Red Blood Cells 2

Question 1

define anaemia

Answer 1

Haemoglobin below normal for age and sex

Question 2

factors influence haemoglobin normal range

Answer 2

Age 
Sex
Ethnic origin 
Time of day sample taken
Time to analysis

Question 3

Haemoglobin Normal ranges

Answer 3

Male 12-70 (140-180g/l)

Female 12-70 (120-160)

Question 4

Anaemia clinical features

Answer 4

Tiredness/ pallor
Breathlessness
Swelling of ankles 
Dizziness
Chest pain

Question 5

Anaemia clinical features

Answer 5

Evidence of bleeding:

• menorrhagia
• dyspepsia, PR bleeding

Symptoms of malabsorption:

• diarrhoea,
• weight loss

Jaundice

Splenomegaly/ lymphadenopathy

Question 6

What are the main branch causes of anaemia

Answer 6

Bone marrow- cellularity, stoma, nutrients

Red cell- membrane, haemoglobin, enzymes

Destruction loss- blood loss, haemolysis, hypersplenism

Question 7

What does MCH and MCV stand for?

Answer 7

MCH= Mean Cell Haemoglobin 
MCV= Mean Cell Volume

Question 8

Anaemia morphological classes?

Answer 8

Hypochromic microcytic (pale and small)

Normochromic normocytic (normal looking)

Microcytic

Question 9

Best investigation for hypochromic microcytic anaemia

Answer 9

Serum ferritin

Question 10

Best investigation for normochromic normocytic

Answer 10

Reticulocyte count

Question 11

Best investigation for macrocytic anaemia

Answer 11

B12/ folate

Bone marrow

Question 12

In hypochromic microcytic anaemia what will the results of the serum ferritin show as the cause

Answer 12

Low= iron deficiency 
Normal= thalassaemia OR secondary anaemia OR sideroblastic anaemia

Question 13

Role of ferroportin

Answer 13

Transporter for iron across basement membrane

Can also be transported bound to mucosal ferritin

THEN
Bound to transferrin in plasma

Question 14

Role of hepcidin

Answer 14

Released from hepatocytes in response to

• increased iron levels
• inflammation

Regulates Fe transport by blocking ferroportin and thus further Fe absorption

Question 15

History and examination to take from iron deficiency anaemia

Answer 15

Dyspepsia (?Gi bleed)
Other bleeding ? Eg menorrhagia
Diet
Increased requirement ? Eg pregnancy

Examination:

• signs of iron deficiency
• abdominal and rectal

Question 16

Cells appearance in iron deficiency anaemia

Answer 16

Pencil/ rod cell

Hypochromic microcytic red cells

Question 17

Clinical features of iron deficiency

Answer 17

Atrophic tongue
Angular stomatitis
Koilonychia

Question 18

Causes of iron deficiency

Answer 18

GI blood loss
Menorrhagia
Malabsorption- gastrectomy, coeliac disease

Question 19

For normochromic normocytic anaemia you do a reticulocyte count, what would the causes be depending on the results

Answer 19

Increased reticulocyte count - acute blood loss or haemolysis

Normal/ low reticulocyte count- secondary anaemia, hypoplasia, marrow infiltration

Question 20

Secondary anaemia causes

Answer 20

Defective iron utilisation (increased hepcidin in inflammation)

Identifiable underlying disease (infection, inflammation and malignancy)

Question 21

Describe haemolytic anaemia

Answer 21

Accelerated red cell destruction (decreased Hb)
Compensation by bone marrow (increased reticulocyte)

So balance between red cell production and destruction

Question 22

What are the 2 types of haemolysis

Answer 22

Extravascular:
-Auto-immune haemolytic anaemia 
Intravascular:
-Mechanical eg artificial valve 
-Severe infection/ DIC 
-PET/HUS (haemolytic uraemia syndrome) /TTP )THrombotic Thrombocytopenic purpura)

Question 23

What is a DAT test

Answer 23

Direct Antiglobulin Test

Detects antibody or complement on red cells

Reagents contains either:

• antihuman IgG
• anticomplement

Reagent then binds to Ab on red cell surface and causes agglutination in vitro

Implies immune basis for haemolysis

Question 24

Results from DAT test meaning

Answer 24

Positive- immune mediated haemolysis

Negative- non-immune mediated haemolysis

Question 25

Immune haemolysis causes

Answer 25

If:
Warm auto-antibody: auto-immune, drugs CLL

Cold auto-antibody: CHAD, infections, lymphoma

Alloantibody: transfusion reaction

Question 26

How would immune haemolysis cells appear

Answer 26

Spherocytes on film

Agglutination (clumping) in cold AIHA

Question 27

What do intravascular haemolysis cells appear like

Answer 27

Red cell fragments- “schistocytes”

Question 28

Tests to do for haemolytic anaemia?

Answer 28

FBC
Reticulocyte count 
Blood film
Serum bilirubin 
LDH
Serum haptoglobin

History and examination
Blood film
Direct Antiglobulin Test
Urine for haemosiderin/urobillinogen

Question 29

Haemolytic anaemia management?

Answer 29

Folic acid
If autoimmune- steroids 
Splenectomy 
Treat underlying cause 
Consider transfusion

Question 30

What test would you do in macrocytic anaemia

Answer 30

B12/ folate assay

Blood film/ bone marrow

Question 31

Causes of megaloblastic macrocytic anaemia

Answer 31

B12 deficiency

Folate deficiency

Question 32

Causes of macrocytic non-megaloblastic anaemia

Answer 32

Myelodysplasia
Marrow infiltration
Drugs

Question 33

Megaloblastic anaemia presentation

Answer 33

Due to B12/ folate deficiency
So presents:
-anaemia
-Neurological symptoms (B12)

-“lemon yellow” tinge

Question 34

B12 and folate deficiency causes?

Answer 34

B12 deficiency:
Pernicious anaemia
Gastric/ileal disease

Folate deficiency:
Dietary
Increased requirements (eg haemolysis)
GI pathology (eg Coeliac disease)

Question 35

What is Pernicious anaemia

Answer 35

Autoimmune disease 
Autoantibodies against:
-intrinsic factor 
-gastric parietal cells 
Malabsorption of dietary B12 (s/s take 1-2 years to develop)

Question 36

Megaloblastic anaemia treatment

Answer 36

Replace vitamin:

B12 deficiency- im 3 monthly injections

Folate- oral folate replacement

Question 37

Other causes of Macrocytosis

Answer 37

Alcohol 
Drugs (methotrexate, antiretrovirals, hydroxycarbamide)
Disordered liver function 
Hypothyroidism 
Myelodysplasia