Haematology

Question 1

Anaemia of chronic disease

Answer 1

Def: form of anaemia
Commonest form in hospital patients, second commonest ww

Due to:

1) Dysfunctional erythropoeisis
2) Cytokine-induced shortening of RBC survival
3) Decrease production and response to EPO

Causes
Chronic infection
Vasculitis
Rheumatoid
Malignacy 
Renal failure

Treatment
Underlying cause
EPO

Question 2

Iron deficient anaemia

Answer 2

Def: anaemia refers to a Hb conc. <135g/L men, and <115g/L women

Very common (14% of menstruating women)

Causes

1) Blood loss - menstruation, upper and lower GI tract bleed
2) Poor diet - usually in children
3) Malabsorption - coeliac
4) Hookworm (most common in the tropics)

Symptoms - see anaemia 
Signs
Koilonychia (spooning)
Atrophic glossitis 
Angular stomatitis
Post-cricoid webs (in Plummer-Vinson syndrome - v.rare)

Tests
FBC
Blood film - microcytic hypochromic RBCs, anisocytosis (abnormality in size) and poikilocytosis (abnormality in shape)
Iron markers - NB ferritin decreases (serum iron decrease and total iron binding cap TIBC increases) but becasue this is an acute phase protein it changes with inflammation. Therefore transferritin increase is a more reliable marker.

Refer to gastroscopy and colonoscopy

Treat with iron suppliments - 200mg/8h ferrous sulphate
NB. Compliance, SE - black stool, nausea, diarrhoea, constipation