Introduction to anaemia

Question 1

What colour do reticulocytes stain and why?

Answer 1

Stain purple/red because still have remnants of protein making machinery

-blood film appears ‘polychromatic’

Question 2

What does a blood film look at?

Answer 2

Looks at cellular morphology

Question 3

If MCV is low, you should consider problems with ____

Answer 3

Haemoglobinisation

Question 4

If MCV is high, you should consider problems with ____

Answer 4

Maturation

Question 5

Where does haemoglobin synthesis occur?

Answer 5

Cytsoplasm

Question 6

What makes up haem?

Answer 6

• porphyrin ring

- iron (Fe2+)

Question 7

Why is iron essential?

Answer 7

Oxygen transport: Hb, myoglobin

Electron transport: mitochondrial production of ATP

Question 8

Roughly how many mg of iron do we absorb per day?

Answer 8

1mg

Question 9

Roughly how many mg of iron are present in plasma?

Answer 9

4mg

Question 10

Roughly how many mg of iron are stored in macrophages?

Answer 10

400mg

Question 11

Roughly how many mg of iron in red cell haemoglobin (in total in body)

Answer 11

2500mg

= most of the iron is in haemoglobin!

Question 12

How is iron stored in liver?

Answer 12

Ferritin

Question 13

How is iron transported?

Answer 13

Transferrin

Question 14

Tests for functional iron?

Answer 14

Measure haemoglobin

Question 15

Tests for transported iron?

Answer 15

Measure serum iron, transferrin and transferring saturation

Question 16

How do you measure storage iron?

Answer 16

Serum ferritin

Question 17

Hb levels for anaemia? (g/l)

Answer 17

Adults:
Males:

Question 18

What does % saturation of transferrin with iron measure?

Answer 18

% saturation of transferrin with iron measures IRON SUPPLY

Question 19

Large INTRACELLULAR protein

Answer 19

Ferritin

because its intracellular, its only going to be present in teeny amounts in the serum

Question 20

What does a low ferritin mean?

Answer 20

Iron deficiency

Question 21

How can iron deficiency be confirmed?

Answer 21

Iron deficiency can be confirmed by a combination of a

-microcytic hypochromic anaemia (decreased functional iron)
AND
-reduced storage iron (low serum ferritin)

Question 22

Causes of iron deficiency

Answer 22

• not eating enough
• Losing too much - blood loss (usually GI if occult)
• not absorbing enough (coeliac disease, achlorhydria)

Question 23

Causes of chronic blood loss

Answer 23

• menorrhagia
• GI (tumours, ulcers, NSAIDS)
• haematuria

Question 24

Consequences of negative iron balance?

Answer 24

• exhaustion of iron stores
• iron deficient erythropoiesis (falling MCV)
• Anaemia
• Epithelial changes (skin, koilonychia)