Case 4 SBA

Question 1

How does iron deficiency cause anaemia?

Answer 1

Reduces the amount of haemoglobin produced, so is microcytic

Question 2

How does renal failure cause anaemia?

Answer 2

No EPO produced

Question 3

How does cancer or chronic inflammation cause anaemia?

Answer 3

Turns on hepcidin so less iron available

Question 4

How does thalassemia cause anaemia?

Answer 4

Not enough haemoglobin produced

Question 5

How does B12 and folate deficiency cause anaemia?

Answer 5

Necessary for methylation in DNA synthesis so macrocytic

Question 6

For the synthesis of what are folic acid derivatives needed?

Answer 6

Purine and thymidine

Question 7

What causes a B12 deficiency?

Answer 7

Diet, lack of intrinsic factor (pernicious anaemia), removal of terminal ileum

Question 8

How do drugs cause anaemia?

Answer 8

Make it harder to absorb B12
Can cause immune system to confuse RBCs with foreign substances so can lead to haemolytic anaemia

Question 9

Aetiology of microcytic anaemia

Answer 9

Nucleus divides before sufficient haemoglobin is synthesised, leads to small pale cells

Question 10

Aetiology of macrocytic anaemia

Answer 10

DNA can’t replicate properly so a megaloblast forms

Question 11

What do red blood cells need to be produced?

Answer 11

Free iron, haem, globin proteins, B12, folate, DNA synthesis, normally functioning bone marrow

Question 12

What are the oral iron supplements for IDA?

Answer 12

Ferrous sulfate, ferrous gluconate, ferrous fumarate

Question 13

Side effects of IDA treatment

Answer 13

GI upset, diarrhoea, constipation, nausea, epigastric pain, iron toxicity

Question 14

Describe the treatment for IDA

Answer 14

Oral replacement daily until 3 months after resolution
Should take on an empty stomach and with orange juice to aid absorption
Avoid calcium, tea, and coffee for 1-2 hours after to promote absorption

Question 15

What reduces the side effects of IDA treatment and what are the consequences of this?

Answer 15

Taking the tablets with food but this reduces absorption

Question 16

What happens if daily oral iron replacement not tolerated in IDA treatment?

Answer 16

Move to alternate days
If still not tolerated then move to IV ferrinject

Question 17

Describe the treatment for folate deficiency

Answer 17

5mg folic acid daily for four months, or longer if the cause is persistent

Question 18

Treatment of folate deficiency in pregnancy

Answer 18

400 micrograms daily until 12 weeks
5mg if high risk

Question 19

What embryological defect can folic acid supplements cause?

Answer 19

Neural tube defects leading to spina bifida

Question 20

Side effects of folic acid treatment

Answer 20

Nausea, GI upset, anorexia, abdominal distension, flatulence, immune response

Question 21

Treatment of renal anaemia

Answer 21

EPO replacement darbepoeitin subcutaneously every 1-4 weeks

Question 22

Side effects of darbepoeitin treatment (SHEATS)

Answer 22

Skin reaction, risk of embolism and thrombosis, increased risk of stroke, arthralgia, hypertension

Question 23

Describe treatment for B12 deficiency

Answer 23

IM preparations e.g. hydroxocobalamin every 2-3 months
Daily oral preparation may be needed for a dietary cause

Question 24

Side effects of B12 deficiency treatment

Answer 24

Hot flushes, nausea, vomiting, diarrhoea, dizziness, pain at injection site

Question 25

Classification of acute anaemia

Answer 25

Macrocytic or normocytic

Question 26

Causes of acute anaemia

Answer 26

GI bleed, drugs, haemolytic, bone marrow failure