Anaemia Overview

Question 1

Anaemic pt has a low reticulocyte count and a low MCV, what are the three potential causes?

Answer 1

Iron deficiency anaemia
Thalassaemia
Chronic disease

Question 2

Anaemic pt has a high reticulocyte count - where especially would you check for haemorrhage?

Answer 2

GI (PR)
Genitourinary (catheter)

On the floor and four more (head, thorax, abdo, pelvis) ?long bones

Question 3

Anaemic pt has a low reticulocyte count and a high MCV, what are the 3 potential causes?

Answer 3

Alcohol
Myelodysplasia
B12/folate deficiency

Question 4

Anaemic pt has a normal reticulocyte count and a normal MCV, what could be causing their anaemia?

Answer 4

Chronic disease
Renal disease
Marrow suppression

Question 5

Pt has a high reticulocyte count and they are showing no evidence of bleeding/haemorrhage, what categories of disease could be causing their anaemia?

Answer 5

Immune (non-acquired/hereditary)

Non-immune (acquired)

Question 6

What is a microcytic hypochromic anaemia?

Answer 6

Iron deficiency anaemia

Question 7

What are the 6 main symptoms of anaemia?

Answer 7

Fatigue
Dyspnoea
Palpitations
Faitness
Headache
Tinnitus

Question 8

What are the 3 main signs of anaemia?

Answer 8

Pallor
Hyperdynamic circulation (fast HR, flow murmer: apical ESM, cardiac enlargement)
Ankle swelling with heart failure

Question 9

What does apical ESM stand for?

Answer 9

Apical end-systolic murmer

Question 10

As MCV is an average, what do you use to make sure there aren’t two pathologies going on, one raising MCV and the other one lowering?

Answer 10

RDW - red call distribution width

Gives the range of sizes seen - so a large figure = two populations present

Question 11

What are haematinics?

Answer 11

Iron, Vit B12, Folate

Question 12

Where is iron absorbed?

Answer 12

Duodenum and jejunum

Question 13

Where is B12 absorbed?

Answer 13

Terminal ileum

Question 14

Where is folate absorbed?

Answer 14

Small bowel

Question 15

What is ferritin indicative of?

Answer 15

Iron stores

Question 16

What can make a ferritin level dubious?

Answer 16

It is an acute-phase reactant, so goes up during episodes of acute inflammation, similar to ESR and CRP

Question 17

What is the single best test for iron deficiency anaemia

Answer 17

ferritin

Question 18

What investigation can be taken if iron deficiency anaemia is suspected but there is diagnostic uncertainty from the blood tests?

Answer 18

Bone marrow biopsy

Question 19

What conditions cause an iron overload?

Answer 19

Haemachromatosis

Diseases that require frequent blood transfusions

Question 20

On iron studies, what value is usually low in diseases such as haemachromatosis and having lots of tranfusions?

Answer 20

Total iron-binding capacity

Question 21

What is the iron studies picture in iron-deficiency anaemia?

Serum iron, Serum total iron-binding capacity, Serum ferritin, Transferrin saturation, Serum sTfR’s

Answer 21

Serum iron - Reduced
Serum total iron-binding capacity - Increased (the body tries hard to bind any iron around the system)
Serum ferritin - Reduced
Transferrin saturation - Reduced
Serum sTfR’s (soluble transferrin receptors) - Increased (since red cells attempt to absorb any iron in the system)

Question 22

What is the iron studies picture in anaemia of chronic disease?

(Serum iron, Serum total iron-binding capacity, Serum ferritin, Transferrin saturation, Serum sTfR’s)

Answer 22

Serum iron - Normal or slightly reduced
Serum total iron-binding capacity - Reduced
Serum ferritin - May be raised as acute phase reactant
Transferrin saturation - Reduced
Serum sTfR’s (soluble transferrin receptors) - Normal - reflecting the true state of body iron levels

Question 23

Why do most cases of B12 deficiency occur?

Answer 23

Poor absorption

Question 24

What test is used to distinguish between the various causes of Vit B12 deficiency?

Answer 24

Schilling Test

Question 25

How is the schilling test performed?

Answer 25

Radiolabelled Vit B12 given orally
Normal Vit B12 given IM (so body has too much, encourages excretion of Vit B12)
Collect urine over 24hrs
Assess how much Vit B12 has been absorbed and is present in urine

Then repeat test, this time also give intrinsic factor

Question 26

How do you assess whether or not a folate deficiency is present?

Answer 26

Simply take a serum folate

Question 27

What is the most simple test to detect haemolysis?

Answer 27

Urine dip - you’ll find urobilinogen as increased bilirubin is being broken down

Question 28

What test is used to detect spherocytosis?

Answer 28

Osmotic fragility test - these misshapen blood cells have a more fragile membrane, therefore they are more osmotically fragile

Question 29

What condition is likely if a high reticulocyte is found, and there is red cell membrane abnormality?

Answer 29

Spherocytosis

Question 30

How do you assess whether or not a haemolytic anaemia has an immune cause?

Answer 30

Direct antiglobulin test (DAT, or Coomb’s test)

Question 31

A pt with acquired anaemia has a high reticulocyte count and a -ve direct antiglobulin test, what conditions are they likely to have? (3)

Answer 31

Malaria
Hypersplenism
Burns

Question 32

What is the definition of polycythaemia?

Answer 32

Packed Cell Volume of >0.51 in males, or >0.48 in females

Question 33

What do you measure to see if TRUE polycythaemia is present?

Answer 33

Red Cell Mass

Question 34

What test do you use to find haemoglobinopathies?

Answer 34

Haemoglobin electrophoresis

Question 35

What is haematocrit?

Answer 35

The percentage of blood that is red cells - normally about 45%

Question 36

What does red cell folate show?

Answer 36

Reflects body stores of folate over the last 2-3 months