Lecture 5 - Anaemia

Question 1

Definitions of anaemia

Answer 1

• haemoglobin lower than normal age and sex of patient

- high at birth then decreases, then increases again

Question 2

What are the two Physiological classification of anaemia?

what are they caused by?

Why do you sometimes get jaundice with haemolysis

Answer 2

Ineffective production

• Deficiency of substances essential for red cell production - iron, b12, folate
• genetic defect in production e.g thalassaemia
• failure of bone marrow - e.g leukaemia ect.

Impaired red cell survival

• blood loss e.g surgery, trauma
• Haemolysis - destruction of rbcs (sometiems see jaundice - in eyes- haem broekn down, more bilirubin )

Question 3

When classificying anaemie with Morphologic approach,

what are some measurements that are used ?

Answer 3

Haemoglobin - g/L
Red cell count
Haematocrit (packed cell volume)
Red cell absolute values - mean cell volume, mean cell hb conc

other helpful investigations

• WBC, platelet count
• Reticulocyte count
• examination of blood film
• bone marrow examination

Question 4

Microcytic hypochromic anaemia

• symptoms
• causes
• diagnosis

Answer 4

Microcytic hypochromic anaemia

• iron deficiencey
• chronic illness - iron block( locked down, cannot be used)
• genetic - thalassaemia (cannot make the globin chains correctly, is genetic)

Pale cells, smaller

• measure serum iron, iron binding capacity, iron saturation
• measure serum ferritin
• examine iron stores in bone marrow

(look at iron studies diagram)
Iron deficiency - low iron, high saturation low SF

anaemia of chronic disease - low iron, normal saturation, however less saturation, and normal SF
(cannot get the iron to make the rbcs - gets stuck in macrophages)

haemocromatosis - high iron, fully saturated, high SF

treatment - give patient iron

Question 5

Causes of iron deficiencey

Answer 5

Diet - vegeterian
Malabsorption - proximal small bowel
Increased demands - pregnancy
Chornic blodo loss - periods, gi (e.g colorectal cancer)

Question 6

macrocytic anaemia/ megaloblastic anaemia

Answer 6

B12 or folate deficiencey (megaloblastic anaemia) - interferes with DNA synthesis
-liver disease

• can get abnormal white blood cells
• measure serum b12, folate
• need to determine cause of low vit B12 or folate

Question 7

causes of low b12 and folate

Answer 7

vegans
malabsorption, immune, terminal ileum disease

-gastrosectomy, immune (pernicious anaemia), terminal ileum disease

folate - diets - lack of vegetables, malabsorption - coeliac, increased demands - pregnancy

Question 8

what is haemolytic anaemia ?

what are the 3 main causes?

what are the 3 main symptoms?

Answer 8

• shortened survival of red cells
• intrinsic defect in red cell - (inherited mutation)
• Environmental or extrinsic - autoimmune destruction of red cells
• get increased red cell destruction (at rate liver cannot handle so get more bilirubin) - anaemia, mild jaundice, increased spleen size
• measure reticulocyte count - and will have increased numnber