Approach to anaemia diagnosis

Question 1

MCV v MCH

Answer 1

MCV - cell size

MCH - cell Hb content

Question 2

TAILS mneumonic

Answer 2

thalassemias

Anemia of chronic disease

Iron deficiency

Lead poisoning

Sideroblastic anemia

Question 3

macrocytosis without significant anaemia causes

Answer 3

alcohol use

liver disease

hypothyroidism

Question 4

Normochromic normocytic anaemia

Answer 4

rbcs normal in szie and colour but reduced amount
often indicates an underlying systemic issue

Question 5

renal anemia

Answer 5

patients with chronic kidney disease due to decreased erythropoietin production by the kidneys

Question 6

kidneys effect on erythropoietin

Answer 6

kidneys detect reduced o2 carrying capacity of the blood

when less o2 is delivered to the kidneys they secrete erythropoietin into the blood

erythropoietin stimulates erythropiesis

relives initial stimulus that triggered erythropoietin secretion

Question 7

hypochromic microcytic anaemia

Answer 7

red blood cells that are smaller than normal and have reduced hemoglobin content

This type of anemia is primarily caused by issues in hemoglobin synthesis

Question 8

hypochromia

Answer 8

reduced haemoglobin content

Question 9

red blood cells that are smaller than normal…

Answer 9

microcytosis

Question 10

normal reticulocyte ranges

Answer 10

ranges between 0.5 % to 2.5% in adults and 2% to 6% in infants

Question 11

possible causes of low reticulocyte count

Answer 11

Bone Marrow Disorders:
○ Aplastic anemia
○ Myelodysplastic syndromes
○ Bone marrow suppression (due to chemotherapy or radiation)

Nutritional Deficiencies:
○ Iron deficiency anemia
Vitamin B12 or folate deficiency

Question 12

what does a low relic count indicate

Answer 12

reduced number of immature red blood cells

Question 13

what to look for if haemolytic anaemia suspected

Answer 13

look for evidence of red cell breakdown products and a reticulocytosis

Question 14

tools to investigate anaemia

Answer 14

history/examination/clinical context- the main tool!
full blood count indices
reticulocyte count
blood film features
haematinics (ferritin/B12/folate)
bone marrow biopsy
Specialised tests (Hb A2, HLPC etc)

Question 15

regenerative anemia

Answer 15

bone marrow actively produces and releases new red blood cells (RBCs) to compensate for the loss or destruction of RBCs

Question 16

what does a regenerative anemia suggest

Answer 16

that the bone marrow is functioning properly but that RBCs are being lost or destroyed faster than they can be replaced

Question 17

what causes regenerative anaemia

Answer 17

blood loss or red blood cell destruction- haemolysis

Question 18

why can anemia of chronic disease sometimes be microcytic

Answer 18

May be microcytic due to reduced release of iron from macrophages

	Inflammatory cytokines (like IL-6) increase hepcidin production in the liver.

Hepcidin blocks iron release from macrophages and intestinal absorption, leading to functional iron deficiency.

Question 19

what is anaemia of chronic disease usually

Answer 19

normocytic