RBC 3

Question 1

Define anaemia

Answer 1

a group of disorders in which either hemoglobin concentration of blood or/and RBC count is below the normal range for the age and sex.

Anaemia =Hb concentration is less than:
* 13 g/dL in adult males
* 11.5 g/dL in adult females
* 15 g/dL in newborn
* 9.5 g/dL at 3 months of age.

Question 2

Classifications of Anaemia

Answer 2

Morphology (Wintrobe’s) classification:
Normocytic normochromic anaemias.
Macrocytic normochromic anaemia
Microcytic hypochromic anaemias

Etiological (Whitby’s) classification:
Deficiency Anemia
Haemolytic Anemia
Blood loss Anemia
Anemia due to chronic disease
Aplastic Anaemia

Question 3

Common Anaemia 4

Answer 3

Iron- deficiency Anemia (IDA)
Hereditary Spherocytosis
Sickle Cell Anaemia
Thalassemia

Question 4

Normocytic normochromic anaemias

Answer 4

Normal MCV (78–94μm3) & normal MCHC (30–38%)
* Acute post-haemorrhagic anaemia
* Haemolytic anaemias
* Aplastic anaemias.

Question 5

Microcytic hypochromic anaemias

Answer 5

Reduced MCV (<78μm3) & reduced MCHC (<30%)
* Iron deficiency anaemia
* Chronic post-haemorrhagic
anaemia
* Thalassaemia.

Question 6

Macrocytic normochromic anaemia

Answer 6

Increased MCV (>94μm3) & normal MCHC (30–38%)
* Megaloblastic anaemia due to deficiency of vitamin B12
* Megaloblastic anaemia due to
deficiency of folic acid.

Question 7

Deficiency Anemia

Answer 7

• Iron deficiency anaemia
• Megaloblastic anaemia –Vitamin B12 or folic acid deficiency

Question 8

Blood loss Anemia

Answer 8

Acute post- haemorrhagic anaemia(accidents)
Chronic post- haemorrhagic anaemia.

Question 9

Haemolytic Anemia

Answer 9

• Thalassemia
• Sickle cell anaemia
• Hereditary
  spherocytosis
• G6PD deficiency
• Microangiopathic
  haemolytic anaemia
• Toxic effects(malaria, snake venom)
• Splenomegaly

Question 10

Aplastic Anaemia

Answer 10

It occurs due to the failure of bone marrow to produce RBCs

Question 11

Anemia due to chronic disease

Answer 11

• Tuberculosis * Chronic
  infections
• Malignancies
• Chronic lung diseases

Question 12

Iron Deficiency Anaemia

Answer 12

Total Iron :4 to 5 grams
-65% in form of Hb.
-1% in form of heme compounds-promote intracellular oxidation.
4% in form of myoglobin.
0.1% is combined with protein transferrin in blood plasma.
15%−30% stored for later use, mainly in RES of bone marrow and liver parenchymal cells, principally in form of ferritin.

Question 13

Causes of Iron Deficiency

Answer 13

Inadequate dietary intake of iron
Increased loss iron
Increased demand of iron
Decreased absorption of iron

Question 14

Inadequate dietary intake of iron

Answer 14

• Milk fed infants
• Poor economic status
  individuals
• Anorexia, e.g. in
  pregnancy
• Elderly individuals due
  to atrophy and poor dentition.

Question 15

increased loss iron

Answer 15

• Menses
• Acute blood loss
  -Hook worm infestation
  -Chronic blood loss

Question 16

Increased demand of iron

Answer 16

• Pregnancy
  -Rapid growth in infancy or adolescence
• Erythropoietin therapy

Question 17

Decreased absorption of iron

Answer 17

• Partial or total gastrectomy
• Achlorhydria
• Intestinal
  malabsorption diseases.

Question 18

Clinical Features of Iron Deficiency Anaemia

Answer 18

Symptoms
* irritability,palpitations,dizziness, breathlessness, headache and fatigue
* impair muscular performance, behavioral disturbances
Signs
* Pallor
* Nails: Flattening, Koilonychia
* Tongue: Soreness, Mild papillary
atrophy, Absence of filiform papillae
* Mouth : Angular stomatitis

Question 19

Blood Smear: Iron Deficiency Anaemia

Answer 19

look at pic pg 11

Question 20

Treatments of Iron Deficiency Anaemia

Answer 20

Oral
▪ Ferrous fumarate
▪ Ferrous gluconate

IV
-Sodium ferric gluconate
-Iron sucrose
-Iron dextran

Iron-Rich Diet
* Meat
* Poultry
* Fish
* Leafy greens
* Legumes

Blood Transfusion
* In Hb < 7–8 g/dL
* A unit of packed red cells increases the hemoglobin level by 1 g/dL

Question 21

Megaloblastic Anaemia

Answer 21

-presence of abnormally large developing red cells in the bone marrow
- based on ineffective erythropoiesis.

Question 22

Causes of Megaloblastic Anaemia

Answer 22

-Vitamin B12:Deficiency / abnormal metabolism
-Drugs interfering with synthesis of DNA
-Intrinsic Factor: Deficiency / defect
-Folate:Deficiency / abnormal metabolism / antifolate drug
-Arsenic poisoning
-Nitrous oxide inhalation

Question 23

Megaloblastic anaemia due to vitamin B12 deficiency

Answer 23

cause:
Inadequate dietary intake
Malabsorption of vitamin B12 by GIT System
result:
Pernicious anaemia- failure of secretion of intrinsic factor by the stomach

Question 24

Megaloblastic anaemia due to folate deficiency

Answer 24

Diet-Poor intake of vegetables

Increased demand in haemolysis & pregnancy

Malabsorption e.g. Coeliac disease

Drugs
* Certain anticonvulsants (e.g. phenytoin)
* Contraceptive pill
* Certain cytotoxic drugs (e.g. methotrexate)

Question 25

Clinical Features of Megaloblastic Anaemia

Answer 25

Symptoms * Malaise (90%) * Breathlessness (50%) * Paranesthesia (80%) * Sore mouth (20%) * Weight loss * Altered skin pigmentation * Grey hair * Impotence * Poor memory * Depression * Personality change * Hallucinations * Visual disturbance Signs * Smooth tongue * Angular cheilosis * Vitiligo * Skin pigmentation * Heart failure * Pyrexia

Question 26

Treatments of Megaloblastic Anaemia

Answer 26

Cobalamin -Hydroxocobalamin is preferred because it is more highly protein- bound and therefore remains longer in the circulation (100–1000 mg) Vitamin B12 -Oral doses of 1000 mg of vitamin B12 daily or injections to treat patients with pernicious anemia. Folate 5-15mg; for 4 months

Question 27

Polycythemia

Answer 27

Increase in all cell types of blood, usually it represents increase in number of red cells -Primary Polycythemia(Polycythemia vera) Cause: clonal neoplastic disorder of hematopoietic stem cells -Secondary Polycythemia (Secondary erythrocytosis) Cause: due to appropriate or inappropriate increase in secretion of erythropoietin. -Apparent (relative) polycythemia Cause: not true polycythemia, but a spurious increase in red cells due to dehydration

Question 28

Erythrocyte Sedimentation Rate (ESR)

Answer 28

* Rate at which red cells sediment when an anticoagulated blood is allowed to stand in a vertical tube * Clinical significance – helps in understanding the prognosis of the disease. * Methods: ❖Westergren’s method. ❖ Wintrobe’ s method. Normal Values -In Westergren‘s method: Males : 3–5 mm/hr Females : 5–12 mm/hr -In Wintrobe’s method: Males : 0–9 mm/hr Females : 0–20 mm/hr

Question 29

Factors Affecting ESR

Answer 29

-Rouleaux formation increases ESR -Size of the red blood cells: Increase in ESR -Number of red blood cells: When the number of RBCs increase the ESR -Viscosity of blood: ESR is increased when the viscosity of blood is decreased

Question 30

Physiological Variation of ESR

Answer 30

* Age: ESR is less in infants and old people. * Sex: ESR is greater in females (5–9 mm) than males (3–7 mm). * Pregnancy: ESR is raised in pregnancy from third month to parturition and returns to normal after 3–4 weeks of delivery

Question 31

Pathological Variation of ESR

Answer 31

Increases ESR * Tuberculosis * Malignant diseases * Collagen diseases * All anaemias except sickle cell anaemia * Chronic infections. Decreases ESR * Polycythaemia * Decreased fibrinogen levels * Sickle cell anaemia * Allergic conditions

Question 32

try practice SAQ

Answer 32

slide pg 24