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This is the complete lecture note for MED612 Haematology II. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: MED 612 Course title: Haematology II Course credit load: 2 Units Series 1: Nutritional and Haemolytic Anaemias • Part 1.1: Approach to Anaemia o Sub Part 1.1.1: Classification of anaemia o Sub Part 1.1.2: Clinical presentation of anaemia o Sub Part 1.1.3: Investigation of anaemia • Part 1.2: Nutritional Anaemias I: Iron Deficiency o Sub Part 1.2.1: Pathophysiology and causes of iron deficiency anaemia o Sub Part 1.2.2: Clinical presentation and investigation of iron deficiency anaemia o Sub Part 1.2.3: Management of iron deficiency anaemia • Part 1.3: Nutritional Anaemias II: Megaloblastic Anaemia o Sub Part 1.3.1: Pathophysiology of megaloblastic anaemia o Sub Part 1.3.2: Vitamin B12 deficiency o Sub Part 1.3.3: Folate deficiency • Part 1.4: Haemolytic Anaemia o Sub Part 1.4.1: Classification and mechanisms of haemolysis o Sub Part 1.4.2: Clinical presentation and investigation of haemolytic anaemia o Sub Part 1.4.3: Causes and management of haemolytic anaemia Introduction This opening Series of Haematology II builds the structured framework for approaching anaemia before working through two genuinely major categories in depth, the nutritional anaemias, arising from a deficiency of a specific building block red cell production depends on, and haemolytic anaemia, arising instead from premature red cell destruction rather than inadequate production.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS The aim of this Series is to equip you with the ability to classify anaemia and describe its presentation and investigation, describe the pathophysiology, presentation, and management of iron deficiency anaemia, describe megaloblastic anaemia including vitamin B12 and folate deficiency, and classify haemolytic anaemia and describe its mechanisms, presentation, causes, and management. This Series opens with the approach to anaemia, moves through nutritional anaemias I: iron deficiency and nutritional anaemias II: megaloblastic anaemia, and closes with haemolytic anaemia. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: classify anaemia and describe its clinical presentation • SLO 1.2: describe the investigation of anaemia • SLO 1.3: describe the pathophysiology, presentation, and management of iron deficiency anaemia • SLO 1.4: describe megaloblastic anaemia • SLO 1.5: describe vitamin B12 deficiency • SLO 1.6: describe folate deficiency • SLO 1.7: classify haemolytic anaemia and describe its mechanisms and clinical presentation • SLO 1.8: describe the causes and management of haemolytic anaemia 1.1 Approach to Anaemia 1.1.1 classification of anaemia Sorting by red cell size, the genuinely powerful starting point Anaemia, a reduction in haemoglobin concentration below the normal range for age and sex, is classified according to mean corpuscular volume, the average red cell size, into microcytic, small red cells, normocytic, normal-sized red cells, and macrocytic, large red cells, a classification carrying genuinely powerful diagnostic value, since specific categories of anaemia characteristically fall within one of these three size groups.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Microcytic anaemia most commonly reflects iron deficiency, discussed in depth in the following Part of this Series, macrocytic anaemia most commonly reflects megaloblastic anaemia from vitamin B12 or folate deficiency, discussed further later in this Series, and normocytic anaemia has a genuinely wider differential, including anaemia of chronic disease and many causes of haemolysis, discussed in the closing Part of this Series. Fill in the blank: Anaemia is classified according to mean corpuscular volume into microcytic, normocytic, and ________. 1.1.2 clinical presentation of anaemia Symptoms reflecting reduced oxygen delivery to tissues Anaemia presents with fatigue, breathlessness on exertion, and, in more significant cases, palpitations and dizziness, symptoms directly reflecting reduced oxygen delivery to tissues, and the severity and rate of symptom development depend heavily on both the degree of anaemia and how rapidly it has developed, since gradual, chronic anaemia allows genuine physiological compensation that can mask the severity of even a genuinely low haemoglobin level. Examination findings include pallor, most reliably assessed at the conjunctivae and nail beds given the genuine variability of skin colour assessment across different skin tones, and, in more significant anaemia, tachycardia and, in severe cases, a flow murmur reflecting increased cardiac output compensating for reduced oxygen-carrying capacity, alongside specific signs relevant to the underlying cause covered across the remainder of this Series. Fill in the blank: Pallor is most reliably assessed at the conjunctivae and nail beds given the genuine variability of ________ colour assessment. 1.1.3 investigation of anaemia The full blood count and blood film as the essential starting point The full blood count, providing haemoglobin concentration, mean corpuscular volume, and other red cell indices, forms the essential starting point for investigating any anaemia, and the blood film, direct microscopic examination of the red cells, provides genuinely valuable additional morphological information, including specific red cell shape abnormalities that can themselves point directly towards a specific underlying diagnosis. Further investigation, guided by the initial mean corpuscular volume classification already discussed, includes iron studies for suspected microcytic anaemia, vitamin B12 and folate levels for suspected macrocytic anaemia, and reticulocyte count, alongside haemolysis-specific
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS investigations discussed in the closing Part of this Series, for suspected normocytic anaemia with a haemolytic cause genuinely suspected. Fill in the blank: The blood film provides valuable additional morphological information, including specific red cell shape ________. Figure 1.1: A clinician examining conjunctival pallor as a sign of anaemia. Pilot questions 1.1 1. Describe the classification of anaemia by mean corpuscular volume. (Linked to SLO 1.1) 2. List the causes typically associated with each mean corpuscular volume category. (Linked to SLO 1.1) 3. Describe the symptoms and signs of anaemia. (Linked to SLO 1.1) 4. Explain why chronic, gradual anaemia can mask genuine severity. (Linked to SLO 1.1) 5. Describe the role of the full blood count and blood film in investigating anaemia. (Linked to SLO 1.2)
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.2 Nutritional Anaemias I: Iron Deficiency 1.2.1 pathophysiology and causes of iron deficiency anaemia The most common cause of anaemia worldwide Iron deficiency anaemia, the most common cause of anaemia worldwide, results from inadequate iron available for haemoglobin synthesis, whether from inadequate dietary intake, malabsorption, particularly coeliac disease already discussed in an earlier course of this programme, or, genuinely importantly, chronic blood loss, most commonly gastrointestinal or, in women of reproductive age, menstrual, each requiring a genuinely distinct diagnostic and management approach. In an adult, particularly a man or postmenopausal woman, presenting with genuinely unexplained iron deficiency anaemia, active investigation for an occult gastrointestinal source of blood loss, including the malignancy already discussed in an earlier course of this programme, is genuinely essential rather than assuming a purely nutritional or unidentified cause, given the potentially serious consequences of a missed underlying diagnosis. Fill in the blank: In unexplained iron deficiency anaemia, active investigation for an occult gastrointestinal source of blood ________ is genuinely essential. 1.2.2 clinical presentation and investigation of iron deficiency anaemia Anaemia symptoms alongside specific iron-related features Beyond the general symptoms of anaemia already discussed in Part 1.1, iron deficiency can produce specific additional features including koilonychia, spoon-shaped nails, angular stomatitis, cracking at the corners of the mouth, and, rarely, pica, craving for non-food substances such as ice or dirt, findings that, while genuinely specific to iron deficiency when present, are absent in a considerable proportion of affected patients. Iron studies, including serum ferritin, the most reliable single indicator of total body iron stores, alongside serum iron and total iron-binding capacity, confirm the diagnosis, though ferritin, as an acute phase reactant, can be genuinely falsely elevated in the presence of inflammation or infection, meaning interpretation genuinely requires clinical context rather than the ferritin value alone in isolation. Fill in the blank: Serum ferritin can be genuinely falsely elevated in the presence of inflammation or ________.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.2.3 management of iron deficiency anaemia Replacing the deficient iron, and treating the underlying cause Oral iron replacement, the standard first-line treatment, is genuinely effective though frequently limited by gastrointestinal side effects including constipation and nausea, and, where oral iron is genuinely poorly tolerated or malabsorption prevents adequate absorption, intravenous iron offers an effective alternative, delivering iron directly without relying on intestinal absorption. Genuinely importantly, treating the underlying cause of iron deficiency, whether dietary modification, treating identified malabsorption, or addressing an identified source of chronic blood loss, remains essential alongside iron replacement itself, since replacing iron alone without addressing an ongoing source of loss will genuinely fail to achieve lasting correction of the anaemia. Fill in the blank: Intravenous iron delivers iron directly without relying on intestinal ________. Table 1.1: Interpreting iron studies Test Typical finding in iron deficiency Genuine interpretive caution Serum ferritin Low Falsely elevated by inflammation Serum iron Low Genuinely variable throughout the day Total iron-binding capacity Elevated Reflects transferrin, not iron stores directly Pilot questions 1.2 1. List the causes of
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