approach to a diagnosis of anemia

Question 1

what are the mechanisms of anemia ?

Answer 1

increased destruction

impaired synthesis

Question 2

what are anemias classified based upon ?

Answer 2

cause
morphological abnormalities
underlying pathophysiology

Question 3

what are the morphological abnormalities seen in anemia ?

Answer 3

microcytic/hypochromic
macrocytic/normochromic
normocytic/normochromic

Question 4

what are the types of macrocytic anemias ?

Answer 4

megaloblastic

non-megaloblastic (normoblastic)

Question 5

what could be the causes of megaloblastic anemia ?

Answer 5

b12 deficiency
folic acid deficiency
congenital dyserythropoeitin anemia

Question 6

what does a leucoerythroblastic reaction mean ?

Answer 6

denotes the presence of both the precursors of white blood cells and red blood cells on a blood film

Question 7

when do we see a leucoerythroblastic reaction ?

Answer 7

in severe blood loss and severe infection and acute hemolysis

Question 8

how would you diagnose a case of undiagnosed anemia ?

Answer 8

by describing the size of the red blood cells

Question 9

when do we see microcytic hypochromic anemia ?

Answer 9

in iron deficiency
thalassemia
lead poisoning
sideroblastic anemia

Question 10

when do we see normocytic normochromic anemia ?

Answer 10

blood loss 
anemia of chronic disease 
renal disease 
mixed deficiencies 
bone marrow failure 
hemolytic anemias

Question 11

when do we see macrocytic anemia ?

Answer 11

in megaloblastic and non megaloblastic forms :
b12 deficiency 
folate deficiency 
congenital dyserythropoeitin anemia 
liver cirrhosis 
alcohol

Question 12

how does the body react to anemia?

Answer 12

• increased cardiac output
• redistribution of blood flow between organs
• increased capacity of haemoglobin to release oxygen to the tissue ( shift to the right )

Question 13

what are the clinical features of anemia determined by ?

Answer 13

severity of the anemia
speed of onset of he anemia
patients with co-morbidities

Question 14

which type of anemia may cause neurological deficits ?

Answer 14

b12 deficiency

Question 15

how could we differentiate between bone marrow infiltration and haemolysis ?

Answer 15

reticulocytes would be decrease in BMF and increased in haemolysis

Question 16

what are the causes of high reticulocyte count in anemic patients?

Answer 16

chronic haemolysis

after acute haemorrhage

Question 17

if the reticulocyte count doesn’t rise in an anemic patient what could this suggest ?

Answer 17

impaired bone marrow function

or lack of erythropoietin

Question 18

what is the special reticulocyte stain

Answer 18

supravital stain - billiant cresyl blue or new methylene blue

Question 19

what would be the investigations for detecting anemia

Answer 19

full CBC 
blood film examination 
reticulocytes 
haematinics - serum b12, folate and iron studies 
biochemistry panel

Question 20

what can we do for a patient that old age and has anemia with no underlying cause ?

Answer 20

colonoscopy

Question 21

what is the main managment of anemia ?

Answer 21

treat the underlying cause

Question 22

what stain vcan be used to see iron stores ?

Answer 22

Prussian blue