TAKORADI TECHNICAL UNIVERSITY

FACULTY OF APPLIED SCIENCES

DEPARTMENT OF INDUSTRIAL AND HEALTH SCIENCES
PROGRAMME: B-TECH MEDICAL LABORATORY TECHNOLOGY LEVEL 300

COURSE TITLE: HAEMATOLOGY III COURSE CODE: MLS 335

MID-SEMESTER
Question 1:
George’s only complaint was dark urine and yellow colouration of the eyes. This FBC results
were:
Haemoglobin (Hb) = 3.1 g/dL
Haematocrit (HCT) = 8%
RBC count = 0.71 X 1012 /L
RDW = 21.0
Reticulocyte count = 22%

a. Calculate the erythrocyte indices (MCV, MCH, MCHC) (6 marks)

b. Considering the calculated MCV, MCH and MCHC, classify the iron based on
morphology, state one condition in which we can find this classification. (5
marks)
c. What type of haemolytic anaemia is this? (4 marks)
d. What is the significance of the RDW? (5 marks)
Question 2:
a. Explain why classification of anemia is important, and give the categories of the
morphologic and functional classifications of anaemia. (20 marks)

Question 3:

a. Define anaemia. (10marks)

b. State the signs and symptoms of anaemia. (10 Marks)

Question 1:

**Calculation of Erythrocyte Indices:**

1. Mean Corpuscular Volume (MCV) = (HCT ÷ RBC count) × 10
MCV = (8 ÷ 0.71) × 10 = 112.68 fL

2. Mean Corpuscular Hemoglobin (MCH) = (Hb ÷ RBC count) × 10

MCH = (3.1 ÷ 0.71) × 10 = 43.66 pg

3. Mean Corpuscular Hemoglobin Concentration (MCHC) = (Hb ÷ HCT) × 100

MCHC = (3.1 ÷ 8) × 100 = 38.75 g/dL
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**Classification of Iron Based on Morphology and Condition:**
Based on the calculated indices:
- MCV: 112.68 fL (High)
- MCH: 43.66 pg (Normal)
- MCHC: 38.75 g/dL (Normal)

This classification suggests macrocytic normochromic anemia. One condition associated with
this classification is megaloblastic anemia, commonly caused by vitamin B12 or folate
deficiency.

**Type of Haemolytic Anaemia:**

Given the macrocytic normochromic nature and the presence of reticulocytosis, this suggests a
hemolytic anemia. Specifically, based on the indices and presentation, it could be autoimmune
hemolytic anemia.

**Significance of RDW:**
Red Cell Distribution Width (RDW) is a measure of the variation in size of RBCs (anisocytosis).
In this case, RDW is 21.0, which indicates normal cell size variability. Significantly high RDW
can indicate the presence of different populations of RBCs, which may suggest ongoing or recent
erythropoietic stress or mixed deficiencies.

Question 2:

**Importance of Anemia Classification:**

Anemia classification is crucial for proper diagnosis, prognosis, and treatment. It allows
clinicians to understand the underlying causes, pathophysiology, and severity of anemia, guiding
appropriate management strategies. It also aids in communication among healthcare providers
and ensures consistency in research and clinical practice.

**Categories of Anemia Classification:**

1. **Morphologic Classification:**
- Microcytic Anemia: Characterized by low MCV (<80 fL), often associated with iron
deficiency or thalassemia.
- Normocytic Anemia: Characterized by normal MCV (80-100 fL), seen in conditions like
anemia of chronic disease or hemolytic anemia.
- Macrocytic Anemia: Characterized by high MCV (>100 fL), often due to vitamin B12 or
folate deficiency.

2. **Functional Classification:**
- Hypoproliferative Anemia: Results from decreased production of RBCs in the bone marrow,
seen in conditions like aplastic anemia or chronic kidney disease.
- Hemolytic Anemia: Results from increased destruction of RBCs, seen in conditions like
autoimmune hemolytic anemia or hereditary spherocytosis.
- Blood Loss Anemia: Results from acute or chronic blood loss, seen in conditions like
gastrointestinal bleeding or trauma.

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Question 3:

**Definition of Anemia:**
Anemia is a medical condition characterized by a deficiency in the number of red blood cells
(RBCs) or a deficiency in the amount of hemoglobin in the blood, leading to reduced oxygen-
carrying capacity of the blood.

**Signs and Symptoms of Anemia:**

1. Fatigue and weakness
2. Pale skin (pallor)
3. Shortness of breath (dyspnea) on exertion
4. Dizziness or lightheadedness
5. Rapid or irregular heartbeat (tachycardia or palpitations)
6. Cold hands and feet
7. Headache
8. Chest pain (in severe cases)
9. Cognitive problems, such as difficulty concentrating or memory loss
10. Brittle or spoon-shaped nails (koilonychia) in iron deficiency anemia.

TAKORADI TECHNICAL UNIVERSITY

FACULTY OF APPLIED SCIENCES
DEPARTMENT OF INDUSTRIAL AND HEALTH SCIENCES
PROGRAMME: B-TECH MEDICAL LABORATORY TECHNOLOGY LEVEL 300

COURSE TITLE: HAEMATOLOGY III COURSE CODE: MLS 335

Assignment:

Question 1:

a. States the causes of iron deficiency anaemia. (5 marks)

b. Explain the sequential development of iron deficiency anaemia. (10 marks)
c. State the clinical features of ID. (5 marks)

Question 2:
a. State the major causes of vitamin B12/ folate deficiency anaemia.
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 b. State the clinical features of vitamin B12/folate deficiency anaemia.

Answer

Question 1:

**Causes of Iron Deficiency Anemia:**

1. Inadequate Dietary Intake: Insufficient iron intake, especially in diets lacking in iron-rich foods.

2. Blood Loss: Chronic blood loss from sources such as gastrointestinal bleeding (ulcers, gastritis, colon
cancer), menstrual bleeding, or urinary tract bleeding.

3. Malabsorption: Conditions affecting iron absorption in the gastrointestinal tract, such as celiac disease
or inflammatory bowel disease.

4. Increased Demand: During periods of rapid growth (infancy, adolescence) or pregnancy, where iron
requirements are higher.

5. Poor Iron Utilization: Conditions such as chronic kidney disease or certain inflammatory disorders can
impair iron utilization.

6. Parasitic Infections: Certain parasitic infections, such as hookworm infestation, can lead to chronic
blood loss and iron deficiency.

**Sequential Development of Iron Deficiency Anemia:**

1. Iron Stores Depletion: Initially, there is depletion of iron stores in the body, leading to reduced levels
of stored iron (ferritin) in the bone marrow and liver.

2. Iron-Deficient Erythropoiesis: With continued inadequate iron supply, the bone marrow becomes
unable to produce sufficient hemoglobin, resulting in the production of small, pale red blood cells
(microcytic, hypochromic).

3. Anemia Development: As iron deficiency progresses, the body becomes unable to compensate for the
decreased oxygen-carrying capacity, resulting in the development of anemia characterized by low
hemoglobin levels and diminished oxygen delivery to tissues.

**Clinical Features of Iron Deficiency:**

1. Fatigue and weakness

2. Pallor (pale skin, conjunctiva, nail beds)

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3. Shortness of breath (dyspnea) on exertion

4. Cold intolerance

5. Headaches

6. Pica (craving for non-food items like ice, dirt, or starch)

7. Brittle nails

8. Glossitis (inflammation of the tongue)

9. Restless leg syndrome

10. Cardiac symptoms in severe cases (palpitations, angina)

Question 2:

**Major Causes of Vitamin B12/Folate Deficiency Anemia:**

1. Inadequate Dietary Intake: Lack of foods rich in vitamin B12 or folate, such as meat, eggs, dairy
products, leafy green vegetables, and legumes.

2. Malabsorption: Conditions affecting the absorption of vitamin B12 or folate, such as pernicious
anemia (autoimmune destruction of intrinsic factor), gastrointestinal surgery, Crohn's disease, or celiac
disease.

3. Increased Demand or Utilization: Pregnancy, lactation, rapid growth, or certain medications (e.g.,
methotrexate) can increase the demand for vitamin B12 or folate.

4. Alcoholism: Excessive alcohol consumption can lead to poor dietary intake and impaired absorption of
vitamin B12 and folate.

**Clinical Features of Vitamin B12/Folate Deficiency Anemia:**

1. Fatigue and weakness

2. Pallor (pale skin, conjunctiva, nail beds)

3. Shortness of breath (dyspnea) on exertion

4. Glossitis (inflammation of the tongue)

5. Neurological Symptoms: Peripheral neuropathy, tingling or numbness in hands and feet, balance
problems, cognitive impairment, memory loss, depression, and dementia (seen specifically in vitamin
B12 deficiency due to its role in nerve function).

6. Megaloblastic Changes: Large, immature RBCs (macrocytosis) and hypersegmented neutrophils on

peripheral blood smear.

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7. Pancytopenia: Decreased levels of white blood cells and platelets in addition to anemia in severe
cases.