Approach to Anaemia Diagnosis

Question 1

How do we define anaemia? (2)

Answer 1

Reduction in haemoglobin concentration below that which is optimum for that individual​
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Reduction in haemoglobin concentration below 95% range for the population

Question 2

Classification of anaemia (8)

Answer 2

Decreased production​
-Hypoproliferative – reduced amount of erythropoiesis​

-Maturation abnormality – erythropoiesis present but ineffective=
*Cytoplasmic defects: impaired haemoglobinisation​
*Nuclear defects: impaired cell division​
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Increased loss or destruction of red cells​
-Bleeding​
-Haemolysis​
​

Question 3

Reticulocyte count is a useful marker for (2)

Answer 3

red cell production

-increased red cell production =regenerative anaemia

Question 4

If you suspect haemolytic anaemia =

Answer 4

look for evidence of red cell breakdown products and a reticulocytosis - then consider a potential cause (blood film and history may help)​

Question 5

Is red cell production relatively impaired? (3)

Answer 5

Normal marrow can increase red cell production 3-4 fold​

Reticulocyte count should be appropriately increased for the degree of anaemia​

Anaemia with a lesser reticulocyte response is at least partly due to impaired red cell production​

Question 6

Hypochromic Microcytic anaemia - problems with haemoglobin formation (TAILS) (7)

Answer 6

=Iron deficiency ​
=Commonest cause - remember always to find out why​
=Some anaemias of chronic disease (iron availability to red cell reduced)​
=Haem defects (rare)​
=Lead poisoning, Congential sideroblastic anaemia​
=Globin defects​
=thalassaemias​

Question 7

Macrocytic anaemias (7)

Answer 7

Nuclear maturation defects - failure of cell division​
=Nutritional - B12/folate (megaloblastic anaemias)​
=Myelodysplasia​
=Drugs eg chemotherapy​

Apparent ​
=Agglutination​
=(Reticulocytosis)​

Question 8

Macrocytosis without significant anaemia (3)

Answer 8

Hypothyroidism​
Alcohol​
Liver disease