HAEMATOLOGY

Question 1

What is serum ferritin a measure of?

Answer 1

Ferritin is an iron-protein complex found in most tissues, but particularly the bone marrow and reticuloendothelial system.

Serum ferritin is a measure of TOTAL BODY STORES of iron.

The body stores are often low in patients with iron deficiency anaemia.

Ferritin is an acute phase protein so may be raised in inflammatory or malignant disease.

Question 2

In iron deficiency anaemia, what are the MCV and MCHC likely to be? Raised or lowered?

Answer 2

MCV is LOW (microcytic anaemia)

MCHC is low (mean corpuscular haemoglobin)

Question 3

In a megaloblastic anaemia, if you’re not sure whether it’s B12 or folate deficiency, what are you likely to recommend?

Answer 3

Schillings test- it detects whether you are absorbing vitamin B12
Positive if its B12 deficient anaemia
Negative if its folate deficient anaemia

Question 4

From which part of the gut is iron mainly absorbed?

Answer 4

DUODENUM

Question 5

What is the role of haemoglobin in the body?

Answer 5

Transports oxygen around the body.

Aneamia is characterised by a reduced concentration of haemoglobin or red blood cells in the blood

Question 6

Why can we see low potassium when treating anaemias?

Answer 6

As K+ is required for the production of new red blood cells.

Question 7

Do iron-deficient anaemias result in a high or low MCV? Is it microcytic or macrocytic?

Answer 7

LOW MCV
Microcytic anaemia
Microcytic anaemias result from deficient or defective heme or globin synthesis. Usually caused by iron deficiency and thalassemias (a blood disorder).

Question 8

What kind of anaemia (microcytic or macrocytic/megaloblastic) do vitamin B12/ folate deficient anaemias result in? Why?

Answer 8

MACROCYTIC/MEGALOBLASTIC
Larger cell size/ higher MCV
Caused by impaired DNA synthesis- Vitamin B12 and folic acid required for correct synthesis, deficiency leads to deformity.

Question 9

In microcytic anaemia, MCV is usually

Answer 9

MCV <80 is classed as MICROCYTIC (Iron deficient)

Question 10

Macrocytic anaemias have RBCs with a MCV of >____?

Answer 10

MCV over 100 is MACROCYTIC (B12 and folate deficient)

Question 11

What MCV is classed as Normocytic?

Answer 11

MCV of 80-100= Normocytic

Question 12

Normal range for haemoglobin in males?

Answer 12

13- 17 g/dL (130-170g/L)

Question 13

Normal range for haemoglobin in females?

Answer 13

12- 15 g/dL (120- 150 g/L)

Question 14

What is Mean cell haemoglobin concentration (MCHC)? What is its normal range?

Answer 14

MCHC stands for mean corpuscular (cell) hemoglobin concentration and it is the average concentration of haemoglobin in the red blood cells.

range: 31.5 – 34.5g/dL

Question 15

What is the Haematocrit?

Answer 15

Measurement of the proportion of blood that is made up of red blood cells/ volume of red blood cells

Question 16

Where is serum ferritin made? Where is it stored?

Answer 16

Made in the bone marrow. Stored in the liver

Question 17

Why is TIBC (total iron binding capacity) HIGH in iron deficiency anaemia?

Answer 17

Less iron in the body
Therefore there are more iron binding site available
TIBC therefore goes UP in anaemia (only result that goes up)

Question 18

Microcytic anaemias:
MCV: LOW/HIGH?
MCH: LOW/ HIGH?
MCHC: LOW/ HIGH?
Serum Iron: LOW/ HIGH?
Serum Ferritin: LOW/ HIGH?
TIBC: LOW/ HIGH?

Answer 18

MCV: LOW
MCH: LOW 
MCHC: LOW
Serum Iron: LOW
Serum ferritin: LOW
TIBC: HIGH (as more binding sites free as iron is low)

Remember only thing that is high in MICROcytic anaemias is TIBC

Question 19

What is MCH? Whats the difference between MCH and MCHC?

Answer 19

MCH= Mean corpuscular hemoglobin (MCH), or “mean cell hemoglobin” (MCH) is the average mass of hemoglobin per red blood cell in a sample of blood. MCHC is the mean cell hemoglobin concentration- these two readings go hand in hand.

They are LOW in Microcytic anaemias (Low haemoglobin, low iron)

They are Normal/ high in Macrocytic/ megaloblastic anaemias- we don’t have a problem with iron here, but haemoglobin is usually also low.

Question 20

All anaemias are a result of low haemoglobin.
MCV closely parallels the MCH.
Which type of anaemia displays low MCH and MCHC?

Which one displays high MCH and normal MCHC?

Answer 20

Both macrocytic and microcytic anaemias are a result of low haemoglobin.

In microcytic aneamia, iron is low. MCV is low. This results in low MCH and MCHC.

In macrocytic anaemia, MCV is high, MCH is therefore high and MCHC is normal

Question 21

What causes anemia in chronic kidney disease?

Answer 21

Lack of production of the hormone ERYTHROPOETIN

As a result, the bone marrow makes fewer red blood cells, causing anemia. Can give patients with End stage renal failure erythropoetin injections