Anemia

Question 1

Causes of folate deficiency

Answer 1

Lack of veg + fruit diet. Small bowel disease. Pregnancy. Old age. Poverty. Antiepileptic drugs (Phenytoin)

Question 2

Causes of iron deficiency

Answer 2

GI bleed, NSAIDs, anticoagulants, poor diet, pregnancy, menses

Question 3

Causes of B12 deficiency

Answer 3

Lack of meat (vegetarians), ileal resection, pernicious anemia, gastric surgery, H2 rec blockers/ PPIs, metformin

Question 4

Other than iron def, what are the next main DDx of microcytic hypochromic anemia?

Answer 4

“TIS”: Thalassemia trait, iron def, sideroblastic

Question 5

Features of iron deficiency anemia?

Answer 5

Angular cheilitis/stomatitis, glossitis, koilonychia, pica

Question 6

Se Ferritin levels for microcytic anemias: iron def, sideroblastic, thalassemia

Answer 6

Iron def: low se Ferr
Sideroblastic: high/N
Thalassemia: high/N

Question 7

Mx of iron def anemia + SE

Answer 7

Ferrous sulphate. SE: black stools, constipation

Question 8

How to diagnose thalassemia

Answer 8

Hb electrophoresis = elevated HbA2.
Microcytic hypochromic anemia.
Abnormal RBCs= tear drop, target

Question 9

Why is iron supplement contraindicated in thalassemia

Answer 9

Abnormal erythropoiesis suppresses hepcidin –> allowing unregulated iron absorption –> secondary haemochromatosis.

Question 10

Treatment of thalassemia

Answer 10

Blood transfusions (Hb + packed red cells) + desferrioxamine (iron chelator)

Question 11

MAHA features on blood film

Answer 11

Schistocytes

Question 12

Causes of MAHA

Answer 12

HUS; DIC; TTP

Question 13

Clinical features of HUS - N.B. do not give Abx. Mx with fluids + blood transfusion

Answer 13

Child with recent E.coli infection, bloody diarrhea, abdo pain, anemia, haematuria, HTN

Question 14

Platelets and INR/APTT levels in DIC

Answer 14

Low platelets. high INR/APTT

Question 15

Management of DIC (caused by cancer or infection)

Answer 15

Do not do anything if not actively bleeding. If actively bleeding, give cryoprecipitate (fibrinogen) + FFP (clotting factors)

Question 16

Immune mediated haemolytic anemia caused by auto-ab e.g. in CLL, penicillin. Investigations?

Answer 16

Blood film: spherocytes
Direct Coombs test: test for human Ig
Indirect Coombs test: test for autoAbs against recipient’s blood
Mx: IVIg –> prednisolone

Question 17

Clinical features of B12 deficiency

Answer 17

Sensory ataxia, peripheral neuropathy, glossitis, vitiligo

Mx: IM B12 (hydroxocobalamin)

Question 18

Causes of normocytic anemia

Answer 18

Acute blood loss
BM suppression (lymphoma, aplastic anemia)
Chronic disease (inflammation, malignancy, CKD)
Destruction (haemolysis - G6PD def, spherocytosis)

Question 19

Causes of prolonged INR + normal APTT

Answer 19

Warfarin, Antiphospholipid syndrome

Question 20

Prolonged APTT + normal INR

Answer 20

Heparin, Haemophilia, VwD, Lupus anticoagulant

Question 21

Management of VwD

Answer 21

Desmopressin (DDAVP infusion)

Question 22

Difference between ITP + TTP

Answer 22

ITP is idiopathic due to antiplatelet Abs.
TTP is due to genetic deficiency of ADAMTS13; often coupled with HUS. “FAT RN”: fever, anemia, thrombocytopenia, renal failure, neuro (confusion)

Question 23

Treatment of ITP

Answer 23

Corticosteroids

Question 24

Tumorlysis syndrome: which electrolytes are affected

Answer 24

Dead cells release uric acid, PO4, K+