Haematology

Question 1

what is anaemia

Answer 1

reduced Hb concentration for age and gender — defined as male <13 g/dL & female <12 g/dL

Question 2

what are the red flags of iron deficiency anaemia

Answer 2

male gender, GI S&S, post-menopausal female w/o obv cause, not improving to treatment

Question 3

what can cause anaemia

Answer 3

decreased RBC production — nutritional deficiencies (eg. iron deficiency), chronic disease, malignancy

loss of RBCs — blood loss or trauma

increased RBC breakdown —- haemolytic anaemia, infections, hypersplenism

Question 4

what are your DDx for microcytic vs normocytic vs macrocytic anaemia

Answer 4

microcytic anaemia:
iron deficiency
chronic disease
thalassaemia
sideroblastic anaemia

normocytic anaemia
chronic disease
acute blood loss
haemolytic anaemia
BM infiltration

macrocytic anaemia
megaloblastic anaemia — folate & B12 deficiency
liver disease
hypothyroidism
aplastic anaemia

Question 5

what Ix to check cause of anaemia

Answer 5

FBC — pancytopenia = ?BM cause; increased reticulocytes = ?haemolysis
blood film
+/- OGD/colonoscopy —- ?coeliac, active GIB, ulceration or ca

if microcytic
iron studies —- serum iron, TIBC, ferritin

if normocytic
ESR, CRP
haptoglobin
direct coombs test
SPEP —– ?MM

if macrocytic
B12 & folate levels
anti-parietal cell Ab & intrinsic factor Ab – ?pernicious anaemia
anti-tTG & IgA —- ?coeliac
LFTs
TFTs

Question 6

what is multiple myeloma

Answer 6

malignancy of the plasma cells

they accumulate in BM + overproduce a monoclonal protein

this monoclonal protein can then be detected via serum or urine protein electrophoresis (SPEP/UPEP)

Question 7

what presentation would u expect in multiple myeloma

Answer 7

CRAB
C: Ca elevation
R: renal dysfunction
A: anaemia
B: bone disease

Hx
bone pain
anaemia S&S —- fatigue
thrombocytopenia & hyperviscosity —- bleeding, bruising, headache, blurred vision
abnormal Ab — recurrent infection
hyperCa — bones, groans, stones, moans
+/- SC compression

PE
anaemia — pallor
diaphoresis
carpal tunnel syndrome – sec to protein disposition in hands
peripheral neuropathy
hepatosplenomegaly
bony tenderness
SC compression