PATH 21 - Introduction to Haematology and Anaemia

Question 1

What are the functions of the bone marrow

Answer 1

Make:
>RBC’s – erythroid cells
>Platelets
>White blood cells – myeloid cells
>Respond quickly to a reduction of any of the above
>Involved in the immune reaction

Question 2

What is the Origin of mature bone marrow cells

Answer 2

Common stem cell

Question 3

What are the controlling factors that ensures that marrow stem cells responds to need for increased production of a particular cell type?

Answer 3

1. Erythropoietin
2. Growth factors
3. Cytokines

Question 4

What is anaemia?

Answer 4

Reduction in Haemoglobin due a disorder of globin or heme or supplements

Question 5

State the effects/consequences of anaemia

Answer 5

Fatigue
Hypoxia
Cardiac failure or angina
Dyspnoea

Question 6

Briefly describe anaemia diagnosis

Answer 6

Clinical history
Examination
Investigations
		>FBC
		>Blood film
		>Bone marrow aspirate or biopsy (sometimes)
Others

Question 7

State Laboratory Morphological Classification of Anaemia

Answer 7

Microcytic
Macrocytic
Normocytic

Question 8

State Pathophysiological Classification

Answer 8

Blood loss
Nutritional deficiency (Fe, B12, Folate)
Marrow failure
Anaemia of chronic disease
Increased destruction (Haemolytic)
Congenital or acquired

Question 9

State the causes of microcytic anaemia

Answer 9

Fe deficiency
Thalassaemia
Sideroblastic – why the name sideroblastic?

Question 10

State the causes of the macrocytic anaemia

Answer 10

B12 deficiency
Folate deficiency
Alcohol 
Liver disease
Hypothyroid
Reticulocytosis

Question 11

What is Reticulocyte

Answer 11

A reticulocyte is an early form of RBC.

Increased numbers of reticulocytes indicate increased erythropoiesis i.e. Increased production of red blood cells.

Question 12

State the cause of Normocytic Anaemia

Answer 12

Anaemia of Chronic disease
Anaemia of Renal disease
Acute blood loss

Question 13

State the causes of anaemia

Answer 13

Failure to make red cells: Marrow problem
Lack of haematinics: iron, B12, Folate eg dietary deficiency, malabsorption, loss
Increased loss of red blood cells e.g. bleeding
Increased destruction of red cells: Haemolysis
Chronic disease

Question 14

What is contained in the FBC data for investigation of anaemia

Answer 14

Hb – normal 13-15g/dl approx.
MCV - size
PCV
Reticulocyte count  (No. of immature erythroid cells)
WCC

Question 15

What are the most important things in the diagnosis of anaemia

Answer 15

FBC Report
Hb level 
MCV (RBC cell size)
Reticulocyte count: (index of marrow erythrocyte activity)
Blood film for shape and colour

Bilirubin level unconjugated in haemolytic anaemia
Fe, B12 and Folate level if appropriate
Antibody test: Coomb’s Test Identifies immune mediated haemolysis
Bone marrow trephine to assess state of marrow

Question 16

Why is folate absorbed at?

Answer 16

Absorbed in duodenum and upper jejunum

Question 17

State the cause of folate deficiency

Answer 17

• Malnutrition/Dietary ( green vegetables, overcooking of food and alcoholism
• Malabsorption
  (Coeliac disease, Crohn’s, Sprue)
• ↑ Requirements
  (Pregnancy, Lactation, Haemolytic Anaemia, Malignancy,)
• Drugs – Anticonvulsants impair folate absorption
  Malignant cells have ↑ Folate requirements.

Question 18

Briefly describe the B12 absorption

Answer 18

B12 from diet (milk eggs and meat) combines with intrinsic factor (secreted by gastric parietal cells)
The B12 intrinsic factor complex are absorbed in the terminal ileum

Question 19

What are the causes of B12 Deficiency Anaemia

Answer 19

1. Lack of dietary B12
2. Lack of Intrinsic Factor
   
   • Pernicious Anaemia (Immune)
   • Atrophic Gastritis (any cause)
   • Partial Gastrectomy (rarely causes by celiac disease)
3. Malabsorption
   
   • Crohn’s Disease
   • Loss of Terminal Ileum
4. ↑ Use
   - Blind Loop Bacteria compete for B12

Question 20

What are the Laboratory findings incase of B12 Deficiency

Answer 20

Anaemia: Macrocytic Anaemia
↓ Hb, ↑ MCV
↓ Serum B12

Question 21

What are other very important Clinical Features of B12 Deficiency?

Answer 21

Peripheral neuropathy
Subacute combined degeneration of the cord
Optic Atrophy
Psychiatric Disorder
Atrophic Glossitis

Question 22

Why do we get neurological changes in B12 Deficiency?

Answer 22

Failure of Synthesis of S-Adenosyl Methionine which is necessary for Myelin production
Rx B12 Deficiency? B12

Question 23

What is the other name for B12 ?

Answer 23

Cobalamin

Question 24

What are the causes of Non Megaloblastic Macrocytic Anaemia

Answer 24

Alcohol
Liver disease
Hypothyroidism
Reticulocytosis
Normocytic Anaemia
    - ↓Hb
    Normal or increased  Ferritin Why?
         Normal Fe saturation
         Bone Marrow slightly less cellular

Question 25

What are the causes of Anaemia of Chronic Disease

Answer 25

Rheumatoid Arthritis, Renal failure etc.
Anemia of chronic disease (AOCD) (or anemia of inflammation) is characterized by iron being trapped in bone marrow macrophages, leading to decreased utilization of endogenous iron stores. Laboratory studies show increased serum ferritin with decreased total iron binding capacity.

Question 26

What is hypoplastic/Anaplastic Anaemia?

Answer 26

Marrow producing very few stem cells

Question 27

Aetiology of Hypoplastic/Anaplastic Anaemia

Answer 27

Immune
Hereditary
Unknown