Anaemia Quiz

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Which statement best describes anaemia?

A A disorder caused exclusively by iron deficiency affecting haemoglobin synthesis
B A haemoglobin concentration below the expected range, reducing the oxygen-carrying capacity of blood ✓
C A disease defined by increased destruction of red blood cells in the spleen only
D A condition in which white blood cell production is reduced leading to impaired immunity
E A standalone diagnosis that explains symptoms such as fatigue without further investigation

The answer is B: A haemoglobin concentration below the expected range, reducing the oxygen-carrying capacity of blood

Explanation

Why B is correct

See What is Anaemia?. Option B is correct. Anaemia is the condition in which the body has insufficient haemoglobin (the protein in red cells that carries oxygen) to meet its needs, so tissues receive too little oxygen. In practice it is defined by a haemoglobin level below the reference range. In non-pregnant adults, this is below 130 g/L in males and below 120 g/L in females, although the limits can vary with ethnicity and other conditions. The low haemoglobin causes the symptoms: tiredness, breathlessness, palpitations and pallor, all due to poor oxygen supply. Anaemia can arise at any point in the red cell life cycle: impaired production, increased loss through bleeding or increased destruction (haemolysis). It is also not a diagnosis on its own, because it always reflects something else, such as a deficiency, chronic disease, bleeding or an inherited disorder. That is why the right response to a low haemoglobin is to ask why.

Definition: Too little haemoglobin to meet the body's needs, so tissues receive too little oxygen.
Thresholds: In non-pregnant adults, haemoglobin below 130 g/L in males and below 120 g/L in females.
Mechanisms: Impaired production, increased loss or increased destruction.
Diagnosis: Anaemia is not a diagnosis on its own, so always ask why.

Why the other options are incorrect

A. A disorder caused exclusively by iron deficiency affecting haemoglobin synthesis: Iron deficiency is the commonest single cause but not the only one. Vitamin B12 or folate deficiency, haemolysis, chronic disease and inherited haemoglobin disorders can all cause anaemia.
C. A disease defined by increased destruction of red blood cells in the spleen only: Red cell destruction in the spleen is only one possible mechanism, called extravascular haemolysis, and spleen-only destruction is not a definition. Anaemia can also come from poor production or blood loss.
D. A condition in which white blood cell production is reduced leading to impaired immunity: Reduced white cell production causes leucopenia (a low white cell count) and impaired immunity, which is a separate problem. Anaemia concerns red cells and haemoglobin and the delivery of oxygen to tissues.
E. A standalone diagnosis that explains symptoms such as fatigue without further investigation: Anaemia is not a standalone diagnosis. It is a sign of an underlying problem, so fatigue in an anaemic patient is a reason to look for the cause, not to stop investigating.

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1
Which mechanism most directly explains the development of anaemia in chronic kidney disease?
2
Which principle best underpins the management of anaemia across most causes?

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