Haematology

Question 1

Anaemia flow chart

Answer 1

Memorise slide 7 on anaemia lecture 1

Question 2

How long does it take for reticulocytes to mature

Answer 2

24 hours

Question 3

What are reticulocytes used to monitor

Answer 3

Recovery after treatment

Question 4

What does the reticulocyte count represent?

Answer 4

BM turnover

Question 5

Causes of low reticulocyte count - hypoproliferative type

Answer 5

▪ Lack of nutrients (Iron, Folic acid, Vit B12)
▪ Chronic diseases
▪ Bone marrow disorder (aplastic anaemia, leukemia)
▪ Bone marrow suppression (chemotherapy)

Question 6

Cause of high reticulocyte count - hyperproliferative

Answer 6

▪ Hemolytic anaemia

▪ Chronic Blood loss

Question 7

Difference between central and peripheral anemia

Answer 7

Central : BM defect

Peripheral: dec. prod, inc. destruction, blood loss

Question 8

What is the use of flow cytometry?

Answer 8

of Peripheral blood and Bone marrow,
determines the type of cell based on the receptors and markers
presented on it’s surface.

Question 9

Difference between plasma and serum

Answer 9

Serum is after you centrifuge the blood and all coagulation factors have been removed

Question 10

Algorithm in the case of microcytic anemia

Answer 10

memorise slide 22 of anemia 1 lecture

Question 11

What is the most important marker for the diagnosis of IDA? What is its signficance?

Answer 11

Ferritin

• LOW = always IDA
• NORMAL = does not exclude iron deficiency
• INCREASED= ? Due to the fact that Ferritin is an acute phase protein, it can be increased in chronic
infections without excluding iron deficiency . In these conditions ferritin loses its importance.

Question 12

What is the most important caue of iron def in premenopausal women

Answer 12

Uterine Fibroma : benign tumors that usually lead to heavy bleedings
(menstrual disorders such as menorrhagia)

• Endometrial polyp : is a mass in the inner lining of the uterus
These represent the most frequent causes of iron deficiency in
premenopausal women

Question 13

Site of iron folte an B12 absorption

Answer 13

Dude Is Just Feeling Ill Bro

Question 14

Types of iron

Answer 14

►Haem iron (animal origin): Fe+2
 one stage absorption
• better absorption (20-30%)
• Endocytosis with ΗCP-1 (Heme carrier protein-1)

►Non-Haem iron (plant origin): Fe+3
 two stage absorption
• It is necessary the transformation from Fe+3
to Fe+2, in
low↓ pH and in presence of
• a ferrireductase: Dcytb (Duodenal cytochrome B),
• with the transporter DMT-1 (Divalent Metals
Transporter 1)

Question 15

Where is iron stored and what is stored iron evaluated by

Answer 15

1. Heptocytes
2. Siderblasts
3. Reticuloendothelial cells

• Evaluated by ferritin

Question 16

What is pica

Answer 16

Where people eat non edible things due to severe IDA

Question 17

What is plummer vinson syndrome

Answer 17

►Syderopenic dysphagia is a rare disease
characterized by difficulty in swallowing due to
iron deficiency that leads to
1. Glossitis
2. Angular Cheilitis
3. Esophageal web
►It is a premalignant condition
because can lead t o squamous cell carcinoma

Question 18

Tx of plummer vinson sydrome

Answer 18

• esophageal dilatation

* iron

Question 19

Lab features of IDA

Answer 19

►Hb ↓, Htc ↓
►MCV ↓, MCH ↓, MCHC ↓
►RDW ↑ , RBCs ↓
►Fe ↓,
►TIBC ↑,
►Transferrin satur.=
𝐹𝑒
𝑇𝐼𝐵𝐶
X 100 ↓
►Ferritin ↓
►Soluble Transf.Receptor sTfR↑
►Log (sTfR /serum ferritin) >2

Question 20

What is the transferrin receptor affected by

Answer 20

►Affected by the Iron levels:
• It is increased ONLY in Iron deficiency (IDA)
►Not affected by inflammation
• It is normal in Anaemia of chronic disease (ACD)
• very good indicator for differential diagnosis
between IDA and ACD

Question 21

What is the significance of soluble transferrin receptor

Answer 21

 Soluble Transferrin receptor (sTfR) is the
truncated form of the TfR that is liberated
in the serum.
 Its serum levels reflect the number of TfR
expressed on cell

Question 22

Stages of IDA

Answer 22

See slides 41-44

Question 23

Drugs that induce macrocytosis

Answer 23

Low Vit. B12
 Omeprazole
 Metformin
 N2O

Low folic acid

• methotrexate, hydrea, trimothoprim
• Phenytoin

Normal Vit b12 and folic acid
 Zidovudine
 Azathioprine
 Cytotoxics

Question 24

Causes of asynchrony between the nucleus and cytoplasm

Answer 24

► Ineffective DNA synthesis
in nucleus  immature
► Normal RNA synthesis
in cytoplasm  mature