Anaemia Treatments IN EXAM

Question 1

what makes an anaemia microcytic and hypochromic

Answer 1

low MCV and low MCH (low Hb, what gives it low colour)

Question 2

what causes microcytic anaemias

Answer 2

problems with Hb synthesis = iron deficiency or haemoglobinopathies (alpha/ beta thalassaemia)

Question 3

why do you get anaemia in iron deficiency

Answer 3

cant form heam (porphyrin ring and Fe2+)

Question 4

why are cells microcytic in iron deficiency anaemia

Answer 4

In the bone marrow the erythroblasts start as large nucleated cells, the nucleus is responsible for production for haemoglobin. The signal for enucleation is when cell reaches critical point of Hb. With each cell division the cell gets smaller, if the cell isn’t making much Hb it will continue divide and so there are more divisions than normal and therefore the cells are microcytic.

Question 5

what does ferittin measure

Answer 5

stored iron

Question 6

where is iron stored

Answer 6

macrophages, liver, spleen, bone marrow

Question 7

can iron be raised in iron deficiency

Answer 7

yes- if acute inflammatory process there will be high ferittin as it is an acute phase protein

Question 8

name 3 iron supplements

Answer 8

ferrous sulphate
ferrous fumarate
ferrous gluconate

Question 9

what is the therapy of choice for iron deficiency anaemia

Answer 9

ferrous sulphate 200mg TDS

Question 10

what are side effects of ferrous sulphate

Answer 10

(not uncommon for people to not tolerate them)

• constipation
• diarrhoea
• epigastric pain
• faecal impaction
• GI irritation
• nausea

Question 11

what are the alternative options if someone is struggling to tolerate iron supplements

Answer 11

take the pill with food 
reduce dose to BP or QD
encourage dietary iron intake 
avoid tea (tannis impair absorption of iron) 
vitamin C enhances iron absorption 

ferrous gluconate 300mg

if cant tolerate at all can give S/c or IM iron

Question 12

what are sources of iron in diet

Answer 12

red meat
green veg
breakfast cereals fortified

Question 13

what should you worry about in older people/ non menstruating female with iron deficiency anaemia

Answer 13

right sided colon (caecal) cancers- can cause occult blood loss

Question 14

what Ix for non menstruating females/ males with iron deficiency anaemia

Answer 14

colonoscopy, up GI endoscopy

Question 15

why do children develop anaemia more easily than adults

Answer 15

as have increased need for iron and so can develop deficiency more easily

Question 16

what is the commonest reason for not improving on iron replacement therapy

Answer 16

non compliance

Question 17

how much should Hb conc rise on iron therapy

Answer 17

2g/100ml over 3-4 weeks

Question 18

what tests can assess response to iron therapy

Answer 18

reticulocyte count (marker of bone marrow activity) 
ferritin levels

Question 19

when is blood transfusion indicated for iron deficiency anaemia

Answer 19

Hb <70g/l

Question 20

why are people usually well in chornic anaemia

Answer 20

Haemoglobin will change to become more efficient at delivery to the tissues. The oxygen dissociation curve will shift to the right to increase oxygen tissue delivery to the tissues (increase in 2,3-BPG)

Question 21

what Tx if iron deficiency unresponsive to Tx

Answer 21

Im iron injection
dietary advice
find cause

Question 22

what are B12 and folate required for

Answer 22

cell mitosis

Question 23

is there b12 in seafood

Answer 23

yes

Question 24

where is B12 absorbed

Answer 24

terminal ileum

Question 25

what does B12 bind to

Answer 25

intrinsic factor which is secreted by gastric parietal cells which binds to B12 and facilitates transport across terminal ileum

Question 26

what are common causes of B12 deficiency

Answer 26

crohns (terminal ileum)
diet
metformin (affects absorption)
pernicious anaemia

Question 27

what antibodies will be present in pernicious anaemia

Answer 27

anti IF (intrinsic factor) (these are specific)

gastric pariental cell antibodies not specific but are sensitive so these used less

Antibodies can either bind to gastric parietal cells and prevent secretion of IF or they can bind to IF and prevent it binding to B12

Question 28

what is pernicious anaemia associated with

Answer 28

hypothyroidism, vitiligo, addisons disease

Question 29

what is the treatment for pernicious anaemia

Answer 29

IM vit B12 injections lifelong (1mg 3x a week for 2 weeks, then 1mg every 2-3 months)

alternatives= massive oral doses of B12

Question 30

what is the pathology of pernicious anaemia

Answer 30

• Autoantibodies to the gastric parietal cells of the stomach result in reduced intrinsic factor release and therefore no absorption of vitamin B12 can occur in the terminal ileum of the small bowel
• This results in macrocytic anaemia due to inadequate nuclear maturation of the red cell precursors in the bone marrow and a subsequent apoptosis of dysfunctional red cell precursors
• With the injections of vit B12; normal red cell production can occur resolving the anaemia

Question 31

what is the treatment for macrocytic anaemia in an alcoholic with folate deficiency

Answer 31

5mg folic acid for 3-4 months (or lifelong if think high risk)
would also give B12 injections as important for myelin shealth development

(if you were to just give folate on its own you would switch on haematopoesis and use up B12 quickly causing irreversible neuro disorders)

blood count in 4 weeks to check levels

Question 32

what can a combined deficiency of folate and B12 cause

Answer 32

irreversible sub acute combined degeneration of the cord

Question 33

how can alcohol affect rbcs

Answer 33

cause macrocytosis

Question 34

how can liver disease cause anaemia

Answer 34

causes MACROcytic anaemia due to abnormal lipid metabolism = dysfunctional red cell membrane
(important to remember in alcoholics) (also consider NAFLD)

Question 35

what will you see on blood film of someone with macrocytic anaemia

Answer 35

target cells

Question 36

why is folate low in alcoholics

Answer 36

poor diet

damage to liver

Question 37

why can you get high B12 in alcoholics

Answer 37

as is released when liver is damaged