Anaemia Recap

Question 1

How do we define anaemia?

Answer 1

Reduction in haemaglobin concentration below that which is optimum for that individual

Question 2

How can we diagnose anaemia?

Answer 2

History/ exam/ clinical context
FBC
Retic count 
Blood film
Haematinics (ferritin/ B12/ folate) 
Bone marrow biopsy 
Special tests; HbA2, HLPC

Question 3

What can cause a decreased RBC production?

Answer 3

Hypoproliferative; reduced erythropoiesis
Maturation issues; cytoplasmic (impaired Hb)
Nuclear (impaired division)

Question 4

What is the retic count a useful marker of?

Answer 4

Red cell production; will be increased in haemolysis and acute blood loss

Question 5

What are the productions of red cell destruction seen in haemolysis?

Answer 5

Increased unconjugated serum bilirubin
Increased urinary urobilinogen
Splenomegaly

Question 6

What is the difference between MCV and MCH?

Answer 6

MCV; cell size

MCH; cell Hb content

Question 7

What can cause hypochromic microcytic anaemia?

Answer 7

Iron deficiency
Haem defects; lead poisoning, congenital sideroblastic
Globin defects; thalassaemia
(Rarely; anaemia of chronic disease)

Question 8

What can cause macrocytic anaemias?

Answer 8

Nuclear maturation defects; B12/ folate (megaloblastic), myelodysplasia, chemo
Agglutination
Reticulocytosis

Question 9

What can cause macrocytosis without significant anaemia?

Answer 9

Hypothyroidism
Alcohol
Liver dx

Question 10

What can cause normocytic normochromic anaemia?

Answer 10

Marrow failure; drug induced, aplastic anaemia
Hypometabolic
Marrow infiltration; metastatic malignancy, fibrosis
Renal impairement
Chronic disease

Question 11

Why will renal impairment lead to normochromic normocytic anaemia?

Answer 11

Failure of EPO production

Question 12

Describe the pathogenesis of anaemia of chronic disease?

Answer 12

Chronic inflammation
Pro-inflammatory cytokines
IL-6 induces increased hepcidin levels which decreases serum iron
Decreased EPO producto n
Decreased marrow response
RBC life span decreases and haemophagocytosis via macrophages is induced

Question 13

Why can anaemia of chronic disease sometimes be microcytic?

Answer 13

If predominant mechanism is through hepcidin stimulation
Decreased release of iron from macrophages
Results in a low transferrin saturation despite normal/ raised ferritin
This WILL response to IV iron

Question 14

How can iron deficiency and anaemia of chronic disease be distinguished?

Answer 14

Both have reduced serum iron
Anaemia of CD; reduced transferrin
Iron deficiency; normal or increased transferrin
Both have decreased % transferrin saturation
IDA = DECREASED FERRITIN
ANAEMIA OF CD = INCREASED FERRITIN
MCV reduced in iron deficiency and tends to be normocytic in anaemia of CD

Question 15

In what circumstances can nucleated red cells appear int the blood?

Answer 15

Bone marrow damage or stress
Severe anaemia
Thalassaemia
Hypoxaemia
Myelomas
Leukaemias
Lymphomas 
Myelofibrosis

Question 16

Why does haemoglobin change colour?

Answer 16

When iron is oxygenated (Fe3+) it becomes red
When iron is deoxygenated (Fe2+) is becomes blue
Electrons are added to the D orbitals changing its energy levels. This affects the absorption of light

Question 17

What can result in red cell membrane damage

Answer 17

Mutational; hereditary spherocytosis, zieve’s syndrome (haemolysis related to alcoholic liver disease)
Autoimmune haemolytic anaemia
Infection; DIC, sepsis
Mechanical; severe burns, HUS, heart valve, TTP

Question 18

What are drug causes of oxidative damage in the RBC?

Answer 18

Quinines
Antimalarials
Fava beans
Dapsone

Question 19

What are the clinical manifestations of oxidative damage of RBC?

Answer 19

Tiredness, lethargy, pale gums, pallor
Jaundice
Heinz bodies

Question 20

What are the signs and symptoms of microcytic hypochromic anaemia?

Answer 20

Tachycardia, tachypnoea, extra heart sound, pallor

Palpitations, lethargy, fatigue, TATT, tinnitus, somnolence

Question 21

What blood cells aside from the RBC are produced in the bone marrow?

Answer 21

Granulocytes; neutrophils, basophils, eosinophils, platelets
Agranulocytes; leukocytes, monocytes

Question 22

How can B12 deficiency present?

Answer 22

Pallor
Mild jaundice
Red beefy tongue
Reduced vibration and proprioception