Topic 3 - Anaemia and Polycythaemia

Question 1

Define anaemia.

Answer 1

the inability of the blood to supply the tissue with adequate oxygen for proper metabolic function

Question 2

What is the usual diagnostic criteria for anaemia?

Answer 2

Decreased

• Haemoglobin (Hb in g/dL)
• Hematocrit (40-46% in males, 38-44% in females)
• RBC count (4.7 - 6.1 10^12/L for males, 4.2 - 5.4 10^12/L for females)

Question 3

What are the diff Hb levels by age/sex? (newborn, 6 months, children 1 to 15 years, adult male and adult female)

Answer 3

Newborn - 14 to 22 g/dL
6 Months - 11 to 14 g/dL
Children - 11 to 15 g/dL
Adult Male - 13 to 17 g/dL
Adult Female - 12 to 16 g/dL

Question 4

What are the 9 causes of Anaemia?

Answer 4

1. Blood loss (Haemorrhage)
2. Accelerated destruction of RBCs (immune &
   non-immune hemolytic)
3. Nutritional deficiency (folate or B12)
4. Bone marrow replacement (cancer)
5. Infection
6. Toxicity
7. Hematopoietic stem cell arrest or damage
8. Hereditary or acquired defect
9. Unknown (idiopathic)

Question 5

What are the clinical presentations of anaemia?

Answer 5

Based on:

• Patient history
• Physical signs (pallor - pale looking)
• Changes in the hematologic profile

Signs & symptoms (non-specific) include:

• fatigue & weakness
• dyspnoea (difficulty in breathing) after a level of exertion

Question 6

What are the 3 classifications of anaemia?

Answer 6

Functional, etiological and quantitative

Question 7

What are the functional classifications?

Answer 7

• Hypoproliferative (less than normal bone marrow cells)
• accelerated destruction (haemolytic)
• combination of the above 2 (ineffective haemopoiesis)

Question 8

What are the etiological classifications?

Answer 8

• blood loss, iron deficiency, haemolysis, infection,

- metastatic bone marrow replacement, nutritional deficiency

Question 9

What is the Hb levels for mild, moderate and severe anaemia?

Answer 9

Mild - 9 to 11 g/dL
Moderate - 7 to 9 g/dL
Severe - less than 7 g/dL

Question 10

What are the 3 types of anaemia by RBC indices? (MCV and MCHC)

Answer 10

Normocytic/Normochromic 
Caused by BM failure, hemolytic anaemia, chronic renal disease, leukaemia, metastatic malignancy
Macrocytic/Normochromic
Caused by Megaloblastic &
nonmegaloblastic macrocytic
anemias (eg. liver disease)
Microcytic/Hypochromic 
Caused by Fe deficiency, sideroblastic anaemia, thalassemia, lead poisoning, chronic disease, chronic infection or inflammation

Question 11

Define polycythaemia

Answer 11

increased or excess RBCs in the peripheral blood
with increase in Hb & Packed Cell Volume (PCV) or Hct .
Normal Haematocrit (Hct) 43 ± 3 ; 42 ± 4 % (female)

Question 12

What are the two types of polycythaemia?

Answer 12

1. Absolute polycythaemia
   (real increase in RBC volume)
   caused by polycythaemia vera, secondary polycythaemia and idiopathic erythrocytosis
2. Relative polycythaemia
   (normal RBC volume but less plasma)
   caused by stress, dehydration, smoking, living at high alt for more than 6 months

Question 13

What are the confirmatory lab tests for polycythaemia?

Answer 13

1. Hb levels (will be increased)
2. Hct (will be increased)
3. RBC (may be increased)
4. Total RBC by radio-isotopes (will be increased)

Question 14

What are the observations in a PBF for anaemia and polycythaemia?

Answer 14

Anaemia:
- microcytic/hypochromic
- large spaces between RBC
- less Hb and RBC
Polycythaemia:
- normal rbc
- packed rbcs in blood film
- increased Hb and RBC