12-2 L2 Management of nutritional anemia

Question 1

Name 4 causes of Iron def anemia

Answer 1

1. Inadequate endowment at birth
2. Insufficient iron in diet
3. Blood loss
4. Malabsorption of iron

Question 2

Iron endowment

• when is it accumulated
• found where

Answer 2

• during the 3rd trimester
• hemoglobin

Question 3

what is the most common cause of dietary iron deficiency?

Answer 3

• Excessive consumption of Cow’s milk in young children

Question 4

Name 3 disease that cause malabsorption of iron

Answer 4

• Celiac disease
• Giardiasis
• Chronic gastritis
  
  • H. pylori
  • Autoimmune

Question 5

Name 2 drugs that cause malabsorption of iron

Answer 5

• Ranitidine (H₂ blocker)
• Omeprazole (PPIs)

Question 6

malabsorption of iron seen with IRIDA is seen in what?

Answer 6

• Isolated iron malabsorption
• Inborn errors of iron transport proteins

Question 7

How do you tell the difference b/t iron def and lead poisoning?

Answer 7

• Basophilic stippling in eryhtrocytes
• elevated free eryhtrocyte protoporphyrin
• Not microcytic anemia

Question 8

What is the best treatmnet of iron deficiency anemia?

Answer 8

ferrous sulfate

Question 9

When would you use parenteral iron vs oral iron?

Answer 9

• Indications
  
  • Impaired absorption of oral iron
  • intolerance of oral iron preparations

Question 10

What are 2 main causes of megaloblastic anemia

Answer 10

• folate deficiency
• cobalamin deficiency
• Both folate and cobalamin are required for DNA synthesis

Question 11

What is the functional role of folate and cobalamin?

Answer 11

• Folate
  
  • one carbon transfer (pyrimidine syn)
  • Purine biosynthesis
• Cobalamin
  
  • Syn of methionine (from homocysteine)
  • Formation of succinyl CoA (methylmalonyl CoA)

Question 12

Folate and Cobalamin

• absoprtion
• length of storage

Answer 12

• absorption
  
  • folate: proximal jejunum
  • Cobalamin: distal ileum
• length of storage
  
  • folate: several months
  • Cobalamin: several years

Question 13

Folate and cobalamin deficiency

Answer 13

• Folate: neural tube defects
• Hypersegmentation of neutrophils

Question 14

Folate and cobalamin def

• B12 def
• MMA
• response to treatment

Answer 14

• Folate
  
  • B12 def: no neurologic features of B12 def.
  • Normal MMA
  • complete response to folate (weeks)
• Cobalamin
  
  • B12 def: neurologic features
  • increased MMA
  • complete response to B12
    
    • retics (wks)
    • Hgb (wks)
    • neuro (mo-yrs)

Question 15

Anemia of cobalamin def responst ot folate

but was is key to id that this is cobalamin def rather than folate def.

Answer 15

• neurologic effects do not improve with folate and can progress
• correct diagnosis and treatment are key