Anaemia

Question 1

Microcytic Anaemia (5)

Answer 1

T – Thalassaemia
A – Anaemia of chronic disease
I – Iron deficiency anaemia
L – Lead poisoning
S – Sideroblastic anaemia

Question 2

Normocytic Anaemia Causes (5)

Answer 2

A – Acute blood loss
A – Anaemia of Chronic Disease
A – Aplastic Anaemia
H – Haemolytic Anaemia
H – Hypothyroidism

Question 3

Macrocytic Anaemia Causes

Answer 3

Megaloblastic anaemia
B12 deficiency
Folate deficiency

Normoblastic macrocytic anaemia
Alcohol
Reticulocytosis (usually from haemolytic anaemia or blood loss)
Hypothyroidism
Liver disease
Drugs such as azathioprine

Question 4

Symptoms of Anaemia

Answer 4

Tiredness

Shortness of breath

Headaches

Dizziness

Palpitations

Worsening of other conditions such as angina, heart failure or peripheral vascular disease

Question 5

Signs specific to IDA

Answer 5

Pica describes dietary cravings for abnormal things such as dirt and can signify iron deficiency

Hair loss can indicate iron deficiency anaemia

Question 6

Signs of Anaemia

Answer 6

Pale skin

Conjunctival pallor

Tachycardia

Raised respiratory rate

Question 7

Signs of specific causes of anaemia:

Answer 7

Koilonychia - Spoon shaped nails IDA

Angular cheilitis - IDA

Atrophic glossitis - smooth tongue - IDA

Brittle hair and nails -IDA

Jaundice occurs in haemolytic anaemia

Bone deformities occur in thalassaemia

Oedema, hypertension and excoriations on the skin can indicate chronic kidney disease

Question 8

Investigating anaemia

Answer 8

Haemoglobin
Mean Cell Volume (MCV)
B12
Folate
Ferritin
Blood film

OGD and colonoscopy to investigate for a gastrointestinal cause of unexplained iron deficiency anaemia
Bone marrow biopsy may be required if the cause is unclear

Question 9

Causes of IDA

Answer 9

Blood loss is the most common cause in adults

Dietary Insufficiency is the most common cause in growing children

Poor iron absorption (PPI-Fe3+)

Increased requirements during pregnancy

Question 10

What is pernicious anaemia?

Answer 10

Autoimmune condition where antibodies form against the parietal cells or intrinsic factor

Cause of B12 deficiency anaemia

Question 11

Neurological symptoms of B12 deficiency

Answer 11

Peripheral neuropathy with numbness or paraesthesia (pins and needles)

Loss of vibration sense or proprioception

Visual changes

Mood or cognitive changes

Question 12

Management of B12 deficiency anaemia

Answer 12

Diet - cyanocobalamin

Pernicious anaemia
1mg of intramuscular hydroxycobalamin 3 times weekly for 2 weeks, then every 3 months

If B12 and folate deficient - treat B12 first (subacute combined degeneration of the cord)

Question 13

Inherited Haemolytic Anaemias (5)

Answer 13

Hereditary Spherocytosis

Hereditary Elliptocytosis

Thalassaemia

Sickle Cell Anaemia

G6PD Deficiency

Question 14

Features of Haemolytic Anaemias

Answer 14

Anaemia

Splenomegaly

Jaundice

Question 15

Hereditary Spherocytosis

Hereditary Elliptocytosis

Answer 15

Most common inherited haemolytic anaemia in northern Europeans

Autosomal dominant

Jaundice
Gallstones
Splenomegaly
Notably aplastic crisis in parvovirus

Treat: folate supplementation and splenectomy

Question 16

G6PD Deficiency

Answer 16

More common in Mediterranean and African patients

X linked recessive

Triggered by infections, medications or fava beans

Jaundice gallstones, anaemia, splenomegaly and Heinz bodies on blood film

Question 17

Prosthetic Valve Haemolysis

Answer 17

Caused by turbulence around the valve and collision of red blood cells with the implanted valve

Management - Monitoring
Oral iron
Blood transfusion if severe
Revision surgery may be required in severe case