Red cells 2 - acquired anaemias

Question 1

What does normal haemoglobin depend on?

Answer 1

sex, age, ethnicity, time sample taken etc..

Question 2

Normal male Hb values

Answer 2

12-70 (140-180)

>70 (116-156)

Question 3

Normal female Hb values

Answer 3

12-70 (120-160)

>70 (108-143)

Question 4

clinical features of anaemia

Answer 4

SOB 
pallor
tiredness 
dizziness 
ankle swelling

Question 5

Underlying causes clinical features of anaemia

Answer 5

bleeding eg menorrhagia, GI bleed
malabsorption eg diarrhoea
splenomegaly and jaundice

Question 6

bone marrow pathophysiology anaemia

Answer 6

cellularity, stroma, nutrients

Question 7

RBC pathophysiology anaemia

Answer 7

membrane, enzymes, haemoglobin

Question 8

destruction/loss anaemia pathophysiology

Answer 8

bleeding
haemolysis
hypersplenism

Question 9

MCV

Answer 9

mean cell volume = cell size

Question 10

MCH

Answer 10

mean cell haemoglobin

Question 11

3 morphological types of anaemia

Answer 11

hypochromic microcytic
normochromic normocytic
macrocytic

Question 12

What you would measure in each of the 3 morphological types of anaemia

Answer 12

Hm = Serum ferritin 
Nn = Reticulocyte count
M = Vit B12/folate or bone marrow

Question 13

serum ferritin results and what they mean

Answer 13

low = iron deficiency anaemia 
normal/high = secondary anaemia, thalassaemia

Question 14

Is there a pathway for excess iron excretion?

Answer 14

no

Question 15

What happens to absorbed iron?

Answer 15

bound to mucosal ferritin and shedded OR

transported across basement membrane by ferroportin

Question 16

What is iron bound to in plasma?

Answer 16

transferrin

Question 17

What is iron stored in cells as?

Answer 17

ferritin

Question 18

hepcidin

Answer 18

produced by hepatocytes
bind to ferroportin and stop iron absorption
chronic anaemia of inflammatory diseased

Question 19

History - iron deficiency anaemia

Answer 19

dyspepsia/Gi bleed, menorrhagia, diet, increased requirement eg pregnancy, malabsorption eg coeliac

Question 20

Examination - iron deficiency anaemia

Answer 20

koilonychia
tongue atrophy and angular cheilitis
abdominal and rectal

Question 21

managing iron deficiency anaemia

Answer 21

oral iron (IV if intolerant)
rarely blood transfusion
diet, ulcer therapy, gynae etc..

Question 22

Reticulocyte findings and what it means

Answer 22

increased - acute blood loss/haemolysis

decreased - marrow infiltration , secondary anaemia

Question 23

haemolytic anaemia - 2 main things

Answer 23

increased red cell destruction = decrease Hb

compensation by bone marrow = increase Reticulocyte count

Question 24

extravascular and intravascular haemolysis

Answer 24

extravascular = reticuloendothelial system and immune mediated 
intravascular = in vessels, non immune mediated

Question 25

congenital haemolysis

Answer 25

hereditary spherocytosis enzyme deficiency haemoglobinopathy

Question 26

acquired haemolysis

Answer 26

``` autoimmune mechanical (heart valve), PET, DIC, infection ```

Question 27

Direct antiglobulin test

Answer 27

detects antibody or complement on RBC | reagent is anti human IgG or anti complement

Question 28

DAGT results and what they mean

Answer 28

``` +ve = immune mediated -ve = non-immune mediated ```

Question 29

How to find out if patient is haemolysing

Answer 29

``` FBC reticulocyte count blood film serum bilirubin heptaglobin ```

Question 30

How to find out the mechanism of haemolysis

Answer 30

AGT, urine, blood film

Question 31

managing haemolysis

Answer 31

support marrow function - folic acid autoimmune - steroids splenectomy, transfusion? remove valve, infection, sepsis etc

Question 32

secondary anaemia type

Answer 32

normochromic normocytic

Question 33

megaloblastic anaemia

Answer 33

B12/folate deficiency

Question 34

non-megaloblastic anaemia

Answer 34

marrow infiltrate | drugs

Question 35

appearance of megaloblastic anaemia

Answer 35

yellow tinge - bilirubin

Question 36

Vitamin B12 absorption

Answer 36

binds to intrinsic factor made by parietal cells | absorbed in distal ileum

Question 37

commonest cause of B12 deficiency

Answer 37

pernicious anaemia

Question 38

pernicious anaemia

Answer 38

auto antibodies directed against INTRINSIC FACTOR

Question 39

How long does it take for pernicious anaemia symptoms to appear?

Answer 39

1-2 years

Question 40

megaloblastic anaemia treatment

Answer 40

B12 - im injection | oral folate --> ensure B12 levels normal if neuropathic symptoms

Question 41

other causes of macrocytosis

Answer 41

drugs eg ART, methotrexate hypothyroidism alcohol disordered liver function