Module 4.2 (Anaemia)

Question 1

What are the symptoms of anaemia?

Answer 1

• Fatigue „
• Tachycardia, palpitations „
• Pallor „
• Light-headedness, vertigo, and tinnitus „
• Angina „
• Other specific symptoms depending on cause of anaemia

Question 2

Anaemia lab readings for men and women

Answer 2

• Less than 130g/L for males „
• Less than 120g/L for females

Question 3

What are the types of anaemia?

Answer 3

1. Iron Deficiency Anaemia
2. Vitamin B12 Deficiency Anaemia
3. Folate Deficiency Anaemia
4. Other type of Anaemia(s)

Question 4

What is MCV? What does a low, normal or high MCV mean?

Answer 4

Average volume of the body’s red blood cells (Mean Corpuscular Volume)

• Low MCV (Microcytic cell) – iron deficiency anaemia or anaemia of chronic disease
• High MCV (Macrocytic cell) – B12 and/or folate deficiency anaemia
• Normal MCV – normocytic anaemia or concurrent iron and B12/folate anaemia

Question 5

What does a normal MCV with a large RDW indicate?

Answer 5

Indicates the presence of microcytes and macrocytes

Question 6

What is Pack Cell Volume (Haematocrit)? what does a high value or low value mean

Answer 6

Indicates the proportion of blood that is made up of cells

• PCV rises when the number of red blood cells increases or when the total blood volume is reduced
• PCV decrease in anaemia due to decrease in production of red blood cells or increase destruction of red blood cells

Question 7

What are some causes of iron deficiency anaemia?(microcytic anaemia)

Answer 7

• Microcytic anaemia (low MCV) –> confirm diagnosis with iron studies
• The primary cause of iron deficiency is blood loss

> May be not obvious

> Gastrointestinal blood loss most common

• Inadequate dietary intake is only rarely a cause with the exception of increased requirement (growth spurts, infants, pregnancy)

Question 8

In iron deficiency anaemia, answer the following low or high for the laboratory tests;

A) MCV

B) RDW

C) RBC

D) Serum iron

E) Total iron binding capacity (TIBC)

F) Transferrin

G) Transferrin saturation

H) Ferritin

Answer 8

A)

• Low

B)

• High

C)

• Low

D)

• Low

E)

• High

F)

• High

G)

• Low

H)

• Low

Question 9

How much daily iron required in

A) Adolescent males

B) Adolescent females

C) During pregnancy

Answer 9

A)

• 1.8mg

B)

• 2.4mg

C)

• 3-4 mg

Question 10

What are the S and S of Iron deficiency anaemia?

Answer 10

• Tired and listless „
• Pale, inelastic, and dry skin „
• Dry and often scanty hair „
• Erythema of the tongue, angular cheilitis, and glossitis „
• Pearly white or pale blue sclerae „
• Flattened and concave nails „
• Tachycardia, slight cardiomegaly

Question 11

What are some of the oral manifestations in severe IDA

Answer 11

• Bilateral angular cheilitis
• Pale coloured lips
• Smooth, bald and inflamed tongue: glossitis
• Craving for ice
• Pica: Eating dirt, paint

Question 12

Where is vitamin B12 found?

Answer 12

In foods of animal origin –> Meat, fish, liver, milk, cheese, eggs.

Cannot be synthesized by mammalian tissue – dietary intake or supplementation needed

Question 13

What is the autoimmune disease called where there is no intrinsic factor production and therefore puts a person at risk of developing B12 deficiency anaemia?

Answer 13

Pernicious anaemia

Question 14

What are some causes of Vitamin B12 deficiency anaemia?

Answer 14

• Alcoholism, elderly, vegan
• Post gastric surgery „
• IBD „
• Tapeworm infestation

Medications

• PPIs, H2 antagonist –> decrease absorption of vitamin B12

Defective transport

• Transcobalamin II deficiency –> decrease in transport of vitamin B12 to the liver.

Question 15

In vitamin B12 deficiency anaemia (macrocytic anaemia), indicate whether the following laboratory results will increase or decrease.

A) MCV

B) Vitamin B12

C) Methylmalonic acid (MMA)

D) Homocysteine

Answer 15

A)

• Increased

B)

• Decreased

C)

• Vitamin B12 promotes the conversion of methylmalonyl CoA (a form of MMA) to succinyl Coenzyme A
• Therefore MMA levels will rise if not enough Vit B12

D)

• Common amino acid in the blood
• Levels would rise

Question 16

What are the signs and symptoms of B12 deficiency anaemia?

Answer 16

• Pallor (pale appearance), slight jaundice
• Anorexia, mild weight loss, diarrhoea
• Difficulty in walking, loss of vibratory sense, incoordination of movements, sense of touch impaired
• Dyspnoea, palpitations, weakness, vertigo, tinnitus
• Personality and mood changes, irritability, memory disturbances, depression, phychosis
• Atrophic glossitis / sore tongue

Question 17

What are the sources of folic acid?

Answer 17

Found in plant and animal foods

• leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice

> The body’s folate reserves lasts for about 4 months

Question 18

What are the causes of folic acid deficiency anaemia? provide THREE different types

Answer 18

The body’s folate reserves lasts for about 4 months

• Alcoholism
• Nutritional deficiency

Inadequate intake from increased folic acid requirements

• Pregnancy
• Severe hemolysis

Inadequate absorption

• Crohn disease

Drug-induced interference with folic acid metabolism

• The action of DHFR blocked by methotrexate, trimethoprim
• Reduced folate absorption caused by sulfasalazine

Question 19

If a patient has both Vitamin B12 deficiency anaemia and Folate deficiency anaemia, which one to rule out first?

Answer 19

Rule out vitamin b12 deficiency anaemia first

• If FDA treated first, symptoms of vitamin b12 deficiency anaemia could be masked. Lead to irreversible neurological damage.

Question 20

S and S of folic acid deficiency anaemia?

Answer 20

Very similar to B12 deficiency except for neurological lesions

Question 21

What is anaemia of chronic disease (ACD)? How long does it take to develop?

Answer 21

• Moderate anaemia (Hb not less than 90 g/L)
• Also known as anaemia of inflammation

> Most common form of anaemia in the elderly (ACD & IDA can be concurrent)

• RBC size changes in elderly less marked in anaemia
• Develops after one or two months of sustained disease

Question 22

What are the main causes of ACD?

Answer 22

• Chronic infections „
• TB, lung abscess, subacute endocarditis „
• Non-infectious inflammatory diseases „
• Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) „
• Neoplastic disorders „

But does not include all chronic disease e.g. hypertension, diabetes, COPD are not accompanied by anaemia

Question 23

How to differentiate ACD from IDA through;

A) Transferrin

B) Ferritin

C) Cytokine levels

Answer 23

A)

​ACD: Reduced to normal

IDA: Increased

B)

ACD: Normal to increased

IDA: Reduced

C)

ACD: Increased

IDA: Normal

Question 24

Summmary

Answer 24

• Anaemia is a haematological condition in which there is a deficiency of haemoglobin
• There are different types of anaemia : IDA (microcytic), B12 and folate deficiency anaemia (macrocytic) and others (ACD, anaemia of CKD)
• The different type of anaemia can be differentiated by haematological test parameters (MCV, RDW and the specific test for specific type of anaemia)