Anaemia: approach to diagnosis

Question 1

causes of hypochromic microcytic anaemia? (6)

Answer 1

Iron deficiency
Thalassamia
anaemia of chronic disease
lead poisoning 
Pyridine responsive 
sideroblastic anaemia

Question 2

Causes of macrocytic anaemia? (7)

causes of macrocytosis without anaemia? (3)

Answer 2

Megaloblastic:
B2 deficiency
Folate deficiency

\+Myelodysplasia 
Myeloma
Aplastic anaemia 
reticulocytosis
cold agglutinins 

-alcohol, Liver disease, hypothyroidism

Question 3

Causes of normochromic, normocytic anaemia?

Answer 3

acute blood loss

Hypoproliferative:
chronic disease
anaemia of renal failure 
hypometabolic state 
marrow failure

Question 4

Describe the pathogenesis of renal anaemia in CKD?

Answer 4

kidneys can no longer produce Epo to stimulate erythropoiesis

Question 5

Anaemia of chronic disease

-describe the pathogenesis?

Answer 5

inflammation central to the process
T cells are activated e.g. by malignancy cells and produce cytokines.
This stimulates hepatocytes to produce Hepcidin, inhibiting duodenal absorption of iron
DMT-1 expression increases on macrophages and increases uptake of ferrous iron
transferrin receptor expression is increased and uptake of iron into monocytes increases
ferroportin is down regulated inhibiting iron export from macrophages
ferritin expression is stimulated and and iron is retained in macrophages
there is decreased iron in circulation and less is available for RBC production

Question 6

Describe the effects of an inflammatory stimulus on RBC production?
-driven buy what?

Answer 6

increases hepatic synthesis of hepcidin 
(inhibits iron release from RES)
Inhibits erythropoietin release 
(dec erythropoietic stimulation)
Inhibits erythroid proliferation 
Augments Hemophagocytosis 
(causes release of recycled iron via ferroportin & reduced transferrin which limits iron availability) 

-IFN, TNF, IL-1B, IL-6