Red Cell Disorders (REVISE)

Question 1

What percentage of anaemias are from iron deficiency

Answer 1

95%

Question 2

Is diet a significant cause of anaemia

Answer 2

No it is very rarely a cause

Question 3

Different types of anaemias

Answer 3

Iron deficiency anaemia 
Megaloblastic anaemia
Haemolytic anaemia
Aplastic anaemia
Sickle cell
Thalassaemias

Question 4

Symptoms of Anaemia

Answer 4

Shortness of breath
Weakness/Lethargy
Tachycardia

Question 5

Does skin colour (not race; literal colour) indicate anaemia; what else/alternative

Answer 5

Skin colour not a reliable sign, as this is determined by blood flow. Nail bed and conjunctiva may be pale

Question 6

What might severe anaemia cause in elderly

Answer 6

Angina

Question 7

Oral manifestations of anaemia (REVISE)

Answer 7

Glossitis (painful red tongue)

Angular cheilitis (fissures at corner of mouth)

Question 8

How might DPG levels change in anaemic patients

Answer 8

DPG may be elevated in RBCs so O2 more readily given up to tissues

Question 9

Microcytic Anaemia

Answer 9

Anaemia caused by decreased MCV; type of iron deficiency

Question 10

Why does iron deficiency anaemia cause microcytic anaemia

Answer 10

Body is starved of iron so RBCs are abnormally small as one of their main components is depleted

Question 11

Label

Answer 11

Question 12

Usual treatment for Iron Deficiency Anaemia

Answer 12

Usually Iron Sulfate (FeSO4)

Find and treat the underlying cause (e.g. GI Bleeding, menstrual problems)

REVISE

Question 13

Normocytic Anaemia

Answer 13

Patient has normal-sized red blood cells, but a low number of them

Question 14

Renal Anaemia

Answer 14

Kidney produces EPO, so in chronic kidney disease, RBC production is not stimulated which causes normocytic anaemia

REVISE MINORLY

Question 15

How do pregnancies affect anaemia

Answer 15

Dilution and/or iron deficiency as the foetus is taking iron from the mother

Hormones of pregnancy increase MCV while iron reduces it causing normocytic anaemia

REVISE MINORLY JUST DOUBLE CHECK

Question 16

Megaloblastic Anaemia

Answer 16

Abnormal RBC maturation due to defective DNA synthesis, out of step with cytoplasmic development; bone marrow contains megaloblasts

Macrocytic

Due to Vit B12 or folate deficiency - increased incidence in alcohol abuse

REVISE SIGNIFICANTLY, MAYBE EVEN MORE THAN ONE CARD

Question 17

Folic Acid

Answer 17

Essential for thymidylate synthesis (Rate limiting step in DNA synthesis as thymidine is a pyrimidine base)

Obtained through foods

Question 18

DNA Synthesis mechanism

Answer 18

B12 is relevant or something; folate is similar???

REVISE ASF

Question 19

Methotrexate

Answer 19

Anti-cancer drug and immunosuppressant in rheumatoid arthritis and other diseases

Inhibits dihydrofolate reductase, therefore folate regeneration impaired

They are supplemented with occasional folate to avoid megaloblastic anaemia

Question 20

Pernicious Anaemia

Answer 20

Lack of intrinsic factor for absorption of B12 due to autoimmune disease - treat with hydrocobalamin i.m

REVISE

Question 21

Crohn’s Disease

Answer 21

IBD

Malabsorption of B12, folate or iron

Question 22

Haemolytic Anaemias and causes

Answer 22

Increased rate of RBC destruction

Caused by:
Spherocytosis - genetic - abnormal reduction in RBC membrane protein (spectrin) - cells fragile

Acquired - Haemolytic transfusion reaction, malaria, drug-induced

Question 23

Symptoms of Haemolytic anaemias

Answer 23

Jaundice (?) and enlarged spleen

Folate deficiency may occur due to increased erythropoiesis

Question 24

Sickle cell anaemia

Answer 24

Single Nucleotide Polymorphism (Val -> Glu. Acid)

Abnormal Hb - insoluble forms crystals at low O2, causing RBC forming sickle shapes and potentially blocking microcirculation

Causes haemolytic anaemia

Question 25

Clinical Features of Sickle Cell Anaemia

Answer 25

Vaso-occlusive crisis
Pain
Reduced life expectancy
Risk of stroke
Managed by transfusions

Question 26

Ethnicity Bias of Sickle Cell Anaemia

Answer 26

Very common in sub-saharan africa as the trait has advantages against malaria

2% of Nigerian newborns are affected

8% of black population are carriers

Question 27

Thalessaemias

Answer 27

Genetic disorder - reduced rate of alpha or beta globin units production many variations

Deletion of both alpha genes leads to death in uterus as Hb (γ4) produced

One alpha=gene deletion reduces RBC volume and haematocrit

Question 28

Ethnicity of Thalassaemia

Answer 28

REVISE

Question 29

Aplastic Anaemia

Answer 29

Insufficient production of RBCs, WBCs and platelets (pancytopenia); Although may just be RBCs (pure red cell aplasia)

Question 30

Symptoms of aplastic anaemia

Answer 30

Decreased resistance to infections, increased bleeding, increased tiredness

Question 31

How is aplastic anaemia acquired

Answer 31

Cytotoxic (anticancer) agents
Chloramphenicol
Sulphonamides
Insecticides

REVISE!!

Question 32

Treatment of Aplastic Anaemia

Answer 32

Bone marrow transplant - with tissue match

Immunosuppressants - to prevent immune destruction of stem cells

Colony-stimulating factors - increase WBC count

REVISE!!

Question 33

Polycythaemia

Answer 33

Opposite of Anaemia; Increased Hb content and haematocrit

Increased blood viscosity - poor tissue perfusion

Question 34

Signs and Symptoms of Polycythaemia

Answer 34

Ruddy appearance
Cyanosis
Headaches
Blurred vision
Hypertension

Question 35

Causes of Polycythaemia

Answer 35

Primary: Changes in bone marrow, stem cell defect

Secondary: Increased erythropoietin - altitude, smoking, renal carcinoma, COPD

Question 36

Treatment of polycythaemia (primary and secondary)

Answer 36

Primary - Taking blood from patient regularly (venesection)

Giving patient radioactive phosphorus which causes bone marrow suppression (myelosuppression)

Cytotoxic Agents (myelosuppression)

Secondary polycythaemia is treated by treating the root cause