Normochromic, normocytic anaemia

Question 1

What are all causes of normochromic, normocytic anaemia with a HIGH reticulocyte (haemolysis)?

Answer 1

Inherited conditions:
Hereditary spherocytosis
Elliptocytosis
thalassaemia
sickle cell anaemia
G6PD deficiency 

Acquired conditions:
Autoimmune haemolysis
anaemia
Prosthetic valve replacement haemolysis

Question 2

What are causes of normochromic, normocytic anaemia with a normal or low reticulocyte count?

Answer 2

Secondary anaemie
hypoplasia
marrow infiltration

Question 3

What is secondary anaemia?

Answer 3

Anaemia secondary of a chronic disease

Question 4

What cells are usually seen in secondary anaemia?

Answer 4

70% = normochromic, normocytic.
30% = hypochromic, microcytic.

Question 5

What is a common cause of secondary anaemia?

Answer 5

Infection, inflammation, malignancy or renal impairment.

Increased inflammation causing increased hepcidin production.
Leads to defective iron production.

^Ferritin levels will be normal but the iron just can’t be used.

Question 6

What tests should be done for haemolytic anaemia?

Answer 6

FBC - normochromic, normocytic cells
Blood film - shistocytes (fragments of RBCs0
Direct Coombs test (DAT/DAGT - can be + or -.

Question 7

When is a DAT test positive?

Answer 7

when the cause of haemolysis is autoimmune

Question 8

What are the features of haemolysing anaemia?

Answer 8

splenomegaly

jaundice

Question 9

Why is reticulocyte increased in haemolytic anaemia?

Answer 9

the patient has increased RBC destruction - compensated by bone marrow releasing more immature RBCs (reticulocytes)

Question 10

Where does haemolysis occur?

Answer 10

Intravascular - when erythrocytes are destroyed in the blood vessel itself.

Extravascular - occurs in the hepatic and splenic macrophages within the reticuloendothelial system.

Question 11

What is RBCs broken down into?

Answer 11

Globin (amino acid)
Iron (reused and binds to transferrin)
Bilirubin

Question 12

What happens to the bilirubin in the body?

Answer 12

RBC breaks down into unconjugated bilirubin - binds to albumin and is taken to the liver - is conjugated and you poop rope out the conjugated bilirubin.

Question 13

Where does most immune mediated haemolysis occur?

Answer 13

Mostly extravascular

Question 14

where does most non immune haemolysis occur?

Answer 14

mostly intravascular

Question 15

What test can show of haemolysis is immune related?

Answer 15

DAT/DAGT test (direct antiglobulin test)

Question 16

What does the DAT test show you?

Answer 16

positive - immune related

negative - non immune related

Question 17

What can cause auto immune haemolysis?

Answer 17

autoimmune 
drugs
infection
lymphoma
blood transfusion reaction

Question 18

What is the management of autoimmune haemolytic anaemia?

Answer 18

folic acid
immunosuppression
splenectomy

Question 19

What is autoimmune haemolytic anaemia?

Answer 19

when antibodies are created against the patients red blood cells leading to destruction of the red blood cells.