H1: Anaemia

Question 1

1/3 of total body cells are?

Answer 1

Red cells (24 trillion)

Question 2

What is the lifespan of a red blood cell?

Answer 2

4 months (120 days)

Question 3

Anaemia is low _____?

Answer 3

Haemoglobin

Question 4

What can cause a decrease in red cell production? (5)

Answer 4

• Iron deficiency
• B12 deficiency
• Folate deficiency
• Marrow infiltration
• Chronic disease

Question 5

What are 3 mechanisms that cause anaemia?

Answer 5

• Decreased production of red cells
• Increased destruction of red cells
• Loss of red cells (bleeding)

Question 6

What is Haemolytic anaemia?

Answer 6

A disorder in which red blood cells are destroyed faster than they can be made

Question 7

Name 2 Microcytic anaemias

Answer 7

• Iron deficiency anaemia

- Thalassaemia

Question 8

How much iron is there in 1ml of blood?

Answer 8

0.5mg iron

Question 9

Why does iron deficiency cause anaemia?

Answer 9

Iron is in haem so a deficiency of iron causes defective Hb synthesis. The RBCs produced are small (microcytic) and contain reduced Hb (hypochromic)

Question 10

What are Hypochromic RBCs?

Answer 10

RBCs which contain reduced amounts of Hb

Question 11

How much iron does an average adult contain?

Answer 11

3-5 grams of iron

Question 12

What is the recommended iron consumption per day?

Answer 12

15mg iron/day

Question 13

What are some factors that enhance iron absorption? (6)

Answer 13

• Haem iron (meat)
• Ferrous salts (Fe2+)
• Acid pH
• Iron deficiency
• Pregnancy
• Hypoxia

Question 14

What are some factors that impair iron absorption? (5)

Answer 14

• Non-haem iron (veg)
• Ferric salts (Fe3+)
• Alkaline pH
• Iron overload
• Inflammatory disorders

Question 15

How do you confirm iron deficiency? (5)

Answer 15

1. Conduct full blood count
2. Blood film check
3. Low serum ferritin
4. Low serum iron
5. Transferrin saturation

Question 16

If you were to check red cells under a microscope what would an iron deficiency sample look like? (4)

Answer 16

• Red cells vary in size
• Some cells are very small
• Pale cells
• Pencil cells present

Question 17

What is a common cause for iron deficiency in pre-menopausal females?

Answer 17

Menorrhagia (menstrual periods with abnormally heavy or prolonged bleeding)

Question 18

What is a common cause for iron deficiency in males and post-menopausal females?

Answer 18

GIT bleeding (ulcer, cancer)

Question 19

Which cancers can cause anaemias by marrow infiltration? (5)

Answer 19

• Breast
• Prostate
• Lung
• Thyroid
• Renal

Question 20

What conditions can cause anaemia by marrow infiltration? (4)

Answer 20

• Metastatic cancer
• Myeloma
• Myelofibrosis
• Leukaemia & lymphoma

Question 21

What occurs during anaemia of a chronic disease? (4)

Answer 21

• Reduced RBC lifespan
• Poor marrow response to EPO
• Depressed erythropoiesis
• Inflammatory cytokines released

Question 22

What deficiencies cause macrocytic anaemia? (2)

Answer 22

• Vitamin B12

- Folate

Question 23

What can cause macrocytic anaemias? (7)

Answer 23

• Deficiencies
• Liver disease & alcohol
• Hypothyroidism
• Bone marrow failure
• Aplastic anaemia
• Myelodysplasia
• Drug

Question 24

How do deficiencies in B12 and Folate cause macrocytic anaemias?

Answer 24

• Vitamin B12 & Folate needed for DNA synthesis
• Deficiency causes impaired DNA synthesis
• Cells fail to divide
• Large cells are formed

Question 25

What causes megaloblastic anaemia?

Answer 25

• Delayed Maturation of the nucleus of erythroblasts

- Due to defective DNA synthesis

Question 26

What causes megaloblastic anaemia?

Answer 26

B12/Folate Deficiency

Question 27

Vitamin B12;

Daily requirement?
Stored for (time)?
Absorption site
Destroyed by cooking?

Answer 27

• 1μg/d
• 3 years (1000μg)
• Binds to IF and then absorbed at Ileum
• Not destroyed by cooking

Question 28

Folate;

Daily requirement?
Stored for (time)?
Absorption site
Destroyed by cooking?

Answer 28

• 150μg/d
• 4 months only
• Duodenum & jejunum
• Destroyed by cooking

Question 29

What is Pernicous anaemia?

Answer 29

It is an autoimmune disorder which creates an autoantibody against gastric mucosa and IF

Question 30

What is Pernicous anaemia?

Answer 30

It is an autoimmune disorder which creates an autoantibody against gastric mucosa and IF

Question 31

What are some clinical features of Pernicous anaemia? (4)

Answer 31

• Anaemia
• Glossitis
• Mild jaundice
• Neurological problems (ie dementia)

Question 32

How can anaemias caused by either B12 or Folate be distinguished between by looking at clinical features?

Answer 32

Clinical features present from folate deficiency do not cause neurological problems

Question 33

What abnormalities of the RBC can cause haemolysis?

Answer 33

• Membrane abnormality
• Hb abnormality
• Enzyme abnormality

Question 34

Wha are some clinical presentations of haemolytic anaemia? (4)

Answer 34

• Pallor
• Jaundice
• Gallstones
• Splenomegaly

Question 35

How can you tell from lab investigations that there is Red cell breakdown? (3)

Answer 35

• Increase serum unconjugated bilirubin
• Increased urinary urobilinogen
• Increase serum lactate dehydrogenase

Question 36

How can you tell from lab investigations that there is Red cell production? (2)

Answer 36

• Increased reticulocytes in blood

- Increased RBCs in marrow

Question 37

Give an example of a RBC membrane defect

Answer 37

Hereditary Spherocytosis

Question 38

Give an example of a RBC enzyme defect

Answer 38

G6PD deficiency

Question 39

What causes sickle cell disease?

Answer 39

Point mutation in Globin gene

Glutamine to Valine at Amino acid 6

Question 40

What is Autoimmune haemolytic anaemia?

Answer 40

When self-reacting IgG antibodies attaches to RBC and destroy them