Red cell disorders

Question 1

What is the definition of anaemia

Answer 1

Reduced level of Hb (haemoglobin)

Question 2

Symptoms of anaemia

Answer 2

• Shortness of breath
• Weakness/lethargy
• Tachycardia (high resting heart rate)
• Glossitis (painful red tongue) and angular cheilitis (fissures at corner of mouth)

Question 3

What is not a reliable sign of anaemia vs what is

Answer 3

Skin colour is not reliable

-Instead check nail bed and conjunctiva (they may be pale)

Question 4

What may severe anaemia in elderly patients cause

Answer 4

Angina

Question 5

What may be more elevated in RBCs in those with anaemia

Answer 5

DPG so O2 is more readily given up to tissues

Question 6

What is iron deficiency anaemia

Answer 6

Microcytic (decreased MCV) which means that the mean corpuscular volume is reduced of red blood cells

Question 7

In what ways can you decrease input to cause iron deficiency anaemia

Answer 7

Poor diet

Surgical removal of stomach

Question 8

In what ways can you increase output to cause iron deficiency anaemia

Answer 8

Menstruation

Gastrointestinal bleeding ulcers which may be caused by the use of NSAIDs (eg ibuprofen)

Question 9

IN what ways can you increase demand to increase iron deficiency anaemia

Answer 9

Pregnancy

Question 10

What is the main cause of iron deficiency

Answer 10

Increased output (eg menstruation)

Question 11

Difference between acute vs chronic bleeding

Answer 11

Acute- Over time, there is haemodilution by the addition of water

chronic- long term bleeding ie menstruation and there is no haemodilution

Question 12

How to treat iron deficiency anaemia (not in pregnancy)

Answer 12

Find the underlying cause (eg menstruation or GI tract bleeding)

• Give oral iron (FeSO4)
• sometimes a transfusion

Question 13

How to treat iron deficiency anaemia in pregnant women

Answer 13

Prophylaxis (oral iron) with folic acid

Question 14

What is normocytic anaemia

Answer 14

Normal sized red blood cells, but a low number of red blood cells

Question 15

What leads to normocytic anaemia

Answer 15

Renal anaemia

Question 16

How do you treat renal anaemia

Answer 16

Fe and EPO

Question 17

What type of anaemia could there be in pregnancy

Answer 17

Iron deficiency

Normocytic

Question 18

Why could there be normocytic anaemia in pregnancy

Answer 18

Pregnancy increases MCV but iron deficiency decreases MCV so they could cancel out. This means the anaemia may be normocytic instead

Question 19

What is megaloblastic anaemia

Answer 19

Macrocytic anaemia (abnormally large red blood cells called megaloblasts found in bone marrow)

Question 20

Why is there abnormal red blood cell maturation (causes megaloblastic anaemia)

Answer 20

Due to defective DNA synthesis (due to vitamin b12 or folate deficiency)

Question 21

What is B12 used as

Answer 21

A cofactor for purine and pyrimidine synthesis (therefore cell division)

Question 22

What does B12 require for absorption

Answer 22

Intrinsic factor

Question 23

What can a microcytic but not anaemic patient mean

Answer 23

Evidence of alcohol abuse

Question 24

What can megaloblastic anaemia lead to

Answer 24

Haemolytic anaemia

Question 25

In DNA synthesis, what is folic acid used as

Answer 25

A building block

Question 26

What in DNA synthesis is used as a drug target

Answer 26

DHF reductase which is involved in DNA synthesis

Question 27

What drug inhibits DHF

Answer 27

Methotrexate (so used to prevent DNA synthesis and so is used as an anti-cancer drug)

Question 28

What complication does methotrexate cause and how to solve this

Answer 28

Stops Folate regeneration so this is treated with folonic acid

Question 29

What do haemolytic anaemias do

Answer 29

Increased rate of RBC destruction

Question 30

Two different types of haemolytic anaemias

Answer 30

Spherocytosis- genetic | Acquired

Question 31

What is spherocytosis

Answer 31

Abnormal reduction in RBC membrane protein and so cells become fragile

Question 32

Why might there be a folate deficiency and what are the symptoms of this

Answer 32

Due to increased erythropoiesis (blood cell formation) -Jaundice and enlarged spleen (because that's the site of red cell destruction)

Question 33

What does sickle cell anaemia cause

Answer 33

Haemolytic anaemia

Question 34

What causes thalassaemias and what Is it

Answer 34

Genetics People with thalassaemia produce either no or too little haemoglobin

Question 35

What is aplastic anaemia

Answer 35

Insufficient production of RBCs, WBCs and platelets (pancytopenia)

Question 36

What causes aplastic anaemia

Answer 36

- Viral, radiation or drugs - Cytotoxic agents (anticancer) - Chloramphenicol - INsecticides

Question 37

How is aplastic anaemia treated

Answer 37

- Bone marrow transplant - Immunosuppressants to prevent destruction of stem cells - COlony-stimulating factors which increase white blood cell count

Question 38

What is polycythaemia

Answer 38

Increased haemoglobin content and haematocrit

Question 39

Symptoms of polycythaemia

Answer 39

- HEadaches - Blurred vision - HYpertension - Cyanosis (blue skin) caused by sluggish blood flow

Question 40

What is polycythaemia caused by (primary and secondary)

Answer 40

primary- changes in bone marrow, stem cell defect secondary- increased erythropoietin (stimulates stem cells to turn into red blood cells) which is increased due to altitude, smoking and renal carcinomas

Question 41

Treatment of primary polycythaemia

Answer 41

- Bleeding the patient | - Radioactive phosphorus (myelosuppression which is suppression of bone marrow)