anaemia - data interpretation

Question 1

how would you confirm a diagnosis of megaloblastic anaemia

Answer 1

serum B12 and folate levels

Question 2

what is the diagnostic test for pernicious anaemia

Answer 2

anti-intrinsic factor antibodies

Question 3

when would you give IM vitamin 12 over oral

Answer 3

load up w/ IM

• if there is pernicious anaemia there won’t be proper absorption of oral B12
• neurological complications of b12 deficiency

Question 4

when would you not transfuse blood even w/ low Hb

Answer 4

people who have physiologically adapted to their low Hb - came on over a long time

transfusing lots of blood - concentrated red cells and shift in plasma volume can lead to heart failure

only use 1 unit if desperate

Question 5

differential diagnosis for macrocytic anaemia

Answer 5

myelodysplasia
- evident on blood film w/ hypogranular neutrophils and red cell anisocytosis

macrocytic anaemia - oval macrocytes and hypersegmented neutrophil

Question 6

what lab test would you first do to investigate the cause of hypochromic, microcytic anaemia

Answer 6

ferritin

Question 7

what questions to ask in someone w/ iron deficiency anaemia

Answer 7

any bleeding 
heavy periods (how many sanitary products does she go through), frequency
diet - vegan, vegetarian
any GI symptoms 
pregnant?

Question 8

when would you transfuse in anaemia

Answer 8

symptomatic anaemia e.g. unstable angina
- critical cardiac ischaemia and risk of further events

need to get Hb up relatively quickly

Question 9

possible cause of hypochromic, microcytic anaemia w/ normal ferritin

Answer 9

thalassaemia trait

2y anaemia/anaemia of chronic disease
- more usually normochronic, normocytic

Question 10

2y anaemia/anaemia of chronic disease

Answer 10

more usually normochromic, normocytic

normal/elevated ferritin

ineffective iron utilisation

Question 11

what investigations to order for this hx:

tired, yellow eyes

low Hb
normal MCV
normal MCH
normal WCC
high plts

blood film shows spherocytes and polychromesia (reticulocytes)

Answer 11

reticulocyte count
bilirubin, LDH
serum haptoglobin
DAGT (Coombs test)

Question 12

tired, yellow eyes
low Hb
normal MCV
normal MCH
normal WCC
high plts
blood film shows spherocytes and polychromesia (reticulocytes)

what does +ve DAGT indicate

Answer 12

AI haemolysis

Question 13

alternative diagnosis if DAGT -ve

tired, yellow eyes
low Hb
normal MCV
normal MCH
normal WCC
high plts
blood film shows spherocytes and polychromesia (reticulocytes)

Answer 13

hereditary spherocytosis

ask about prev episodes, FHx, any precipitants (viral infection, drugs)

Question 14

yellow eyes, pain in L chest, SOB, fever

low Hb
normal MCV
normal MCH
normal WCC
high plts

blood film shows sickle cells

what other investigations would you order

Answer 14

reticulocyte count
bilirubin, LDH
haemoglobinopathy screen

Question 15

27y/o, yellow eyes, pain in L chest, SOB, fever

low Hb
normal MCV
normal MCH
normal WCC
high plts

blood film shows sickle cells - diagnosis sickle cell disease (HbSS)

what is least likely to be the cause of his pain: 
bony crisis
pnuemonia
PE
splenic infarction

Answer 15

splenic infarction

most people at 27y/o w/ HbSS will have auto-infarcted their spleen (hyposplenic)

should be considered in differential but not most likely in most

Question 16

what should be included in management of painful sickle cell crisis

Answer 16

analgaesia - usually opiates
oxygen 
fluids 
abx if fever
thromboprophylaxis 
consider blood transfusion if severe anaemia, stroke or chest crisis

Question 17

sickle cell chest crisis

what to do
clinical features

Answer 17

worsening SOB
fever
chest pain
infiltrates on CXR

close observation as can deteriorate rapidly
transfusion top up or exchange