Haematological

Question 1

Who does iron deficiency anaemia affect?

Answer 1

Higher incidence in women due to iron lost through menstruation and pregnancy

Question 2

What are the causes of iron deficiency anaemia?

Answer 2

Excessive blood loss

• from GI tract most common (ulceration/carcinoma)
• menorrhagia most common in pre-menopausal women

Dietary inadequacy

• fairly uncommon
• vegetarians
• growing children/elderly people

Failure of iron absorption

• some drugs can bind to iron and prevent its absorption, tetracyclines and quinolones
• antacids and PPIs may impair absorption by ⬆️ pH
• malabsorption conditions - coeliac

Excessive iron requirements

• rapid growth in children
• pregnancy with twins

Question 3

What are the risk factors for iron deficiency anaemia?

Answer 3

Poor iron intake or impaired absorption
Drug history - NSAIDs SSRIs 
Recent blood donation
Recent illness
History of previous GI surgery
Family history

Question 4

What are the symptoms of iron deficiency anaemia?

Answer 4

Fatigue
Dyspnoea on exertion
Palpitations

Less common:
Headache
Tinnitus
Taste disturbance 
Pruritis
Changes in hair/hair loss

Question 5

What are the signs of iron deficiency anaemia on examination?

Answer 5

May be no signs even if severe anaemia
Pallor (best seen on mucosa of tongue and mouth)

Less commonly
Koilonychia and longitudinal riding
Angular cheilitis
Atrophic glossitis
Tachycardia

Question 6

What are the differential diagnoses of iron deficiency anaemia?

Answer 6

Other causes of microcytic anaemia:
Thalassaemia
Sideroblastic anaemia

Anaemia of chronic disease
Lead poisoning

Question 7

What investigations are necessary to diagnose iron deficiency anaemia?

Answer 7

FBC (if show low Hb and low MCV = microcytic anaemia)
Check ferritin

Dyspepsia + iron deficiency anaemia = urgent endoscopy

Question 8

What are the treatments for iron deficiency anaemia?

Answer 8

Treat with oral ferrous sulphate
Iron rich foods

Side effects of iron supplementation:

• constipation
• black stools
• Diarrhoea
• indigestion
• nausea

Question 9

What is macrocytic anaemia?

Answer 9

When there is a fall on Hb levels in the blood

Macrocytosis means that the red blood cells are larger than normal
This occurs when there are problems with the synthesis of RBCs, as in B12/folic acid deficiency

Can be classed as megaloblastic or non-magaloblastic (megaloblastic is abnormality of erythroblasts in the bone marrow)

Question 10

What is pernicious anaemia?

Answer 10

An autoimmune process that invokes gastritis, atrophy of all layers of the body and fundus of the stomach and the loss of normal gastric glands

Question 11

How common is pernicious anaemia?

Answer 11

Accounts for 80% of megaloblastic anaemia

Question 12

What causes pernicious anaemia?

Answer 12

Vitamin B12 deficiency

Folate deficiency

Question 13

What are the symptoms of pernicious anaemia?

Answer 13

Fatigue & lethargy
Dyspnoea
Faintness
Palpitations
Headache
Tinnitus
Anorexia
Exacerbation of angina

Question 14

What are the signs of pernicious anaemia examination?

Answer 14

Pallor
Bounding pulse
Systolic pulmonary flow murmur

Question 15

What are the signs of B12 deficiency?

Answer 15

Lemon tinge to skin
Glossitis
Oropharyngeal ulceration
Neuropsychiatric: irritability, depression, psychosis, dementia

Question 16

What are the signs of folate deficiency?

Answer 16

Mild peripheral neuropathy

Psychiatric changes

Question 17

What are the differential diagnoses for pernicious anaemia? (Non-megaloblastic causes of macrocytosis)

Answer 17

Alcohol
Severe thyroid deficiency
Pregnancy and neonatal period
Haematological abnormalities

Question 18

What investigations are necessary to diagnose pernicious anaemia?

Answer 18

FBC
If Hb low and MCV high = check serum vit B12 and serum folate concentrations
If Hb low and MCV normal then check ferritin, vit B12 and folate levels

Question 19

What are the treatments for pernicious anaemia?

Answer 19

Hydroxocobalamin 1mg IM

Folic acid supplementation

Dietary advice

Question 20

What is Lymphoma?

Answer 20

Group of blood cell tumours

Question 21

What are they types of lymphoma? And how common are they & who do they affect?

Answer 21

Non-Hodgkin lymphoma = 90% cases

• white people
• median age at presentation >50years

Hodgkin lymphoma = malignant tumour of lymphatic system
- peak incidence in young adults 20-34 years

Question 22

What are the symptoms of non-Hodgkin and Hodgkin lymphomas?

Answer 22

NHL:
Low grade:
- painless slow progressive lymphadenopathy
- systemic symptoms (fatigue, weakness, fever, night sweats, weight loss,
Intermediate and high grade:
- rapidly growing and bulky lymphadenopathy
- systemic symptoms and extra nodal involvement

HL:

• enlarged Asymptomatic lymph node
• mediastinal masses
• chest discomfort with a cough or dyspnoea
• systemic symptoms (drenching night sweats and fever)

Question 23

What are the signs of Hodgkin’s lymphoma on examination?

Answer 23

Lymphadenopathy
Hepatomegaly
Splenomegaly
SVC syndrome

Question 24

What apinvestigations are necessary to diagnose Hodgkin’s and non-Hodgkin’s lymphoma?

Answer 24

Blood tests

• FBC
• ESR
• LFT

Chest X-ray

CT scans of chest neck and abdomen and pelvis to detect enlarged lymph nodes

Question 25

What are the treatments for Hodgkin’s and non-Hodgkin’s lymphoma?

Answer 25

Chemotherapy

Radiotherapy

Question 26

How common is iron deficiency anaemia?

Answer 26

Most common deficiency state on the world

Affects over 2 billion people worldwide