

can lead to;

• endorcrine failure
• liver disease
• cardiac toxicity

Question 17

what are the S&S of sickle cell disease?

Answer 17

Fhx

persistent pain in skeleton, chest and/or abdomen

Dactylitis i.e swollen hands/feet

Question 18

how is sickle cells disease investigated?

Answer 18

Hb electrophoresis

Blood smear - nucleated RBCs, sickle shaped cells

FBC - anaemia

Question 19

how is sickle cell disease managed?

Answer 19

hydroxycarbamide

L-glutamine

Abx and immunisation for hyposplenism

Bone marrow transplant

Question 20

how can sickle cell crisis manifest and how is treated?

Answer 20

Stroke, Acute chest syndrome, dactiliyits, hyposplenism, kidney infarct, priapism

managed with IV opiates, crossmatch, septic screen, IV fluids, keep warm, 02

Question 21

what are the signs of B12 deficiency and how is treated?

Answer 21

pallor
Glossitis
Cheliosis
Neuropsychriatric i.e irritiability, depression, paraesthesiae
Neurological = peipheral neuropathy, paraesthesiae and absent reflexes

treat with hydroxocobalamin

Question 22

what lab tests indicates haemolytic anaemia?

Answer 22

Increased RBC breakdown

• anaemia with normal/increased MCV
• increased bilirubin
• increased urinary urobilinogen
• increased serum LDH (released from RBCs)

RBC production
- increased reticulocytes causing increased MCV

Question 23

what are the signs and symptoms of haemolytic anaemia?

Answer 23

jaundice 
dark urine 
hepatosplenomegaly 
gallstones (increased bilirubin) 
Anaemia symptoms 
Leg ulcers (poor bloodflow)

Question 24

what are the causes of immune mediated/coombs +ve haemolytic anaemia?

Answer 24

Drug induced
Autoimmune haemolytic anaemia
Isoimmune e.g transfusion reaction

Question 25

what are the causes of Coombs negative haemolytic anaemia?

Answer 25

Autoimmune hepatitis

Hep B and C

Question 26

what are the causes of microangiopathic haemolytic anaemia?

Answer 26

haemolytic uraemic syndrome
thrombotic thrombocytopenic purpure
DIC
Pre-eclampsia

Question 27

Outline Warm AIHA

Answer 27

IgG mediated

Casued by CLL, lymphoma, drugs, autoimmune disease

RBCs spherocytic and polychromic

Treat with steroids/immunosupression and/or splenectomy

Question 28

Outline cold AIHA

Answer 28

IgM mediated

causes a chronic anaemia worsened by cold

may follow infection e.g Mycoplasma or EBV

treatment = keep warm and usually self limiting