Anaemia: Diagnosis

Question 1

What is anaemia?

Answer 1

Reduction in haemoglobin concentration below that which is optimum for that individual
Reduction in haemoglobin concentration below 95% range for the population

Question 2

How is anaemia classified?

Answer 2

Decreased production
Hypoproliferative- reduced amount of erythropoiesis
Maturation abnormality- erythropoiesis present but ineffective:
Cytoplasmic defects: impaired haemoglobinisation
Nuclear defects: impaired cell division
Increased loss or destruction of red cells- Bleeding, Haemolysis

Question 3

What is reticulocyte count a marker of?

Answer 3

Red cell production

Question 4

If you suspect haemolytic anaemia what should you look for?

Answer 4

Evidence of red cell breakdown products and a reticulocytosis - then consider a potential cause (blood film and history may help)

Question 5

How much can normal marrow increase red cell production by?

Answer 5

3-4x

Question 6

What is anaemia with a lesser reticulocyte response at least partly due to?

Answer 6

Impaired red cell production

Question 7

What are the causes of microcytic anaemia?

Answer 7

Iron deficiency
Thalassaemia
Some causes of anaemia of chronic disease- chronic inflammation, malignancy
Lead poisoning
Pyridoxine responsive anaemias
Sideroblastic anaemia

Question 8

What are the causes of macrocytic anaemias?

Answer 8

Megaloblastic anaemia- B12 deficiency, Folate deficiency
Myelodysplasia
Myeloma
Aplastic anaemia
Reticulocytosis
Cold agglutinins

Question 9

What can cause a macrocytosis without anaemia?

Answer 9

Alcohol
Liver disease
Hypothyroidism

Question 10

What can cause a normochromic normocytic anaemia?

Answer 10

Acute blood loss/early iron deficiency
Hypoproliferative (low retic):
Chronic diseases -inflammatory, infective, malignant disorders
Anaemia of renal failure
Hypometabolic states (e.g. hypothyroidism)
Marrow failure (e.g. aplasia or infiltration)

Question 11

What causes renal anaemia?

Answer 11

Epo production goes down in most cases of renal failure

Question 12

What are the mechanisms of chronic disease mechanisms?

Answer 12

Blunted epo response by kidney
Impaired iron availability to erythroid precursors
Inhibition of erythroid precursor proliferation and differentiation
Reduced red cell survival
Driven by inflammatory cytokines induced by infection/malignancy/autoimmune disease dysregulation

Question 13

What are most chronic anaemias primarily the result of?

Answer 13

Impaired red cell production
More than one factor can be present: RA anaemia of chronic disease with NSAID GI blood loss, where iron deficiency limits erythroid marrow response to blood loss