Haematology

Question 1

Name some causes of microcytic anaemia

Answer 1

Thalassaemia
Anaemia of chronic disease
Iron-deficiency anaemia
Lead poisoning
Sideroblastic anaemia

Question 2

Name some causes of normocytic anaemia

Answer 2

Blood loss
Bone marrow failure
Pregnancy
Hypothyroidism
Haemolysis (normocytic or macrocytic)
Anaemia of chronic disease (normocytic or microcytic)

Question 3

Name some symptoms of anaemia

Answer 3

Dyspnoea
Palpitations
Fatigue
Headache
Tinnitus
Anorexia

Question 4

Name some signs of anaemia

Answer 4

Pale conjunctiva
Tachycardia
Hypotension
Murmurs

Question 5

Name some causes of macrocytic anaemia

Answer 5

B12 or folate deficiency
Alcohol excess/liver disease
Reticulocytosis
Marrow infiltration
Antifolate drugs e.g. Phenytoin
Myelodysplastic syndromes

Question 6

What is haemolytic anaemia?

Answer 6

When there is premature breakdown of RBCs but the bone marrow can’t produce enough RBC to compensate. Can be normocytic or macrocytic

Question 7

What is iron-deficiency anaemia?

Answer 7

When there is insufficient iron to produce enough Hb

Question 8

What is the definition of ‘anaemia’?

Answer 8

A low Hb concentration, may be due to either a low red cell mass or increased plasma volume.

Question 9

Name some causes of iron deficiency anaemia

Answer 9

Blood loss e.g. Menorrhagia or GI bleeding
Poor diet
Malabsorption of iron e.g. Coeliac’s

Question 10

What sign present in the nails may indicate iron deficiency?

Answer 10

Koilonychia, spooning of the nails

Question 11

What is the normal treatment for iron deficiency anaemia?

Answer 11

Treat the cause

Give oral iron e.g. Ferrous sulphate

Question 12

Name some conditions where patients can get anaemia of chronic disease

Answer 12

Chronic infection
Vasculitis
Rheumatoid arthritis
Malignancy
Renal failure

Question 13

What is anaemia of chronic disease?

Answer 13

Anaemia that occurs in people with a chronic disease, can occur due to 3 possible methods:

• poor use of iron in erythropoiesis
• cytokine-induced shortening of RBC survival
• decreased production of EPO

Question 14

What are Howell-Jolly Bodies and when are you likely to see them?

Answer 14

DNA nuclear remnants in RBC, which would normally be removed by the spleen, seen in post-splenectomy patients and in hyposplenism

Question 15

What is megaloblastic anaemia?

Answer 15

A type of macrocytic anaemia where the cell has delayed nuclear maturation compared to the cytoplasm. This occurs with B12 and folate deficiency as both B12 and folate are required for DNA synthesis

Question 16

What is the Coombs test? What is the difference between direct and indirect?

Answer 16

Direct - detects antibodies stuck to the surfaces of RBC.
Indirect - detects antibodies that are floating freely in the blood, used in prenatal testing and before blood transfusion.

Question 17

Why is reticulocyte count important on a FBC?

Answer 17

Gives you an indication of how much erythropoiesis is occurring and whether the bone marrow is working.

Question 18

How can you check a patient’s iron levels?

Answer 18

Either serum iron or ferritin (although always check CRP with ferritin as ferritin can also be elevated with inflammation/infection).

Question 19

What is a dimorphic blood film?

Answer 19

When there are 2 different populations of RBC - this is often seen after blood transfusions or starting iron tablets as more normal RBC are suddenly produced with a normal width - leads to an increased red cell distribution width (RDW).

Question 20

What are some side effects of iron tablets/ferrous sulphate?

Answer 20

GI side-effects including dark faeces, constipation or diarrhoea.

Question 21

When would you see Howell-Jolly Bodies and what are they?

Answer 21

RBC with some nuclear remnants, seen in patients with hyposplenism.

Question 22

When would you get a physiological macrocytic anaemia?

Answer 22

Pregnancy

Neonates

Question 23

What is pernicious anaemia?

Answer 23

Type of megaloblastic anaemia where the body isn’t able to absorb enough vitamin B12 due to a lack of intrinsic factor in stomach secretions.

Question 24

What bloods would be included in a confusion screen?

Answer 24

FBC (WCC for signs of infection)
U+Es (deranged electrolytes, especially sodium can cause confusion)
LFTs (liver failure can cause confusion)
INR
TFTs
Calcium (hypercalcaemia often causes confusion/delirium)
B12 + folate
Glucose (hypoglycaemia can cause confusion)

Question 25

What does MDS stand for and what is it?

Answer 25

Myelodysplastic syndrome - a group of cancers where immature blood cells in the bone marrow do not mature properly.

Question 26

What is the normal range for MCV (mean corpuscular volume)? Why is it important to know whether the value is in range?

Answer 26

80-96fL/red cell in adults
If the patient is anaemic then the MCV can tell you whether it is macrocytic, normocytic or microcytic - thus helping to find out the cause of the anaemia.

Question 27

What is a vaso-occlusive crisis/sickle cell crisis?

Answer 27

Painful complication of sickle cell disease where there is microvascular occlusion, can lead to occlusion of bone marrow, mesenteric ischaemia or cerebral infarction.

Question 28

Why is splenic infarction a complication of sickle cell anaemia?

Answer 28

Due to micro-vascular occlusion, a common complication of sickle cell disease.

Question 29

What type of haemoglobin is present in sickle cell disease?

Answer 29

HbS - when HbS is deoxygenated it’s undergoes polymerisation to form a polymer, this causes an alteration in the RBC membrane and leads to the characteristic sickle shape.