Clinical Approach to Patient with Anaemia

Question 1

Classifications of anaemia

Answer 1

Physiological: impaired production of red cells, vs blood loss/haemolysis

Morphological: based on appearance of red cells

Question 2

Causes of impaired production of red cells

Answer 2

Deficiency of essential substances: iron, folate, B12
Thalassaemia
Bone marrow failure: infiltration, leukaemia, drug damage

Question 3

Reduced red cell survival

Answer 3

Blood loss, usually acute

Haemolysis: shortened rbc survival, environmental or intrinsic

Question 4

Basic morphological approach to anaemia with MCV values

uses MCV, Hb conc, Hb and blood film comment.
PCV= haematocrit

Answer 4

Micocytic, hypochromic <76
Normochromic normocytic 76-96
macrocytic >96

Question 5

Microcytic hypochromic anaemia causes

Answer 5

• Iron deficiency
• Chronic illness/inflammation (iron block)
• Genetic, thalassaemia (note heterozygote mild anaemia, homozygote recessive, low)

Question 6

Diagnosis of iron deficiency, what do we measure?

Answer 6

measure serum iron, iron binding capacity (transferrin), iron saturation and serum ferritin

Question 7

Causes of iron deficiency? (4)

Holistic age group classification

Holistically: Children ___, pre menopausal= imbalance between ____ and _____, male and post menopausal females= ___ ___ ___

Answer 7

Diet: vege?
Malabsorption: proximal small bowel
Increased demands i.e pregnancy
Chronic blood lossin GI or GU tract

Holistically: Children dietary, pre menopausal, imbalance between uptake and menorrhage, male and post menopausal females, occult blood loss (GI carcinoma)

Question 8

Iron deficiency treatments

Answer 8

iron replacement therapy e.g ferrogradumet

Note that Hg conc increases about 20 g/L every 3 weeks

Question 9

Macrocytic (megaloblastic) anaemia causes

Answer 9

B12 deficiency
Folate deficiency
Liver disease, hypothyroid, excess alcohol, primary bone marrow)

Question 10

B12/ Folate deficiency consequences

Answer 10

Impaired DNA synthesis, may affect all cell lineages (e.g hypersegmented neutrophils)
Diagnosis- measure serum B12 and folate
Need to determine cause

Question 11

Cause of a low vitamin B12

body stores?

Answer 11

Diet: uncommon
Malabsoprtion: Gastrectomy, AI e.g pernicious anaemia, against parietal cells no IF) NB terminal ileum absorption
NB body stores 3-4 years worth

Question 12

Causes of low folate

Answer 12

Dietary: most common
malabsorption (proximal small bowel)
Increased demands i.e pregnancy, haemolytic anaemia

Question 13

Haemolytic anaemia classifications

Answer 13

Intrinsic red cell defects, usually hereditary (membrane defect)
Extrinisic, environmental or acquired such as AI

Question 14

Haemolytic anaemia features

Answer 14

Jaundice, enlarged spleen, raised reticulocyte,

Question 15

Iron studies (normal, deficiency, chronic disease, overload)

Serum ion: ____ in deficiency, _____ in chronic illness, ___ ____ in overload
Transferrin: ____ in deficiency, to ______. Chronic illness, ratio ____, slightly ____ ____. In overload fully _____
Ferritin: ___ in deficiency, ____ or ____ in chronic inflammation

Answer 15

Serum ion: low in deficiency, lower in chronic illness, very high in overload
Transferrin: High in deficiency, to compensate. Chronic illness, ratio normal, slightly less saturated. In overload fully saturated
Ferritin: low in deficiency, higher or normal in chronic inflammation