Case 11: Anaemia

Question 1

What test is done to cross match blood?

Answer 1

Indirect Coombs
A positive test means the donor red cells are incompatible and should not be transfused.
A blood sample from The donor and the recipients serum (containing antibodies) are mixed. Anti-human antibodies(coombs reagent) is added. If the cells agglutinate this is a positive result which means the cells are incompatible for transfusion

Question 2

What is the direct coomb’s test?

Answer 2

Detects antibodies to the patient’s own serum.

Detects autoimmune haemolytic anaemia

Question 3

Anaemia tests

Answer 3

FBC
LFT
Blood film
Cross match
Reticulocye count 
Coagulation screen 
U&E

Question 4

Signs and symptoms of iron deficiency anaemia

Answer 4

Headache on exertion 
Fatigue 
Loss of appetite 
Weight loss
Conjunctival pallor 
Koilonychia 
Brittle nails and hair loss
Pica (craving for non food items)

Question 5

Tests and investigations for iron deficiency anaemia

Answer 5

FBC and film 
Endoscopy - to rule out malignancy!
Iron studies (serum ferritin, serum iron, transferrin saturation, zinc protoporphyrin)

Question 6

Management of iron deficiency anaemia

Answer 6

Ferrous sulphate oral (or IV if can’t tolerate)

Increased dietary iron intake

Question 7

Side effects of oral ferrous sulphate

Answer 7

Constipation
Diarrhoea
Abdominal discomfort
Nausea

Question 8

Causes of iron deficiency anaemia

Answer 8

Physiological - rapid growth, menarche, pregnancy. Menorrhagia is the most common cause in premenopausal women if there is a positive history. Need to know length of periods, regularity of cycles, number of tampons or pads used

Neonatal - prematurity, low birth weight, blood loss, early cord clamping

GIT: NSAID induced. Must exclude colonic cancer is in males and postmenopausal women

Misc: renal tract bleeding, idiopathic pulmonary haemoisderosis

Question 9

Blood film of an iron deficiency anaemia

Answer 9

Microcytic, hypochromic,
Increased RDW (red cell distribution width)

Question 10

Common causes of microcytic anaemia

Answer 10

Iron deficiency
Thalassaemia
Lead poisoning
Sideroblastic anaemia

Question 11

Common causes of normocytic anaemia

Answer 11

Acute blood loss
Anaemia of chronic disease
Renal anaemia
Haemolytic anaemia
Marrow failure
Pregnancy

Question 12

Common causes of macrocytic anaemia

Answer 12

B12 deficiency 
Folate deficiency 
Alcohol excess
Myelodysplastic syndromes
Severe hypothyroidism

Question 13

And iron deficiency anaemia how long should treatment last

Answer 13

For three months after iron levels have normalised