Review of the Week 1

Question 1

What are miscellaneous causes of macrocytosis?

Answer 1

Alcoholism
Liver disease
Hypothyroidism

Question 2

What are physiological causes of macrocytosis?

Answer 2

Pregnancy
Neonatal
Reticulocytosis

Question 3

What are nuclear maturation defect causes of macrocytosis?

Answer 3

Megaloblastic erythropoeisis - B12 or folate deficiency
Myelodysplasia - stem cell mutation

Question 4

When considering macrocytosis, if there is a MCV >120fl, what diagnoses are more likely?

Answer 4

B12 or folate deficiency

Question 5

When considering macrocytosis, and there is anaemia, what diagnoses are more likely?

Answer 5

Megaloblastic or myelodysplasia more likely

Question 6

When considering macrocytosis, if neutrophils or platelets are also low, what conditions are more likely?

Answer 6

Myelodysplasia or megaloblastic

Question 7

Uniform macrocytosis is more likely to be what diagnosis?

Answer 7

Alcoholism

Question 8

MAcrocytosis + polychromasia = ?

Answer 8

Reticulocytosis

Question 9

Macrocytosis + agglutinates = ?

Answer 9

Artefact with cold agglutinins

Question 10

Hypersegmented neutrophils + oval macrocytoes + macrocytosis = ?

Answer 10

Megaloblastic anaemia

Question 11

Macrocytosis + Dysplastic neutrophils = ?

Answer 11

Myelodysplasia

Question 12

What are causes of microcytic anaemias?

Answer 12

Globin synthesis defect - thalassaemia
Haem synthesis defect - iron deficiency; defective porphyrin synthesis (sideroblastic anaemias)

Question 13

What forms of iron are exhausted first in microcytic anaemia and what is then affected?

Answer 13

Storage iron is exhausted before transport iron is affected, and only then is red cell production reduced

Question 14

What three compartments are assessed in iron deficiency?

Answer 14

Functional iron - Hb concentration
Storage iron - serum ferritin
Transport iron - serum transferrin (% saturation with iron)

Question 15

What are causes of iron deficiency?

Answer 15

Reduced dietary iron
Increased physiological requirements (pregnancy)
Blood loss
Malabsorption (jejunum, needs gastric acid)

Question 16

What are common causes of iron deficiency in adults?

Answer 16

Menstrual blood loss
GI bleeding

Question 17

How do we investigate iron deficiency?

Answer 17

History - directed by symptoms (e.g. heartburn)

Blood loss - faecal occult blood testing of little value in established iron deficiency
GI tract investigations - upper GI endoscopy; barium enema or colonoscopy

Question 18

Reticlucytosis is a response to what?

Answer 18

A response to increased erythropoeitin production which manifests only at 1-2 days after an acute bleed

Question 19

What are signs of shock?

Answer 19

Tachycardia
Hypotension
Peripheral vasoconstriction (pallor)

Question 20

What are causes of shock?

Answer 20

Hypovolemic e.g. acute blood loss (Hb unchanged until redistribution of body water occurs)
Cardiogenic e.g. pump failure
Neurogenic e.g. loss of sympathetic tone
Vasogenic - anaphylactic, septic

Question 21

What is immediate treatment of choice for shock?

Answer 21

Synthetic colloids

Question 22

What are types of reactions to red cell transfusion?

Answer 22

Febrile non-haemolytic due to white cell antibodies or hypersensitivity to donor plasma proteins
Immediate (intravascular) or delayed (extravascular) haemolytic reactions
Infection transmission: bacterial, viral, prion
Fluid overload (short term)
Iron overload (long term)

Question 23

What do you do in cross match?

Answer 23

ABO + RhD antigen grouping of patient
Screen for alloantibodies in patient
- Antibodies in the patient to antigens that might be on the donor red cells; if alloantibody identified in patient check donor unit is negative for that antigen

Mix donor cells and recipient plasma as a final check in wet crossmatch