microcytic anaemia

Question 1

what questions should you ask a female presenting with fatigue?

Answer 1

Menstrual periods? GI issues? diet? infections? bleeding? medications? operations?

Question 2

How can the mucosa change in anaemia?

Answer 2

become pale

Question 3

what is MCV?

Answer 3

Mean cell volume. This is for the size of the red blood cells

Question 4

In MCV what is the size of the RBC often compared to?

Answer 4

A lymphocyte

Question 5

what is microcytosis?

Answer 5

A small RBC

Question 6

what is the most common cause of microcytic anaemia?

Answer 6

iron deficiency

Question 7

what is macrocytosis?

Answer 7

A large RBC

Question 8

What is hypochromia?

Answer 8

The RBC are paler than normal

Question 9

What is an ellipotocyte?

Answer 9

A cell shaped liked a pencil. Seen in iron deficiency

Question 10

what is the difference in pencil cells seen in iron deficiency compared to those seen in sickle cell?

Answer 10

Sickle Cell; the pencil cells won’t be pale on the inside

Iron deficiency microcytic anaemia; pencil cells will be pale on the inside

Question 11

what is the reticulocyte count?

Answer 11

The number of immature red blood cells.

Question 12

if the anaemia is due to a problem in the bone marrow will the retiiculocyte number be higher or lower?

Answer 12

Lower

Question 13

If the anaemia is due to blood loss will the reticulocyte be higher or lower?

Answer 13

High as the body is trying to make more

Question 14

If anaemia is due to low iron will the reticulocyte count be higher or lower?

Answer 14

Lower

Question 15

What is the role of MCV when looking at anaemia?

Answer 15

to determine if it’s microcytic or macrocytic as this can help with cause

Question 16

what is the WHO definition for anaemia?

Answer 16

Anaemia is a condition in which the number of red blood cells is insufficient to meet the bodies physiological needs

Question 17

What is the main change in the blood seen in anaemia?

Answer 17

reduction in haemoglobin number

Question 18

what is needed for normal erythropoiesis?

Answer 18

Vitamin B12
folate acid
Iron

Question 19

What is haemocrit?

Answer 19

Shortened to Hct

Percentage of blood as RBC

Question 20

What is MCH?

Answer 20

This is the average haemoglobin content of a RBC.

Question 21

what is MCHC?

Answer 21

calculated measure of haemoglobin concentration in given red blood cells (takes into account conc)

Question 22

what is RDW?

Answer 22

the range of deviation around RBC size

Question 23

what are howell jolly bodies?

Answer 23

normally during maturation of RBC in the bone marrow they expel their nuclei this is where a small proportion of DNA still remains.

Question 24

in iron deficient anaemia how will the total iron binding capacity cahnge?

Answer 24

it will increase because you’re low on iron so you’re capacity to bind it will be increased

Question 25

how will ferritin change in iron deficient anaemia?

Answer 25

often goes down | note: this is unreliable because it's an acute phase protein

Question 26

in terms of reticulocyte count, what is the appropriate response from the bone marrow for anaemia?

Answer 26

to increase reticulocyte count as the body wants to increase amount of RBC

Question 27

what are two types of anaemia that present with high reticulocyte count?

Answer 27

blood loss | haemolysis

Question 28

what types of anaemia present with a low reticulocyte count?

Answer 28

Macrocytic Microcytic Normocytic

Question 29

what are causes of microcytic anaemia?

Answer 29

``` iron deficiency thalasaemmia lead ACD sideroblastic anaemia ```

Question 30

what are causes of normocytic anaemia?

Answer 30

BM invasion, low EPO

Question 31

what are causes of macrocytic anaemia?

Answer 31

Megaloblastic: B12/ Folate deficiency Medications Non-megaloblastic: hypoplasia

Question 32

What are causes of macrocytic anaemia?

Answer 32

``` b12 deficiency folate deficiency myelodysplasia drugs liver disease alcohol hypothyroidism ```

Question 33

what is sideroblastic anaemia?

Answer 33

A rare congenital type which is X linked.

Question 34

what foods are rich in iron?

Answer 34

``` Meats (especially red) Seafood Vege: spinach, broccoli, kale breads and cereal fruit: prunes, watermelon ```

Question 35

where in the body is iron absorbed?

Answer 35

Duodenum via enterocytes

Question 36

how do iron ions circulate?

Answer 36

in the plasma bound to transferrin

Question 37

what is iron stored as?

Answer 37

ferritin

Question 38

Other than for red blood cells where else is iron found?

Answer 38

hepatocytes, reticuloendothelial macrophages

Question 39

what is the role of reticuloendothelial macrophages?

Answer 39

They ingest old red blood cells, catabolise the haemoglobin and take the iron for reuse

Question 40

what is the average amount of iron loss per day?

Answer 40

1-2mg

Question 41

how does hepcidin affect iron regulation?

Answer 41

it decreases iron transfer from the duodenum into the blood

Question 42

what is one of the main causes of juvenille haemochromatosis?

Answer 42

mutations in hepcidin causing iron overload by increased absorption

Question 43

what will happen to ferritin and transferrin in iron deficiency?

Answer 43

``` reduced ferritin (iron stores) increased transferrin ```

Question 44

what is transferrin saturation?

Answer 44

the ratio of serum iron and total binding capacity

Question 45

what does transferrin saturation tell you?

Answer 45

the percentage of transferrin binding sites that have been occupied by iron

Question 46

is serum iron reliable as an iron study?

Answer 46

No because it varies throughout the day

Question 47

why is ferritin not always reliable?

Answer 47

its an acute phase protein so will increase with inflammation

Question 48

what does total iron binding capacity measure?

Answer 48

the capacity of transferrin to bind iron

Question 49

why can coeliac disease cause iron deficiency?

Answer 49

because it means less iron is absorbed.

Question 50

what parasite is known to cause iron deficiency?

Answer 50

Hookwork

Question 51

what are the lab results seen in iron deficiency anaemia?

Answer 51

Low ferritin low transferrin saturation high total iron binding capacity low serum iron

Question 52

what vitamin can help iron absorption?

Answer 52

Vitamin C

Question 53

what things decrease iron absorption?

Answer 53

Tea Phylates in cereal calcium

Question 54

what are signs and symptoms of anaemia?

Answer 54

lethargy, malaise, exertional dyspnoea, fatigue, pallor, tachycardia

Question 55

what signs and symptoms are specifically seen in iron deficient anaemia?

Answer 55

abdominal discomfort, epigastric and central pain, menorrhagia, angular stomatitis, atrophic glossitis, koilonychia