Blood disorders

Question 1

Symptoms of anaemia

Answer 1

Fatigue

Pale skin

Tachycardia

Palpitations

Insomnia

Leg cramps

Difficulty concentrating

Dyspnoea or headache

Depression

Koilonychia (thin and flat or concave nails)

Question 2

Causes of anaemia

Answer 2

Increased haemoglobin loss

Reduced haemoglobin synthesis

Pregnancy- increase of plasma volume leads to dilutional anaemia

Question 3

Causes of iron deficiency anaemia

Answer 3

Developing world- multiple pregnancies, parasitic infections and dietary intake

Developed world- blood loss (pregnancy, menstruation and gastrointestinal bleeding)

Question 4

Symptoms of iron deficiency anaemia

Answer 4

Koilonychia

Tinnitus

Pale skin

Mouth ulcers

Sore tongue

Hair loss

Food tasting strange

Itchy feeling

Pale skin

Cravings for paper or ice

Question 5

Sources of iron

Answer 5

Red meat

Poultry

Fish

Beans

Nuts

Dried fruit

Wholegrains (brown rice)

Fortified cereals

Dark green leafy veg

Question 6

When is IV iron given?

Answer 6

With severe blood loss or malabsorption

Severe renal failure (can be given with
erythropoietin)

Patients intolerant of oral or non-compliant

Question 7

Side effects of iron supplements

Answer 7

Constipation

Nausea and abdominal pain

IV iron- anaphylactoid reactions

Question 8

Managing side effects of iron supplements

Answer 8

Take iron with food

Reduce daily dose (alternative iron salt)

Gradual dose titration

Treat side effects (laxative)

Question 9

Monitoring iron treatment

Answer 9

Monitor full blood count after 2-4 weeks to assess response

Hb levels should increase by 1g/L per day

Question 10

What drugs do iron salts reduce the absorption of

Answer 10

By chelation:

1. Levothyroxine
2. Bisphosphonates
3. Tetracycline antibiotics

Question 10

What drugs/supplements impact the absorption of iron

Answer 10

1. Vitamin C (ascorbic acid) improves absorption
2. Calcium inhibits absorption
3. PPIs inhibit absorption

Question 11

What counselling would you give a patient that is taking levothyroxine and iron

Answer 11

Take your iron supplement 4 hours after having the levothyroxine

Question 12

List two megaloblastic anaemias

Answer 12

Folic acid deficiency

B12 deficiency

Question 13

What is the role of B12 and folic acid

Answer 13

Folic acid is demethylated by a B12 reaction to be absorbed for DNA synthesis

Question 14

What are the signs of megaloblastic anaemia

Answer 14

Raised mean cell volume (macrocytic)

Decreased levels of white cells and platelets

Unexplained neurological symptoms

Hyper-segmented neutrophils

Question 15

Symptoms of megaloblastic anaemia

Answer 15

Sore, pale tongue

Altered bowel habit

Anorexia

Mild jaundice

Peripheral neuropathy or dementia (B12)

Fever (B12)

Question 16

Treatment for folic acid deficiency

Answer 16

Oral folic acid

4 months for poor dietary intake or lifelong for other causes

Rule out B12 deficiency before starting folate

Question 17

What are the monitoring requirements for folate?

Answer 17

Monitor FBC and reticulocytes after 10 days and after 8 weeks

Question 18

Why is folic acid given in pregnancy?

Answer 18

Used as prophylaxis to prevent neural tube defects

Question 19

Causes of folate deficiency

Answer 19

Poor dietary intake

Malabsorption

Pregnancy

Question 20

Causes of B12 deficiency

Answer 20

Inflammatory bowel disease

Resection of the ileum

H. pylori infection

Gastrectomy (stomach)

Question 21

Treatment for B12 deficiency

Answer 21

IM hydroxycobalamin 1mg

Cyanocobalamin between meals for poor dietary intake

Question 22

What monitoring is required for B12 treatment

Answer 22

Monitor FBC and reticulocytes after 10 days and 8 weeks