Haematology

Question 1

Where is erythropoietin produced?

Answer 1

Kidneys

Question 2

What is erythropoietin secreted in response to?

Answer 2

Cellular hypoxia

Question 3

Erythropoietin secretion stimulates RBC’s production from which tissue?

Answer 3

Bone marrow

Question 4

Explain the process of erythropoiesis (cell types in each part of the process) - 7

Answer 4

Haemocytoblast –> proerythroblast –> Early erythroblast –> late erythroblast –> normoblast –> reticulocyte –> erythrocyte

Question 5

Erythrocytes are derived from which common progenitor?

Answer 5

Myeloid

Question 6

As well as erythrocytes, which cell types are also derived from common myeloid progenitor cells? (3)

Answer 6

Megkaryocyte
Mast cell
Myeloblast

Question 7

In which part of the GI tract is the majority of Iron (Fe2+) absorbed?

Answer 7

Duodenum

Question 8

What happens to Fe2+ once it has been absorbed via the GI tract?

Answer 8

Some stored as ferritin.

Most absorbed into blood via ferroportin 1 carrier

Question 9

Folic acid is important for synthesis of what?

Answer 9

DNA/RNA

Question 10

What is FE2+ used for?

Answer 10

Haemoglobin production

Question 11

What type of anaemia is caused by folic acid deficiency?

Answer 11

Megaloblastic anaemia

Question 12

Where in the GI system is vitamin B12 absorbed?

Answer 12

Terminal ilium

Question 13

Which enzyme is typically absorbed alongside B12?

Answer 13

Intrinsic factor

Question 14

Vit B12 is a co-factor for synthesis of what?

Answer 14

DNA synthesis

Question 15

What type of anaemia is caused by Vit B12 deficiency?

Answer 15

Megaloblastic anaemia

Question 16

Small RBCs, low MCV and low staining (low Hb) indicates which type of anaemia?

Answer 16

Microcytic anaemia

Question 17

What is the MCC of microcytic hypochromic anaemia?

Answer 17

Fe2+ deficiency

Question 18

LCC of mircocytic hypochromic anaemia (2)

Answer 18

Thalassaemia

Anaemia of chronic disease

Question 19

RBC are a normal size and colour but RBC is low - this may indicate which type of aneamia?

Answer 19

Normocytic normochromic

Question 20

MCC of normocytic normochromic anaemia

Answer 20

Blood loss

Question 21

LCC of normocytic normochromic anaemia (3)

Answer 21

Bone marrow failure
Anaemic of chronic disease
Haemolysis

Question 22

Large RBC, high MCV and normal staining (Hb) indicates which type of anaemia?

Answer 22

Macrocytic normochromic

Question 23

MCC of macrocytic normochromic anaemia (2)

Answer 23

B12/folate deficiency OR pernicious anaemia

Question 24

LCC of macrocytic normochromic anaemia (3)

Answer 24

Liver disease
Excess ETOH intake
Bone marrow failure

Question 25

(5) DD for anaemia inc. red flag diseases

Answer 25

* IDA * Vit B12 deficiency anaemia * Folate deficiency anaemia * Acute GI bleed * Leukaemia

Question 26

(3) causes of IDA

Answer 26

1. Inadequate intake 2. Increased iron loss 3. Excessive iron requirements e.g. pregnancy, growth in childhood, menstruation, lactation

Question 27

What level of Hb is considered as anaemic (IDA)

Answer 27

<130g/L

Question 28

(4) causes of inadequate iron intake

Answer 28

Coeliac disease Gastric surgery Pica Achlorhydria

Question 29

(8) causes of increased iron loss

Answer 29

1. GI bleeding from unknown lesion 2. Haemorrhoids 3. Salicylate ingestion 4. Peptic ulcers 5. Hiatus hernia 6. Diverticulosis 7. Neoplasm 8. Ulcerative colitis

Question 30

MCC of IDA

Answer 30

Blood loss (usually chronic)

Question 31

Why does IDA cause fatigue and SOB?

Answer 31

Impaired Hb synthesis plus anaemia type = decreased O2 carrying capacity

Question 32

What type of anaemia is IDA?

Answer 32

Hypochromic microcytic

Question 33

Risk factors for IDA (7)

Answer 33

* Black female * Pregnancy * Vegan diet * Menorrhagia * Coeliac disease * NSAID use * Gastrectomy

Question 34

(3) examination findings of IDA

Answer 34

Koilonychia Glossitis Angular stomatitis

Question 35

Investigations for IDA (and what they show)

Answer 35

1. Bloods + blood film --> low Hb, low haematocrit, normal/elevated platelets 2. Haematinics --> low serum Fe2, raised Fe2 carrying capacity, low transferrin saturation, low serum ferritin

Question 36

1st line Tx for IDA

Answer 36

Iron replacement PO - FERROUS FUMURATE

Question 37

Which vitamin can be supplemented to aid iron absorption?

Answer 37

Vitamin C (ascorbic acid)

Question 38

Tx for Tx if symptomatic at rest with SOB, chest pain, pre-syncope etc?

Answer 38

RBC transfusion

Question 39

Risk factors for Vit B12 anaemia (5)

Answer 39

``` Increased age (>65 yrs) Vegan/vegetarian diets Pregnancy Gastric surgery Chronic GI disease Medications ```

Question 40

Which group of medications can reduce B12 breakdown from foods? (2)

Answer 40

NAIDs | Metformin

Question 41

Vitamin B12 is necessary for the metabolism of which other micronutrient?

Answer 41

Folate

Question 42

How does pernicious anaemia relate to vitamin B12 deficiency?

Answer 42

Autoimmune destruction of parietal cells --> lack of IF ---> impaired B12 absorption

Question 43

Examination signs of B12 deficiency (6)

Answer 43

``` Ataxia Positive Romberg test Pallor Petechia Glossitis Cognitive impairment ```

Question 44

Investigations (and findings) for B12 deficiency anaemia

Answer 44

FBC --> low Hb, raised mCV Serum B12 <148 picomoles/L Reticulocyte count --> low Blood smear --> hyper-segmented polymorphonucleated cells

Question 45

Management of B12 deficiency anaemia

Answer 45

Hydroxocobalamin/cyanocobalamin Injections

Question 46

Folate deficiency causes what type of anaemia?

Answer 46

Megaloblastic anaemia

Question 47

Groups of people most affected by folate deficiency

Answer 47

People in countries with folic acid fortification. | Esp. Pre-school children, pregnant women, elderly

Question 48

Risk factors for folate deficiency (5)

Answer 48

``` Low folate intake >65 yrs Alcoholism Pregnancy Drug use ```

Question 49

Sx of folate deficiency (5)

Answer 49

``` Diarrhoea Headache Weight loss Anorexia Fatigue ```

Question 50

Examination findings of folate deficiency (5)

Answer 50

``` SoB Dizziness Tachycardia Tachypnoea Signs of heart failure or chronic alcohol abuse ```

Question 51

1st line Tx for folic acid deficiency

Answer 51

Oral folic acid supplements (multi-vit)

Question 52

Blood investigations for folic acid deficiency (and what each one will show)

Answer 52

``` FBC --> low Hb, raised MCV, raised MCH Blood smear --> macrocytosis Reticulocyte count --> low Serum folate --> low Serum LDH --> elevated ```