Treatment of Anaemia

Question 1

What does MHC tell you?

Answer 1

Mean haemaglobin count

This is what gives cells the red colour; will be reduced in hypochromic anaemia

Question 2

What does microcytic anaemia tell you?

Answer 2

Problems with haemaglobin synthesis; iron deficiency or haemoglobinopathies (alpha and beta thal)

Question 3

Why will cells become microcytic in iron deficiency?

Answer 3

Due to a lack of Hb, the erythroblasts will go through more rounds of cell division before the critical Hb is reached for enucleation

Question 4

What is the therapy of choice for iron deficiency anaemia?

Answer 4

Ferrous sulfate 200mg TDS

Question 5

What are the side effects of iron supplements?

Answer 5

Constipation 
Black faeces 
Diarrhoea
Epigastric pain 
Faecal impaction 
GI irritation 
Nausea

Question 6

What are the alternative options if iron supplementation is not tolerated?

Answer 6

Take pill with food
Reduce dose
Try different formulation of iron; gluconate or fumarate
S/c or IM injection
Encourage optimal dietary intake; red meat, green vegetables, breakfast cereals
Encourage vitamin C containing products (enhances absorption)
Tannins in tea may impact iron absorption

Question 7

What degree of response would you expect to see to iron therapy supplementation?

Answer 7

10g/L every 2 weeks

2g/100 mL over 3-4 weeks

Question 8

What tests can be performed to assess response to iron supplementation therapy?

Answer 8

Reticulocyte count level; marker of bone marrow activity

Ferritin levels will take a while to increase

Question 9

Why will people with chronic anaemia do well?

Answer 9

Hb will alter to have more efficient oxygen delivery to tissues via shift of the oxygen dissociation curve to the right
Increased production of 2,3-BPG via rapoport luebering shunt

Question 10

Which GI disease commonly affects the terminal ileum and therefore can result in B12 deficiency?

Answer 10

Crohn’s disease

Question 11

What other autoimmune conditions is pernicious anaemia associated with?

Answer 11

Hypothyroidism
Vitiligo
Addison’s disease

Question 12

How is pernicious anaemia treated?

Answer 12

IM vit B12 injections initially 1mg 3x a week for 2 weeks than 1mg every 2-3 months

Question 13

Can you give oral B12 in patients with pernicious anaemia?

Answer 13

Yes; ideally not because masssssive doses are needed for absorption

Question 14

What autoantibodies are best for detecting pernicious anaemia?

Answer 14

Anti intrinsic factor

Question 15

In people with a folate deficiency who you suspect have a B12 deficiency, should you replace both?

Answer 15

YES; if there is a combined deficiency it and you switch back on haematopoiesis via replacement of folate, then the little stores of B12 could be used up resulting in subacute combined degeneration of the cord

Question 16

What is a very common cause of macrocytic anemia in alcoholics with normal folate/B12 levels?

Answer 16

Liver disease; can result in abnormal lipid metabolism resulting in a dysfunctional red cell membrane
Will see target cells on the blood film