Normocytic Anaemia

Question 1

Anaemia of Chronic Disease

-Mechanism

Answer 1

AOCD is most common cause of normocytic anaemia.
Inflammation leads to rise in cytokines, e.g. IL-6, which upregulate hepicidin expression.
This causes: decreased iron release from splenic macrophages, decreased intestinal iron absorption, decreased repsonse to EPO (reduced synthesis) and reduced RBC lifespan

Question 2

Diseases that cause AOCD

Answer 2

Inflammatory conditions, e.g. RA, SLE
Malignancy, e.g. lymphoma, lung cancer
Chronic infections, e.g. TB

Question 3

Labs in AOCD

Answer 3

L Fe, L TIBC and transferrin saturation
H ferritin
N MCV but longstanding can progress to L

Question 4

Treatment of AOCD

Answer 4

Address underlying cause
Blood transfusion if req.
ESA if no response

Question 5

CKD and Anaemia

• mechanism
• labs
• treatment

Answer 5

In CKD, low EPO leading to reduced RBC production
Labs: L reticulocyte count, L serum EPO, N/L Fe
Rx. ESA (ensure iron stores sufficient) and Iron supplements
Avoid blood transfusion if transplantation possibility to avoid allosensitisation

Question 6

Aplastic Anaemia

-Mechanism

Answer 6

Aplastic anaemia= non-haemolytic, normocytic anaemia

Rare stem cell disorder: reduced or absent haematopoietic stem cells causing pancytopenia and bone marrow aplasia

Question 7

Causes of Aplastic Anaemia

Answer 7

Drugs: benzene, chloramphenicol, anti-epileptics, alcohol
Irradiation
Insecticides
Viruses: parvovirus B19, EBV, HIV, CMV, HCV
Inherited: Fanconi anaemia
Idiopathic
Paroxysmal nocturnal haemoglobinuria (PNH)
SLE

Question 8

Fanconi Anaemia

• Mode of inheritance
• Anatomical defects
• Risk of other diseases

Answer 8

Autosomal recessive HLA-DRB1*04 –> defective stem cell repair and chromosomal fragility causing aplastic anaemia
Anatomical defects: short stature, microcephaly, syndactyly
Assoc: increased risk AML, breast cancer and skin pigmentation

Question 9

Presentation of Aplastic Anaemia

Answer 9

Fatigue, malaise and pallor
Thrombocytopenia: mucosal bleeding, petechiae
Leukopenia: infections

Question 10

Diagnosis and Treatment of Aplastic Anaemia

Answer 10

Diagnosis by bone marrow biopsy
Rx. supportive therapy (e.g. transfusions), bone marrow transplant from HLA-matched sibling, immunosuppression (anti-thymocyte globulin + ciclosporin)