Week 1- Approach to anaemia and diagnosis

Question 1

What are the two definitions of anaemia?

Answer 1

Reduction in haemoglobin concentration which is below that which is optimum for the individual. Reduction in haemoglobin concentration below 95% of the population range.

Question 2

What Hb concentration in children (6 months to 6 years) below which anaemia is likely to be present?

Answer 2

110g/L

Question 3

What Hb concentration in children (6-14 years) below which is anaemia likely to be present?

Answer 3

120g/L

Question 4

In adult men, what Hb concentration below which anaemia is likely to be present?

Answer 4

130g/L

Question 5

In adult women, what Hb concentration below which anaemia is likely to be present?

Answer 5

120g/L

Question 6

In pregnant women, what Hb concentration below which anaemia is likely to be present?

Answer 6

110g/L

Question 7

What two broad categories is anaemia classified into? (Just a way of thinking about what causes the problem rather than a diagnosis)

Answer 7

Decreased production- hypo proliferative (reduced amount of erythropoeisis) Maturation abnormality- erythropoiesis present but ineffective. Increased destruction-bleeding, haemolysis

Question 8

How can anaemia’s reticulocyte response be divided?

Answer 8

Increased response or decreased response. If its an increased response its likely to be increased destruction of cells (haemolysis or blood loss). If it is a decreased response from the reticulocytes there is either something wrong with the red blood cells, or not enough proliferation is occuring.

Question 9

What does reticulocytosis mean? What is the significance of this?

Answer 9

Increased reticulocytes. It means red cell production has increased.

Question 10

How can you tell clinically if someone is haemolysing their red blood cells prematurely?

Answer 10

You can get increased bilirubin and therefore jaundice. And also increased urinary urobilinogen. Also get hypertrophy of macrophage rich tissues (these breakdown the RBC’s therefore get bigger). Can get splenomegaly and hepatomegaly.

Question 11

This is v helpful to remember.

Answer 11

Question 12

What is haemolytic anaemia?

Answer 12

Anaemia due to haemolysis.

Question 13

What is the normal body response to anaemia?

Answer 13

The EPO should increase, causing erythropoeisis to increase.

Question 14

How much can normal marrow increase its erythropoeisis by?

Answer 14

3-4 fold.

Question 15

What can your MCV be described as?

Answer 15

Normocytic (normal)

Macrocytic- big

Microcytic- small

Question 16

What is the commenest cause of hypochromic, microcytic anaemia?

Answer 16

Iron deficiency.

Question 17

What are some other less common causes of anaemia?

Answer 17

Thalassaemias

Anaemia of chronic disease

Sideroblastic anaemia (bone marrow produces ringed sideroblasts rather than healthy RBCs)

Question 18

Nutritional causes for macrocytic anaemia?

Answer 18

B12 or folate deficiency (you get immature cells as they cant undergo DNA replication without these, this means they will be bigger).

Question 19

Name some other causes of macrocytic anaemia?

Answer 19

Myelodysplagia

myeloma

aplastic anaemia (stem cells are damaged causing pancytopenia)

Reticulocytosis

Cold agglutinins

Question 20

What can cause macrocytosis without anaemia?

Answer 20

Alcohol

Liver disease

Hypothyroidism

Question 21

What can cause normocytic normochromic anaemia?

Answer 21

Acute blood loss or early in iron deficiency

Hypoproliferative- low reticulocyte count- (they havent had time to respond yet.

Could be due to chronic diseases, anaemia of renal failure, hypometabolic states, marrow failure

Question 22

Why does renal failure cause a failure in reticulocytosis?

Answer 22

Renal failure means EPO is not produced therefore the bone marrow isnt stimulated.

Question 23

How can an inflammatory stimulus result in anaemia?

Answer 23

It activates T cells and monocytes

Which inhibit EPO release, increase hepatic synthesis of hepcidin, augment hemophagocytosis and inhibit erythroid proliferation.

Question 24

How can you distinguish between iron deficiency anaemia and anaemia of chronic disease?

Answer 24

Iron deficiency- low ferritin and transferase. MCV will be reduced.

Chronic disease- normal/high ferritin and low transferase. MCV will also be normal.