red cells 2

Question 1

what factors influence normal range ?

Answer 1

age
sex
ethnicity
time of day sample is taken
time to analysis

Question 2

what are clinical features of anaemia ?

Answer 2

tiredness
pallor
SOB
ankle swelling
dizziness
chest pain

Question 3

what anaemic features relate to underlying cause ?

Answer 3

evidence of bleeding - menorrhagia, dyspepsia, PR bleeding
symptoms of malabsorption - diarrhoea, weight loss
jaundice
splenomealy/lymphadenopathy

Question 4

what are the red cell indices ?

Answer 4

MCH - mean cell haemoglobin (27-32)

MCV - mean cell volume - cell size (82-99)

Question 5

what further test do you do for hypochromic, microcytic RBC ?

Answer 5

serum ferritin

Question 6

what results from serum ferritin indicate ?

Answer 6

low - iron deficiency

normal/increased - thalassaemia/secondary anaemia

Question 7

what is the role of hepcidin ?

Answer 7

blocks ferroportin so reduces iron absorption from the gut

Question 8

what history features are typical for iron deficiency anaemia ?

Answer 8

dyspepsia/GI bleeding
menorrhagia
diet - child/elderly
increased requirement - pregnancy

Question 9

what are clinical features of iron deficiency ?

Answer 9

atrophic tongue
angular cheilitis
koilonychia

pencil/rod cells blood film

Question 10

how do you manage iron deficiency ?

Answer 10

oral iron, IV if intolerant

correct the cause

Question 11

what is the further investigation for normochromic, normocytic anaemia ?

Answer 11

reticulocyte count

Question 12

what do the results for reticulocyte count indicate ?

Answer 12

increased - acute blood loss/haemolysis

normal/low - secondary anaemia, hypoplasia, marrow infiltration

Question 13

what is secondary anaemia ?

Answer 13

anaemia of chronic disease

increased hepcidin in inflammation, elevated ferritin

Question 14

what can cause haemolytic anaemia ?

Answer 14

congenital - hereditary spherocytosis, G6PD deficiency, HbSS
acquired - autoimmune (extravascular)
mechanical valve, DIC (intravascular)

Question 15

what tests should be done for haemolytic anaemia and what do results indicate ?

Answer 15

direct antiglobulin test

positive - immune mediated
negative - non-immune mediated

Question 16

what are the different ‘types’ of antibody in immune haemolysis and what do they indicate ?

Answer 16

warm - autoimmune, drugs, CLL
cold - CHAD, infection, lymphoma
alloantibody - transfusion reaction

Question 17

what other tests are useful to check if patient is haemolysing ?

Answer 17

serum bilirubin

serum haptoglobin

Question 18

how do you manage haemolytic anaemia ?

Answer 18

folic acid - support marrow function

correct cause
immunosuppression is autoimmune - steroids, treat CLL, lymphoma
remove site of red cell destruction - splenectomy

Question 19

what further tests should you do for macrocytic anaemia ?

Answer 19

B12/folate assay

blood film/bone marrow

Question 20

what do the results of blood film/bone marrow indicate ?

Answer 20

megaloblastic - B12/folate deficiency

non-megaloblastic - myelodysplasia, marrow infiltration, drugs

Question 21

what are clinical features of B12/folate deficiency ?

Answer 21

anaemia

neurological symptoms

Question 22

what causes B12/folate deficiency /

Answer 22

B12 - pernicious anaemia, gastric/ileal disease

folate - dietary, haemolysis, GI pathology

Question 23

how do you treat megaloblastic anaemia ?

Answer 23

replace vitamin
B12 - IM injection 3 month

folate - oral folate

Question 24

what are other causes of macrocytosis ?

Answer 24

alcohol
drugs - MTX, antiretrovirals, hydroxycarbamide
liver function impairment
hypothyroidism
myelodysplasia