1.
Dr Paul Grant

2.
 Men <135 g/L
 Women <115 g/L
 When to transfuse?
◦ Depends on acute vs chronic
◦ In acute, <80 g/L
◦ In chronic can cope with lower
◦ Take care in heart failure

3.
 Group and save vs crossmatch?

4.
 https://www.nobelprize.org/educational/med
icine/bloodtypinggame/gamev2/index.html

5.
 Iron deficiency anaemia
 Thalassaemia
 Sideroblastic anaemia
 Anaemia of chronic disease

6.
 Not a diagnosis on its own, there’s always a
cause
 Bleeding
◦ GI- endoscopy
◦ Menorrhagia
 Malabsorption
◦ Coeliac
 Hookworm

7.
 Mutated Hb
 Normal adult Hb (HbA)= 2α + 2β
 α chain has 2 genes (4 alleles)
 β chain has 1 gene (2 alleles)
 Diagnosis= Hb electrophoresis
Microcytic

8.
 Minor= 1 mutated allele= asymptomatic
 Major= both alleles mutated
◦ Anaemia
 Poor RBC production
 Haemolysis in speen (extravascular haemolysis)-
splenomegaly
◦ Secondary haemochromatosis
◦ Skeletal deformities
Microcytic

9.
Microcytic

10.
Microcytic

11.
 One allele mutated= silent carrier
 2 alleles= trait- like β minor
 3 alleles= HbH disease- more like β major
 4 alleles= Hydrops foetalis (death in utero)
Microcytic

12.
Microcytic

13.
 Acute blood loss
 Anaemic of chronic disease (or microcytic)
 Bone marrow failure
 Renal failure
 Hypothyroidism (or macrocytic)
 Haemolysis (or macrocytic)
 Mixed
 Dilutional

14.
 Megaloblastic anaemia
◦ B12 and folate deficiency
 Non-megaloblastic anaemia
◦ Alcohol
◦ Reticulocytosis (e.g. haemolysis)
◦ Hypothyroid, pregnancy, liver disease

15.
Macrocytic

16.
 Folate deficiency
◦ Diet
 B12 deficiency
◦ Pernicious anaemia- parietal cell/ intrinsic factor
antibodies
◦ Sub-acute combined degeneration of the cord
◦ Replace B12 first!
Macrocytic

17.
 Extravascular vs intravascular
 Features
◦ Increased bilirubin (unconjugated)
◦ Increased reticulocyte count (hence increased MCV)
◦ Decreased haptoglobin (less so in extravascular)
◦ Haemoglobinuria (not in extravascular)
Macrocytic

18.
 Hereditary
◦ G6PD (Heinz bodies, bite cells)
◦ Pyruvate kinase deficiency
◦ Hereditary spherocytosis / elliptocytosis
◦ Sickle cell/ thalassaemia
Macrocytic

19.
 Acquired
◦ Autoimmune haemolytic anaemia- warm vs cold
(Coombs test- direct vs indirect)
◦ Microangiopathic haemolytic anaemia- HUS, TTP,
DIC (schistocytes)
◦ Macroangiopathic haemolytic anaemia- heart valves
◦ Paroxysmal nocturnal haemoglobinuria
Macrocytic

20.
Macrocytic

21.
Macrocytic

22.
Macrocytic

23.
 Decreased production
◦ Generalised bone marrow dysfunction
 Decreased survival
◦ Immune mediated- ITP, HIT
◦ Consumption- microangiopathic haemolytic
anaemia- DIC, TTP, HUS

24.
 Chronic
◦ Women 20-40
◦ Antibodies against platelet membrane glycoproteins
resulting in destruction by spleen
 Acute
◦ Self limiting, children after viral infections
◦ Petechiae and increased bleeding tendency

25.
 Consumption of platelets due to deficiency in
ADAMTS 13
 Degrades certain vWF, promotes platelet
aggregation
 Fever, thrombocytopaenia, microangiopathic
haemolytic anaemia, transient neurological
defects, renal failure

26.
 Acute renal failure more severe than in TTP
 Largely due to E coli 0157- produces a toxin
which damages endothelial cells
 Patients present with bloody diarrhoea,
followed a few days later by acute renal
failure and microangiopathic anaemia

27.
 Massive activation of clotting cascade due to
severe physiological stressor
 Obstetric complications, infections (sepsis),
neoplasms, massive tissue injury (burns)

28.
 ANAEMIA – consider by size
 KNOW different cell types / names / describe
 PLATELET DISORDERS
 TRANSFUSION
 Signs & symptoms

29.
 What is your own blood type?
 Why give B12 before folate?
 What is the COOMB’s test?
 Take the Haematology quiz -
https://www.proprofs.com/quiz-
school/story.php?title=hematology-
competency-quiz