Haematology Lecture on Anaemias

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Questions and Answers

Which characteristic feature is specifically associated with iron deficiency anaemia?

Hemolytic uremic syndrome

Glossitis (correct)

Hyperchromic red blood cells

Leukopenia

What physiological response occurs in the body to attempt to maintain adequate oxygenation during anaemia?

Elevated blood pH

Increased levels of 2,3-DPG (correct)

Reduced activity of red bone marrow

Decreased cardiac output

What is the typical lab finding on a blood film for someone with iron deficiency anaemia?

Normocytic normochromic red cells

Macrocytic hyperchromic red cells

Elliptocytosis

Microcytic hypochromic red cells (correct)

Which condition is a common cause of iron deficiency anaemia due to blood loss in men?

Gastrointestinal bleeding Signup and view all the answers

In iron deficiency anaemia, which laboratory measurement is indicative of iron deficiency?

Low plasma ferritin Signup and view all the answers

Which physiological demand is NOT typically associated with increased iron requirements?

Old age Signup and view all the answers

Which of the following conditions can lead to malabsorption of iron?

Celiac disease Signup and view all the answers

What type of anemia is characterized by microcytic, hypochromic red blood cells?

Iron deficiency anaemia Signup and view all the answers

In iron deficiency anaemia, what happens to serum transferrin and total iron binding capacity (TIBC)?

Both are increased Signup and view all the answers

Which of the following methods is NOT recommended for investigating the underlying cause of iron deficiency in men over 40 years and post-menopausal women?

Liver biopsy Signup and view all the answers

What is the recommended oral iron supplementation dosage for treating iron deficiency anaemia?

200 mg 3 times daily Signup and view all the answers

What indicates a failure to respond adequately to iron supplementation therapy?

Hb rise by less than 10 g/L every 7–10 days Signup and view all the answers

What distinguishes anaemia of chronic disease from iron deficiency anaemia regarding ferritin levels?

Ferritin is high in anaemia of chronic disease Signup and view all the answers

Which of the following is an indication for using parenteral iron therapy?

Inability to tolerate oral iron preparations Signup and view all the answers

What is the primary role of hepcidin in the context of anaemia of chronic disease?

To inhibit iron export from cells Signup and view all the answers

Which of these conditions is likely to lead to anaemia of chronic disease?

Chronic ulcers Signup and view all the answers

What characterizes megaloblastic anemia in terms of red cell maturation?

Arrested nuclear maturation with normal cytoplasmic development Signup and view all the answers

Which parameter typically shows increased levels in iron deficiency anemia?

Serum transferrin receptors Signup and view all the answers

What is the primary dietary source of vitamin B12?

Meat, eggs, and milk Signup and view all the answers

Which condition can lead to neurological manifestations due to vitamin B12 deficiency?

Subacute combined degeneration of the cord Signup and view all the answers

What occurs in the stomach that is crucial for vitamin B12 absorption?

Binding of vitamin B12 to intrinsic factor Signup and view all the answers

In patients with strict vegan diets, what deficiency could be a major risk?

Vitamin B12 deficiency Signup and view all the answers

What is the typical shape of mature red blood cells in megaloblastic anemia?

Oval-shaped Signup and view all the answers

Which of the following conditions is associated with increased Total Iron Binding Capacity (TIBC)?

Iron deficiency Signup and view all the answers

What can be observed in the bone marrow examination of a patient with megaloblastic anemia?

Hypercellularity with megaloblastic changes Signup and view all the answers

Signup and view all the answers

Study Notes

Haematology Lecture Notes

The lecture, titled "Anaemias," was presented on October 29, 2024.
The lecturer was Mohammed Ismael Dawood, an Assistant Professor in the Department of Medicine at the University of Fallujah, College of Medicine.
The lecture's stage was 5th.
The lecture covered three basic learning objectives
- Iron Deficiency anaemia
- Anaemia of chronic disease
- Megaloblastic Anaemia

Anaemias Overview

Approximately 30% of the global population is anemic, with iron deficiency being the cause in half of those cases.
The body's physiological response to anemia involves increasing 2,3-DPG levels to facilitate oxygen unloading in tissues.
This heightened activity leads to a hyperdynamic circulation, recognizable by a rapid pulse and potential heart murmurs.

Iron Deficiency Anemia

Iron deficiency anemia occurs when iron absorption cannot keep pace with iron loss.
Common causes include:
- Blood loss (GI tract bleeding, especially in men >40 and postmenopausal women due to colorectal or gastric malignancies, peptic ulcers, inflammatory bowel diseases, diverticulitis or angiodysplasia);
- Worldwide, parasites like hookworms and schistosomiasis;
- Menstrual bleeding (younger women);
- Pregnancy;
- Use of aspirin or NSAIDs exacerbating GI bleeding.
Other factors include:
- Malabsorption (gastric acid is required to dissolve iron from food for absorption; deficiency might arise from proton pump inhibitors or prior gastric surgery, and conditions like coeliac disease impacts the small intestine's ability to absorb iron);
- Increased physiological demands (puberty and pregnancy).

Iron Deficiency Anemia: Clinical Features

Glossitis (smooth, sore, red tongue)
Koilonychia (spoon-shaped nails)
Angular stomatitis (sores/cracks at mouth corners)
Alopecia (hair loss)
Pica (unusual food cravings, like clay or ice).

Iron Deficiency Anemia: Investigations

Blood film shows microcytic hypochromic red cells (low MCV and MCH).
Low plasma ferritin levels; however, elevated ferritin levels might occur due to liver disease or inflammation.
Helpful investigations include:
- Transferrin saturation (<16%)
- Elevated soluble transferrin receptor.

Anaemia of Chronic Disease

This type of anemia is often associated with chronic infections, inflammation, and cancer.
A key regulatory protein, hepcidin, inhibits iron export from cells; despite high iron stores.
Characteristic features include: diminished total iron binding capacity (TIBC), and low/normal soluble transferrin receptor.
The anemia is usually normocytic and normochromic, but reduced MCV may occur in long-standing inflammation.

Investigations to Differentiate Anemia Types

A comparison table (refer to page 14 of notes) highlights how different markers vary across iron deficiency anemia, and anaemia of chronic inflammation cases.

Megaloblastic Anemia

This anemia results from vitamin B12 or folate deficiency, which are needed for DNA synthesis.
The anemia presents with large, immature red blood cells (megaloblasts).
Mature red blood cells often have an oval shape, and white blood cells exhibit hypersegmented nuclei.
Severe cases can lead to pancytopenia.
Bone marrow examination shows increased cellularity and megaloblastic changes.

Vitamin B12 Deficiency

The average diet contains more than needed, mainly from meat, eggs, and milk.
Gastric enzymes release vitamin B12, which then bonds with R protein.
Intrinsic factor, a different protein, is then involved in releasing vitamin B12 from R protein as gastric emptying occurs.
Absorption occurs in the terminal ileum and transport is facilitated by transcobalamin II (produced by the liver).
Liver vitamin B12 stores typically last for 3 years; deficiency may take a while to manifest.
Neurological manifestations include peripheral neuropathy, subacute combined degeneration of the spinal cord (posterior columns affecting proprioception and vibration sense; corticospinal tract damage causing upper motor neuron signs), dementia, and optic atrophy.

Causes of Vitamin B12 Deficiency

Dietary deficiency (very rare).
Gastric factors (gastric surgery, or conditions impairing gastric acid and intrinsic factor production/secretion)

Pernicious Anemia

An autoimmune condition; Atrophy of the gastric mucosa, and loss of the parietal cells cause intrinsic factor deficiency and vitamin B12 malabsorption.
Often associated with other autoimmune conditions (e.g., Hashimoto's thyroiditis, Graves' disease, vitiligo, and Addison's disease).
Diagnosed with the Schilling test (formerly but less so, with the advent of autoantibody tests, radioactive tracers being less used).

Terminal ileal disease (e.g., Crohn's disease) or ileal resection impairs vitamin B12 absorption.
Motility disorders causing bacterial overgrowth can compete for free vitamin B12 leading to deficiency.

Megaloblastic Anemia: Clinical Features

General signs and symptoms (malaise, breathlessness, paraesthesias, etc.), or skin pigmentation, heart failure, or fever might be present.
Specific signs include smooth tongue, angular cheilosis, or vitiligo.

Folate Deficiency

Dietary sources include leafy green vegetables, fruits, liver, and kidneys.
Deficiency can develop within weeks, as total body folate stores are small.
Causes include poor dietary intake, malabsorption, increased demand (pregnancy, hemolysis), and drug interactions (like phenytoin, oral contraceptives, or methotrexate).

Management

Iron Deficiency: Oral iron supplementation (ferrous sulfate 200 mg three times a day) for 3-6 months, alongside treatment of the underlying cause. Hemoglobin (Hb) should increase by 10 g/L every 7–10 days.
B12 Deficiency: Treatment involves IM injections of hydroxycobalamin (1000 μg, 6 doses, 2-3 days apart), followed by lifelong maintenance doses (1000 µg every 3 months). Neurology improvement takes 6-12 months.
Folate Deficiency: Oral folic acid (5 mg daily). Also used as prophylactic measure in pregnancy or chronic conditions with reduced red blood cell lifespan (e.g., autoimmune hemolytic anemia or hemoglobinopathies).

Megaloblastic Anemia Investigations

A table (page 27/notes) displays related investigations—hemoglobin, mean cell volume, erythrocyte count, blood film (oval macrocytosis; poikilocytosis), reticulocyte count, bone marrow, serum ferritin, or plasma lactate dehydrogenase.

Key takeaway:

Careful consideration of clinical presentation, associated conditions, and relevant investigations are key in differentiating types of anemia.

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Description

Explore the key concepts from the haematology lecture on anaemias including iron deficiency anaemia, anaemia of chronic disease, and megaloblastic anaemia. Understand the physiological responses and prevalence of anaemia globally. This quiz covers the important aspects of these medical conditions as presented by Professor Mohammed Ismael Dawood.