Anaemias

Question 1

Give the normal haemoglobin reference ranges for males and females aged 12-70

Answer 1

Male = 140-180
Femal = 120-160

Question 2

What test should be done if a patient’s blood film shows hypochromic, microcytic anaemia?

Answer 2

Serum ferritin level to test for iron-deficiency

Question 3

What test should be done if a patient’s blood film shows normochromic, normocytic anaemia?

Answer 3

Reticulocyte count

Question 4

What test should be done if a patient’s blood film shows macrocytic anaemia?

Answer 4

B12 and folate

also test bone marrow

Question 5

What is the differential diagnosis for hypochromic, microcytic anaemia?

Answer 5

Iron deficiency (low serum ferritin)
Thalassaemia (normal or increased ferritin)
Sideroblastic anaemia (normal or increased ferritin)
Secondary anaemias

Question 6

What is the differential diagnosis for normochromic, normocytic anaemia?

Answer 6

Marrow infiltration (e.g. leukaemia)
Marrow hypoplasia
Secondary anaemia
Acute blood loss (raised reticulocyte count)
Haemolytic anaemia (raised reticulocyte count)

Question 7

What is the differential diagnosis for macrocytic anaemia?

Answer 7

Megaloblastic anaemia (B12/folate deficiency)

• Pernicious anaemia
• Gastric/ileal disease
• Dietary folate deficiency

Non-megaloblastic anaemia

• myelodysplasia
• marrow infiltration (e.g. leukaemia?)
• drug-induced

Question 8

What is pernicious anaemia?

Answer 8

Megaloblastic anaemia caused by B12 deficiency.

Antibodies against intrinsic factor cause malabsorption of dietary B12.

Question 9

Describe the red cell indices measured by blood tests

Answer 9

Red cell indices are automated measurements of red cell size and Hb content:
Mean cell volume (MCV) = cell size
Mean cell haemoglobin (MCH) = how much Hb is present

Question 10

What test is done if a patient is thought to have acquired haemolytic anaemia?

Answer 10

Direct Antiglobulin Test (DAGT)
Positive = autoimmune haemolysis
Negative = non-immune haemolysis

Question 11

What are the three classifications of congenital anaemias?

Answer 11

Membrane defects e.g. hereditary spherocytosis
Enzyme defects e.g. G6PD deficiency
Haemoglobin defects e.g. Thalassaemia and Sickle Cell

Question 12

Give three rare anaemias that are caused by membrane defects

Answer 12

Hereditary elliptocytosis
Hereditary pyropoikilocytosis
Southeast Asian Ovalocytosis

Question 13

Which form of thalassaemia is incompatible with life?

Answer 13

Alpha Thalassaemia –> no alpha chains

full name: Haemogenous alpha zero thalassaemia

Question 14

What are the four classifications of thalassaemia?

Answer 14

Alpha
Beta - transfusion-dependent
Thalassaemia intermedia
Thalassaemia minor

Question 15

Describe the general clinical features of anaemia

Answer 15

Fatigue and lethargy - often the only symptom
Breathlessness, dizziness
Conjunctival pallor
Palpitations, chest pain
Ankle swelling

Question 16

Describe the clinical features of severe anaemia

Answer 16

Hypotension
Tachycardia
Tachypnoea
(Angina, weakness)

Question 17

Which clinical features are specific to iron-deficiency anaemia?

Answer 17

Koilonychia

Angular stomatis

Question 18

Which clinical features are specific to haemolytic anaemia?

Answer 18

Dark urine (haemoglobinuria)
Jaundice
Hepatosplenomegaly
Gallstones, leg ulcers (more severe/chronic cases)

Question 19

Give an example of a megaloblastic anaemia. Which clinical features are specific to megaloblastic anaemia?

Answer 19

Pernicious anaemia
"lemon tinge" - due to pallor + mild jaundice
"sore tongue" - glossitis
Neurological symptoms
 - paraesthesia
 - peripheral neuropathy
Neuropsychiatric symptoms
 - irritability
 - depression
 - psychosis
 - dementia

Question 20

What are the possible causes of iron-deficiency anaemia?

Answer 20

Low-iron diet
Malabsorption e.g. gastrectomy, coeliac disease
Blood loss e.g. menorrhagia, GI bleeding (GI symptoms should always be asked about when taking a history)

Question 21

What is the most common cause of acquired haemolytic anaemia?

Answer 21

Auto-immune haemolytic anaemia

- body forms antibodies against its own red blood cells. Extravascular haemolysis (exaggeration of normal process)

Question 22

Describe the approach to managing haemolytic anaemia

Answer 22

Support marrow function by giving folic acid
Correct the underlying cause e.g.
- immunosuppression
- treat trigger of autoimmunity (e.g. CLL)
- splenectomy (site of red cell destruction)
Consider blood transfusion

Question 23

How is hereditary spherocytosis diagnosed?

Answer 23

Blood film - see spherocytes
negative DAGT
decreased EMA fluoroscopy

Question 24

Describe the clinical presentation of G6PD deficiency

Answer 24

Episodic acute haemolysis

• follows an acute oxidative stressor
• prominant haemoglobulinaemia