Intro to Anaemia

Question 1

What are the clinical signs of anaemia + cause?

Answer 1

Fatigue, weakness - reduced oxygen transport
Short of breath - reflex respiratory drive
Heart racing - reflex stimulation, palpitations
Pounding in head (increased cardiac output)
Pallor of mucus membranes
Feeling cold - peripheral circulation constricted

If + artery disease: angina, claudication, kidney dysfunction, confusion

Question 2

Name two causes of microcytic hypochromic anaemia

Answer 2

Iron deficiency, thalassaemias

Question 3

What will the blood film look like shortly after treatment of iron deficiency?

Answer 3

Double population (e.g. some small, underfilled cells, some normal in size + Hb content)

Question 4

What is thalassaemia?

Answer 4

When alpha or beta globin peptides are reduced/absent

Question 5

What are causes of megaloblastic anaemia? Outline pathogenesis.

Answer 5

Vitamin B12, folate deficiency. Both result in reduced synthesis of thymidine needed for DNA replication. S-phase of mitosis is slowed, therefore cells become larger than normal.

Question 6

What are some more obscure causes of macrocytic anaemia?

Answer 6

Chronic liver disease
Alcohol abuse
Reticulocytosis
Pregnancy
Normal neonates (physiologically normal)
Drugs e.g. chemo drugs that interfere with folate or B12 metabolism

Question 7

Why do we get anaemia in renal disease?

Answer 7

EPO deficiency!

Question 8

What causes normocytic normochromic anaemia?

Answer 8

Bleeding + replacement with fluids –> dilutional anaemia

Anaemia of chronic disease

Anaemia in renal disease (EPO down)

Anaemia in cancer (ACD + bleeding + reduced responsiveness to EPO)

Question 9

Outline the pathogenesis behind anaemia of chronic disease

Answer 9

Main mechanism: reduced iron avaliability, due to hepatic hepcidin (a peptide), which stops release of iron from stores and decreases iron absorption in the gut.

Phagocytosis of RBCs increased due to inflammation.

EPO production decreases + marrow less responsive.

Inflammatory cytokines can impair RBC proliferation.

Question 10

What do we seperate haemolytic anaemia into?

Answer 10

Acquired and inherited

Question 11

Name inherited causes of haemolytic anaemia

Answer 11

hereditary spherocytosis, G6PD deficiency, sickle cell anaemia, Hb E

Question 12

What are acquired causes of haemolytic anaemia?

Answer 12

autoimmune, blood group antibody (e.g. wrong transfusion), infection e.g. malaria, drugs, physical damage e.g. burns, trauma

Question 13

Anaemia of chronic disease vs anaemia of liver disease?

Answer 13

BOTH NORMOCYTIC, NORMOCHROMIC however…
CD - tends to microcytosis
Liver failure - tends to macrocytosis, cholesterol literally deposits on the RBCs

Question 14

What will reticulocytes be in the following conditions:
1) following large haemorrhage
2) Iron deficiency
3) Megaloblastic anaemia
4) Renal failure
5) Haemolytic anaemia

Answer 14

1) low-normal
2) low-normal
3) low-normal
4) low-normal
5) increased

Question 15

What is polychromasia?

Answer 15

e.g. more blue staining like reticulocytes, shows RBC production is increased e.g. haemolysis

Question 16

How is a reticulocyte count performed?

Answer 16

By staining RNA remnants in red cells and counting positively stained cells

Question 17

Features in the blood film of iron deficiency

Answer 17

Microcytic, hypochromic.

Target cells and pencil cells

Question 18

What happens if you treat thalassaemia with iron?

Answer 18

No effect. In fact, iron is normal or raised in thalassaemia.

Question 19

Why does anaemia of chronic disease fail to respond to iron therapy?

Answer 19

Through serum iron may be low, actual iron is high but HEPCIDIN from the liver is stopping release from stores. Need to treat underlying condition.

Question 20

What is the main store of iron?

Answer 20

Macrophages. (which release iron to transferrin, a transport protein)

Question 21

What is ESR?

Answer 21

Erythrocyte sedimentation rate, usually low as RBCs are -vely charged

Question 22

What is meant by rouleaux formation?

Answer 22

stacking of RBCs, signifies inflammation which makes RBC negative charge partially neutralised

Question 23

What are the main clotting proteins which increase ESR?

Answer 23

fibrinogen, immunoglobulins

Question 24

How to treat anaemia in renal disease?

Answer 24

EPO injections 3x weekly