Haematinics Flashcards
what are haematinics
Haematinics are the nutrients needed by the bone marrow to make blood cells in the process of haematopoiesis. Without adequate amounts of these nutrients, cytopenia(s) and related symptoms can develop. Excess amounts can also be pathological and can point to various underlying disease states.
ferritin? range? importance?
Ferritin is an intracellular protein complex that binds iron and is responsible for most iron storage in the body.
also is an acute phase protein so increases in inflammatory states, chronic kidney disease, liver disease, and malignancy.
<15 μg/l is indicative of an iron deficiency in those aged >5 years.
A level of <150 μg/l should act as a trigger to consider further investigations for potential iron deficiency if a patient has a concurrent inflammatory condition (acute or chronic) or renal impairment.
if testing ferritin, what else do you test?
CRP
as serum ferritin within the normal range cannot exclude iron deficiency if a patient has raised inflammatory markers or a history of acute or chronic illness.
transferrin vs total iron binding capacity
total iron binding capacity (TIBC) = percentage of transferrin free to bind (if high = looking for iron in the body. When iron is low, more is produced to try and search for iron so total binding capcity is high)
transferrin = the protein that binds to iron so transferrin saturations is the percentage of transferrin bound
Like TIBC, transferrin can rise in iron deficiency as the body tries to increase the total iron-binding capacity. However, transferrin is a negative acute-phase protein and so decreases in inflammatory states.
transferrin saturation = Transferrin saturation, abbreviated TS and measured as a percentage, is the ratio of serum iron and total iron-binding capacity (TIBC). TS is a more useful indicator of iron status than just iron or TIBC alone.
For instance, a value of 15% means that 15% of iron-binding sites of transferrin are being occupied by iron. The three results are usually reported together. A low transferrin saturation is a common indicator of iron deficiency anemia whereas a high transferrin saturation may indicate iron overload or hemochromatosis.
transferrin saturation value supportive of IDA
<16% as supportive of a diagnosis of iron deficiency
transferrin and inflammation?
negative acute-phase protein and so decreases in inflammatory states.
serum cobalamin levels
serum cobalamin
<148pmol/l as evidence of B12 deficiency
It is possible to be clinically deficient in vitamin B12 with a normal range serum cobalamin level and vice versa.
what autoantibodies would you test if b12 defieciency
pernicious anaemia:
- anti- intrinsic factor (anti-IF)
- anti-gastric parietal cell
coeliac:
- anti-ttg
- anti-EMA
when is secondary testing for 12 defiency indiacted? what does it involve? main one?
Secondary testing is indicated if a patient presents with convincing clinical features of vitamin B12 deficiency (e.g. macrocytic anaemia and glossitis or neurological symptoms) but has normal serum cobalamin levels.
Total plasma homocysteine
Plasma methylmalonic acid MMA - RAISED in b12 DEF
Holotranscobalamin
what should happen to reticulocyte count once b12 injections commenced
Once treatment is commenced, an increase in reticulocyte count should occur in the first 7-10 days.
what vitamin is folate?
vitamin B9
foalte vs folic acid
Folate is the term for all biological forms of vitamin B9, while folic acid refers to the synthetic form used for treatment
where is folate absorbed and found?
terminal ileum, and half of the body’s folate is found in the liver
how do you test for folate defiency? ranges
The serum folate level is the most useful initial screening test. No internationally recognised level defines deficiency, but a level <7nmol/l is generally used. Below this level, the risk of megaloblastic anaemia sharply increases.
Therefore, there is a grey area from 7-10nmol/l, in which case a treatment trial may be helpful.
what is secodnary testing folate def
if initial neg but suspicion
high plasma homocysteine supports diagnosis (but is also high in b12
