Anemia

Question 1

what are the appropriate haemoglobin levels for males and females

Answer 1

females:110-147 g/l
males:131-166

Question 2

what is MCV and its classes

Answer 2

mean cell (corpuscular) volume (cell size)
-macrocytis - cells larger than norm
-microcytic- cells smaller than norm
-normocytic- cells within norm range

Question 3

what are the microcytic anemias

Answer 3

iron and thallessemia

Question 4

what are the macrocytic anemias

Answer 4

• folate defic, b12 defic (both magoblastic)
• haemoloysis
• bone marrrow disorders

Question 5

what are the normolytic anemias

Answer 5

• chronic disease
• renal disease (EPO)
• acute bleading
• mixed picture( mix of big and small cells)

Question 6

what are some characteristics of b12 deficiency (histology)

Answer 6

-oval macrocytes
-hypersegmenteg neutrophils (many lobes)

Question 7

how do you treat b12 anemia

Answer 7

b12 injections
Diet

Question 8

What is the pathology of B12 deficiency

Answer 8

low b12
low intrinsic factor (prevents b12 absorbing)

Question 9

what much iron is cosumed in araaege diet and how much is absorbed

Answer 9

• 15mg
• 1mg

Question 10

where is haemoglobin absorbed

Answer 10

duodenum and the upper jejunum.

Question 11

why is pregnancy important with iron

Answer 11

body stores appros 4g of iron, baby takes between 500-1000mg of the iron, if mother is borderline before hand, pregnancy could be cussing the anemia caused by iron deficiency (microcytic). Will need supplemental iron

Question 12

why would celiac disease be important in iron anemia

Answer 12

iron is absorbed in dedenum and jejenum, celiac affects the jejenum

Question 13

how to treat iron anemia (if not caused bu GI malignancy)

Answer 13

-200mg iron supplement oral (ferrous sulphate)
-HB shuld inc 20g each 3-4 weeks
-contrinue 3 months after normal values

Question 14

what are the transferrin value for males and females

Answer 14

F:15-45%
M:15-50%

Treanferrrin synthesis inc in iron deficiency. Low

Question 15

How many mg of folate does a non pregnant person need per day

Answer 15

0.1-0.2 mg -needed for DNA

Question 16

where is Folate absorbed

Answer 16

Proximal jejenum

Question 17

what causes folate deficiency

Answer 17

• diet
• pregnancy
• crohns
• coeliac

Question 18

how to treat folate deficiency

Answer 18

Supplement
-check B12 first before supplement

Question 19

where is b12 absorbed

Answer 19

• absorbed in terminal illeum
• must be bound to IF (produce be gatric parietal cells)

Question 20

how long do b12 stores last for

Answer 20

3 yrs

Question 21

what is B12 required for

Answer 21

Fatty acid synth and DNA synth

Question 22

what are presenting symptoms of B12 defic

Answer 22

neurological symptoms (parasthesia)

Question 23

describe immunology of pernicious anemia (b12)

Answer 23

-autoimmunedisctuctin of gastric parietal cells that produce IF

Question 24

investigations for haemolytic anemia

Answer 24

• blood film showing
  -spherocytes
  -polychromasia
  -bilirubin + uncoj
• Direct antiglobulin test/ Cooms test

Question 25

what are presenting symptoms of haemolytic anemia

Answer 25

-normal general anemia symptoms -jaundices -gallstones -leg ulcers

Question 26

Aetiology haemolotic anemia

Answer 26

* inherited -RBC membrane deffet (spherocytes) * Acquired -autoimmune

Question 27

What is sideroblastic aneamia?

Answer 27

- Defective Hb synthesis within mitochondria - microcytic - Often X inherited ALA synthetase deficiency - High Fe but not used in Hb synthesis, trapped in mitochondria!

Question 28

what tests are for sideroblastic anaemia

Answer 28

* FBC + Blood film= Microcytic, low mcv, RINGED SIDEROBLASTS * Iron studies - High Serum Fe, High Ferritin, High Transferrin Saturation, Low Total Iron Binding Capacity (TIBC). * Marrow biopsy - Increased iron deposition and ringed sideroblasts.

Question 29

how is sideroblastic anermia treated

Answer 29

chelation therapy blood transfusions avoiding triggers- alchohol

Question 30

Describe G6PD Deficiency

Answer 30

* deficiency of the G6PD Enzyme which leads to anaemia through h**aemolysis. * x linked males of Mediterranean, African and Middle Eastern descent **and in patients from countries where malaria is prevalent as it is protective against the infection.

Question 31

whate are the signs and symptoms of G6PD deficiency

Answer 31

* signs = normal anemia= breathlessness,palpitations, fatigue. dsypsnoe * symptoms = jaundice, palloe, splenogolamy, dark urine, gall stones

Question 32

how is G6PD Deficiency diagnosed

Answer 32

**FBC + blood film ** * normocytic * normochromatic * low rbc * high reticulocytes * heinz bodies + Bitez cells **G6PD Enzyme Assay** – Low G6PD

Question 33

how to treat G6PD deficiency

Answer 33

* Avoid Precipitating Factors * Blood Transfusions during G6PD attack (rapid anaemia + jaundice

Question 34

what are the signs of iron aneamia

Answer 34

* spoon nails (Koilonychia) * Angular stomatitis * Atrophic glossitis * Brittle hair and nails * Subconjunctival pallor

Question 35

what are the signs of beta thallassemia

Answer 35

*  Jaundice *  Pallor *  Hepatosplenomegaly *  Chipmunk face: enlarged forehead and cheekbones *  Failure to thrive *  Bone deformities