Lecture 5: Clinical approach to patient with anaemia

Question 1

2 broad types of anaemia

Answer 1

1. Physiological

2. Morphological

Question 2

causes of impaired production of RBCs?

Answer 2

• Deficiency of essential substances
• genetic defects e.g thalassaemia
• failure in bone marrow

Question 3

Reduced RBC survival?

Answer 3

• Blood loss

- haemolysis

Question 4

Investigation for low haemoglobin?

Answer 4

• Appearence: use MCV, average Hb conc, and blood film count

- Red cell count

Question 5

Reticulocyte count?

Answer 5

• Way of determining if Bone marrow is responding low Hb

- Non-invasive

Question 6

Microcytic hypochromic anaemia?

Answer 6

• iron deficiency
• chronic illness
• genetic: thalassaemia

Things that result in less Hb

Question 7

Diagnosis of iron deficiency?

Answer 7

• Measure serum iron, iron binding capacity (transferrin) and iron saturation
• Measure serum ferritin
• Rarely examine iron stores in bone marrow

Question 8

Serum iron and transferrin results of iron studies in iron deficiency, anaemia of chronic disorders and iron overload?

Answer 8

• Iron deficiency have decreased serum iron and increased serum transferrin (compensation of body)
• Anaemia of chronic disorders have normal iron but decreased transferrin
• Iron overload have too much serum iron but no transferrin

Question 9

Causes of iron deficiency

Answer 9

• Diet (common in children)
• Malabsorption
• Increased demands
• Chronic blood loss (common in males and post menopause f.)

Question 10

Treatment for Iron deficiency?

Answer 10

-Iron replacement therapy (note that this can result in dimorphic results)

Question 11

Results of blood tests for people with anaemia of chronic inflammation?

Answer 11

• Mild anaemia
• normochromic or mildly hypochromic
• Raised ferritin
• Normal Fe
• Low transferrin (TIBE)
• normal saturation

Question 12

Causes of macrocytic anaemia?

Answer 12

• B12 or folate deficiency (megaloblastic anaemia)
• Liver disease
• Alcohol
• Primary bone marrow disorders
• Hypothyroidism

Question 13

B12 and folate deficiency?

Answer 13

• Impaired DNA synthesis
• May affect all cell lineages if severe
• diagnosis measure serum levels
• Pernicious anaemia

Question 14

Signs of haemolytic anaemia?

Answer 14

• Mild jaundice
• Increase in spleen size
• Raised reticulocyte count