intro to haematology and anaemia

Question 1

the hb ranges :
in nonpreg woman:
in men :
in pregnant women :
in sever anemia its:

Answer 1

• less than 12
• less than 13
• 11
• less than 7

Question 1

anemia refers to the reduction of —- due to disorder of globin or haem

Answer 1

hb

Question 2

causes of reduction of the bone marrow function:
1- —- of the bone marrow by anything that — the bone marrow as —- for priamry , infection , granulsomes
2- —- process which includes myelofibrosis can be primary of —-
2- bone marrow —- syndrome and conditions as :

Answer 2

• repalacemnt
• invaded
• cancer
• fibrotic
• secondary
• failure
• aplastic anamia and myeolodyplasia

Question 3

—– is a condition in which the number of rbc or their o2 carrying capacity is insufficient to meet their physiological needs which varies by —–

Answer 3

• anemia
• age sex smoking pregnant starts , altitude

Question 4

hemoglobin structure is a —- consisiting of — pairs of similar polypeptide chains called —–
each 4 chains is attached to — which is a complex of iron in — state and —– .
the majority of hb (96%) present in adults is — which has :

Answer 4

• tetramer
• 2 pairs
• globin chain
• team
• ferrous
• protoporphyrin
• hbA
• 2 alpha globin and 2 beta globin

Question 5

symptoms in anemia include:

Answer 5

• fainting and fatigue
• skin - yellow
• muscle -pain
• digestion- change in stool color
• respiratory - shortness of breath

Question 6

true or false:
anemia is a major global public health concern which has prevalence in India is 42% in women 15-59% and men 30% 15-59 years , it affects disportionalling women and girls globally due to iron deficency and inadequate access to health care

Answer 6

true

Question 7

the 2 classifications of anemia are;

Answer 7

1- morphological
2- phathological

Question 8

the full blood count includes :

Answer 8

• Platete count
• white blood cell count as: neutrophils basophils estinophils monocytes lymphocytes
• hb

Question 9

a morphological classification by which the mcv is less than 80fl and the major cause is menorrhagia

Answer 9

microcytic anemia

Question 10

a morphological classification when mcv is more than 100fl

Answer 10

macrocytic anemia

Question 11

a morphological classification where the mcv is between 80-100 fl

Answer 11

normocytic

Question 12

iron diffencuey anaemia and maneorrge , thalasemia , sideroblastic anemia are all under —-

Answer 12

microcytic anemia

Question 13

megaloblastic anemia as: b12 diffencuy m folate deficient ,
non megaloblastic as:
- liver Diases , myelodysplasia , hypothyroidism , haemolytic anemia , alcohol excess
all fall under:

Answer 13

microcytic anmeia

Question 14

anemia of chronic disease and aplastic anmeia , chronic kidney disease as EPO diffency fall under:

Answer 14

normocytic anemia

Question 15

mean corpuscular hb ( MCV ) or mean cell volume refers to the measure of the average — of the —-

Answer 15

volume of the rbc

Question 16

1-mean corpuscular hb refers to the average amount of — in each —
2- mean corpsularar hb concentration refers to the average ——- of — in inside a group of rbc which is ——
3- reticylaocyte are —– rbc larger than the mature ones and they have the ability to —– the MCV , they usually reside in the — but in the state of erythroid stress they are pushed into the — so they are ready to be mature which is why we see —- reticulocyte count in name as the bone marrow trees to compensate

Answer 16

• hb in each red ce;;
• avg koncentration of hb
• 31-37 g/dl
• immature rbc
• increase
• bone marrow
• high

Question 17

pathological causes of anaemia:
1- —- to make rbc which is a —- problem
2- lack of —– as:
3- increase — pf rbc due to :
4- increase — of rbc aka :
5- —- diseases

Answer 17

• failure , marrow
• heamaticnic as: b12 , folate m dietary deofocmey , malabsorption , loss
• loss , bleeding
• destruction , heamolysis
• chronic

Question 18

read:

Answer 18

1- history taking anaemia:
- diet history, chronic blood loss , heredity as sickle cell and thalesmia
- alcohol and renal disease
- chronic disease as rheumatoid arthritic
- history of systemic symptoms as: b symptoms which include: nigh sweats weight loss and itch
- recent travel
2- menorrhagia history taking:
* Detailed history
– Menarche
– Length of cycle and bleeding days
– Pads/tampons
– Soaks clothes
– Days off work/school
– Previous iron deficiency
– Other bleeding issues
* Be sensitive and professional
* Encourage self assessment
* Keep a diary
* Cultural and social norms
* Family norms can mask heavy periods
3- more detailed blood tests :
* Reticulocyte count
* Blood film
* ESR – old fashioned test not clinically useful
* B12 and folic acid
* Liver function – bilirubin
* Renal function
* EPO level
* Iron profile
* LDH, uric acid
* Hb electrophoresis if you suspect hereditary anaemia
* Bone marrow test
* Direct antibody test (DAT) used to be called Coombes test

Question 19

koilonchyia aka spoon nail and glossitis aka Plummer visons syndrom are seen in —-

Answer 19

severe iron defiency anemia

Question 19

iron deficiency anaemia causes — of blood as menaces , GI blood loss can cause celiac disease , h pylori infection
history of pica includes :

Answer 19

• loss of blood
• eating ice clay or starch

Question 20

causes of IDA includes:

Answer 20

• Dietary
• Malabsorption
  – Coeliac disease
  – Crohn’s disease
  – Intestinal resection
• Loss e.g.
  – GIT e.g. Duodenal or gastric ulcer, Ca colon
  – Menorrhagia
• Increased requirements requirement Childhood,
  Pregnancy

Question 21

treatment of IDA includes:

Answer 21

• Find out the underlying cause and manage that
  – Iron will continue to drop until this is addressed
  – Ulcer management
  – Menorrhagia management – OCP, coil, tranexamic acid
• Oral iron replacement
• IV iron replacement in cases where iron deficiency is
  severe (Hb <7) and oral iron is not tolerated or will not
  work fast enough
• Avoid blood transfusion if at all possible
• Only in cases where patient is severely symptomatic
  (e.g. coronary disease) or Hb < 5
• REMEMBER TO FOLLOW THE PATIENT UP!!!

Question 22

—–is a term used to describe disorders of impaired DNA synthesis in hematopoietic cells but affects all proliferating cells.
* Due to folic acid or vitamin B12 deficiency

Answer 22

megaloblastic anemia

Question 23

diagnosis of megablastic anaemia include :

Answer 23

Diagnosis-
* In addition to sx of anemia peripheral neuropathy,
paresthesias,
Seizures and dementia may found due to vit b12
deficiency
* On examination- Jaundice or splenomegaly
* Decreased vibratory and positional sense, ataxia,

Question 24

megaloblastic anemia include and increase in —– and —- while low ——-
other investigations include:

Answer 24

• MCV , MCH
• RBC , WBC , platelets only in severe cases
• other investigation includes : * Blood film – oval macrocytic red cells
  – Hypersegmented neutrophils
• LDH is raised
• Serum B12 and or folate reduced
• Normal B12 level 160-200ng/L folate 2-15ug/L)
• Serum methylmalonic acid (MMA) and homocysteine are
  elevated in B12 def, only HC is elevated in folate def –
  we don’t use these tests much in Ireland
• Antibodies to intrinsic factor

Question 25

the investigation of iron difiencey anemia include —-

Answer 25

• low hb mcv mch mchc
• reticloucyte count is normal or decreases
• iron ferritin decreased

Question 26

b12 is gained from — such as :
it combines w intrinstic factors which are secreted by gastric parietal cells
the b12 intrinsic factor complex are absorbed in —–

Answer 26

• diet as milk eggs meat
• terminal ileum

Question 27

lack of b12 which causes megaloblastic anaemia lead to :

Answer 27

pernicious anemia

Question 28

causes of b12 deficiency :

Answer 28

• Lack of B12 in diet
  – Main sources are liver, beef, sardines, nuts, wholegrain breads
• Inability to absorb B12
  – Pernicious anaemia which is due to antibodies to intrinsic factor
  or to the gastric parietal cell
  – Patient cannot absorb any oral B12
  – Must receive lifelong parenteral B12 replacement usually as
  intramuscular injections every 3 months
• Some patients with Coeliac disease also do not absorb
  B12 very well
• Conditions of the stomach that interfere with gastric
  parietal cells – e.g. surgery
• Conditions of the bowel that cause the terminal ileum to
  be damaged e.g. Crohn’s disease

Question 29

folate is absorbed in —- and — and the causes of folate deficiency may include:
treatment :

Answer 29

• duodenum and upper jejunum
  -diet , alcohol , drugs , malabsorption , increased requirements as preg lactation , haemolytic anaemia and chronic blood loss
• oral folic acid