Immuno: Malabsorption CPC Pt.1

Question 1

List three causes of microcytic anaemia.

Answer 1

• Iron deficiency
• Thalassaemia trait
• Anaemia of a chronic disease

Question 2

What is anisopoikilocytosis and which type of anaemia is it associated with?

Answer 2

• Variations in size (aniso-) and shape (poikilo-) of cells
• Associated with iron deficiency anaemia (and thalassaemia trait to a lesser degree)

Question 3

What are tear drop cells and elliptocytes associated with?

Answer 3

• Tear drop cell (darcocyte) - myelofibrosis
• Elliptocyte - hereditary elliptocytosis, iron deficiency anaemia

Question 4

What is basophilic stippling? List some causes.

Answer 4

Basophilic appearance of red blood cells caused by the presence of aggregated ribosomal material

• Lead poisoning
• Beta-thalassaemia trait
• Alcoholism
• Sidroblastic anaemia

Question 5

Which condition do hypersegmented neutrophils tend to be present in?

Answer 5

Megaloblastic anaemia - reflects impaired DNA synthesis

Hypersegmented is >5 segments

Question 6

List some causes of megaloblastic anaemia.

Answer 6

• B12 deficiency
• Folate deficiency
• Drugs (nitrous oxide, valproate, chemotherapy)

Question 7

In which conditions might you see target cells (codocytes)?

Answer 7

• Iron deficiency
• Thalassaemia
• Hyposplenism
• Liver disease

NOTE: target cells have a high SA: V ratio

Question 8

What are Howell-Jolly bodies? Which condition are they associated with?

Answer 8

• Nuclear remnants present within red blood cells
• Present in hyposplenism

Target cells and Howell-Jolly bodies = hyposplenism

Question 9

List some causes of iron deficiency.

Answer 9

• Blood loss (major cause)
• Dietary deficiency
• Malabsorption

Can occur in combination

Question 10

List some causes of B12 and folate deficiency.

Answer 10

• Dietary deficiency
• Malabsorption
• Pernicious anaemia (B12 only)

Question 11

List some causes of hyposplenism.

Answer 11

Absent spleen

• Therapeutic
• Trauma

Poorly-functioning spleen

• Inflammatory bowel disease
• Coeliac disease
• Sickle cell disease
• SLE

Question 12

Why ALP is raised in bone turnover?

Answer 12

Released by active osteoblasts

Question 13

What are some causes of vitamin D deficiency?

Answer 13

• Lack of sunlight
• Dietary deficiency
• Malabsorption

Question 14

Which deficiencies are typically seen in Coeliac disease?

Answer 14

• Iron
• B12
• Folate
• Fat
• Calcium

Question 15

Which deficiencies are typically seen in Crohn’s disease?

Answer 15

• B12
• Bile salts
• Iron (from bleeding rather than malabsorption)

Affecting absorption in the terminal ileum

Question 16

Which deficiencies are typically seen in pancreatic disease?

Answer 16

• Fat
• Calcium
• B12

Question 17

Which investigations are typically performed in Coeliac disease?

Answer 17

• CRP and ESR
• Serological tests - anti-tTg
• Upper GI endoscopy and duodenal biopsy (GOLD STANDARD)

Question 18

Which HLA alleles are particularly common in patients with coeliac disease?

Answer 18

• HLA-DQ2 (90%)
• HLA-DQ8