Blood and Anaemia

Question 1

what is anaemia

Answer 1

overall reduction in hb and therefore reduced oxygen carrying capacity of the red blood cell

Question 2

what are the three categories of anaemia

Answer 2

Iron Deficiency Anaemia (IDA)

Anaemia of chronic disease ( AoCD)

Megloblastic Anaemia - folate deficiency or vitamin b12 deficiency

Question 3

Non specific signs and symptoms

Answer 3

Tiredness
Pallor ( pale skin )
Fainting
SOB - shortness of breath
Increased HR
Worsening symptoms of angina, cardiac failure and intermittent claudication.

Question 4

What are the clinical features of IDA?

Answer 4

Pale skin and mucous membrane

Painless glossitis - inflammation of tongue

Angular stomatitis - inflammation and red patches on corners of mouth

Koilonychia - abnormally shaped nails

Dysphagia - difficulty in swallowing

Pica - An eating disorder characterised by a tendency to eat substances that provide no nutritive value such as soil, chalk, hair, paper, etc.

Hair Loss

Question 5

Iron replacement therapy

Answer 5

Ferrous Fumarate - 200mg = 65mg of iron - POM

Ferrous gluconate - 300mg = 35mg of iron - P med

Ferrous sulfate - 300mg = 60mg of iron - P Med

Ferrous sulphate dried - 200mg = 65mh of iron

Question 6

Patient counselling

Answer 6

Take on an empty stomach as food reduced absorption by 40-50%

Side effects include black stools , constipation and diarrhoea but should improve within a few days

Remind pt of dietary sources of iron

Monitoring requirements

Question 7

OTC for ida ?

Answer 7

Vitamin supplements

Question 8

What is anaemia of chronic disease

Answer 8

Associated with several inflammatory diseases, immune disorders and other chronic conditions which can cause reduced blood renal flow.

Question 9

Assessment of AoCD

Answer 9

Serum iron - Low

Ferritin - increased or normal

Serum Transferrin - Decreased or normal

Serum transferrin receptors - decreased or normal

Question 10

Assessment of IDA

Answer 10

Serum Iron - low

Ferritin - low

Serum transferrin - increased or normal

Serum transferrin receptors - increased

Question 11

What is megaloblastic anaemia ?

Answer 11

An abnormality in maturation of haematopoietic cells in the bone marrow resulting in macrocytic rbc

Question 12

Folate and/or B12 deficiency should be suspected if one or more of the following are found :

Answer 12

Presence of oval macrocytic rbcs

Presence of hyper segmented neutrophils

Unexplained neurological signs or symptoms

Question 13

Specific signs and symptoms

Answer 13

Sore pale tongue

Altered bowel habit

Anorexia

Mild Jaundice - discolouration of eyes

Fever

Question 14

Management of folate deficiency

Answer 14

Treat with folic acid 5-15 mg daily

duration depends on cause

MUST EXCLUDE B12 DEFICIENCY BEFORE FOLIC ACID TREATMENT

Question 15

Causes of B12 deficiency

Answer 15

Dietary restriction

Gastric abnormalities

Small bowel disease

Medication

Nitric oxide

Question 16

Management of B12 deficiency

Answer 16

Lifelong therapy

Hydroxocobalamin preferred to cyanocobalamin in the UK - POM