5. Cardiovascular System Pathologies Flashcards
Anaemia
• A deficiency in haemoglobin given the persons age, sex and geographical location.
Anaemia: Signs and Symptoms
SYMPTOMS:
* Feeling fatigued: lack of oxygen being delivered to various tissues -> the cells cannot make energy if they don’t get enough oxygen.
* Shortness of breath on exertion (= effort, strain)
* Palpitations (= heart racing): the heart desperately tries to
move enough blood around the body to
deliver sufficient oxygen to the tissues.
* Irritability and fainting: because of a lack of oxygen in the
brain.
• SIGNS:
* Tachycardia: fast heart rate
* Thin & thready (= weak) pulse: because of the heart
racing
* Pallor skin/conjunctiva (= tissue on the inside of the eye
lids, that covers the white of the eye) -> result of not
enough oxygen to the tissues there.
Normal Haemoglobin ranges
Males 13 - 18 g/dl
Females 11.5 - 16.5 g/dl
Pregnanct >11 g/dl
Iron-Deficiency Anaemia
• The most common cause of anaemia worldwide.
• Iron deficiency: leads to hypochromic (= low in colour,
paler) microcytic (= small) erythrocytes (= red blood cells).
-> Not enough iron available we cannot make haemoglobin in erythrocytes causing them to appear paler & smaller. Hence iron deficiency anaemia is a ‘hypochromic microcytic anaemia’.
Iron-Deficiency Anaemia: Causes
- Deficient dietary intake (e.g. low dark leafy vegetables).
- Malabsorption: you need sufficient stomach acid and a healthy digestive system to absorb iron correctly. Low stomach acid because of coeliac, Crohn’s disease (=malabsorption diseases) can lead to iron-deficiency anaemia.
- Excessive blood loss (i.e. from menses (=menstruation) /GIT bleed (=Gastro Intestinal bleeding).
- Excess requirements (extra iron is needed) e.g. Pregnancy, rapid growth with children.
Iron-Deficiency Anaemia: Signs and Symptoms
SIGNS & SYMPTOMS:
• General anaemia signs & symptoms.
• Key signs: * Koilonychia: Spoon shaped nails
* angular stomatitis: cracking on the outside
of the mouth
* glossitis: a soar red tongue
* brittle hair
* tachycardia (=abnormal rapid heart beat)
• Blood tests: Low RBCs & Hb, low ferritin. Ferritin stores iron. If we recently had to rapidly make a lot of red blood cells, our store of iron is going to be low.
Iron-Deficiency Anaemia: Treatment
TREATMENT:
• Treat cause!
• Also: Herbs (Withania), beetroot, dark green leafy vegetables, pumpkin and sunflower seeds. Iron supplementation (gentle organic ones that don’t upset the stomach)
Megaloblastic Anaemia
- Megaloblastic anaemia is characterised by large, immature and dysfunctional red blood cells.
- Happens because of a lack of folate or vitamin B12
- The maturation of red blood cells relies on having enough folate and B12 available. If they are short in supply the ability to make the red blood cells is compromised.
What happens? That DNA replication slows but the cell division continues -> results in the production of immature blood cells. Some of them might still have their nucleus in and they will be bigger than normal.
They will get more easily damaged as they circulate around the body. They have a shorter life circle.
=> With Megaloblastic Anaemia the erythrocytes are described as macrocytic (they are larger than normal). - Diagnosis by blood test: ‘MCV’>97 fL. MCV = Mean corpuscular volume. This volume is larger than normal in Megablastic Anaemie.
Megaloblastic Anaemia: Causes
• Deficient dietary intake of folate (folic acid) &/or vitamin B12 (rare, except in vegans). Vitamin B12 we find especially in animal products.
• Lack of intrinsic factor:
Intrinsic factor = a protein that is created by the stomach. Is required to absorb enough B12. This factor is a little bit like the guide document for the B12. If there is no intrinsic factor available the B12 just passes through the intestines completely ignored. When the intrinsic factor is there it will bind on to the B12 and helps to carry it into the bloodstream.
People with autoimmune disease (pernicious Anaemia), gastrectomy (=medical procedure where all or part of the stomach is surgically removed), chronic gastritis (=inflammation of the stomach lining), stomach cancer, Coeliac’s disease have a lack of intrinsic factor.
• Malabsorption in Crohn’s disease, surgical excision.
• Drugs–‘methotrexate ’is a folate antagonist -> Drug used for certain autoimmune diseases. It can create Megaloblastic Anaemia.
• In order for folate to function in the body, it must be modified (changed) by an enzyme that requires Vitamin B12.
• The liver has abundant stores of B12. B12 can be stored up for 2 to 4 years in the liver. Folate is only stored for max 4 months in the body. Is not stored in the fat tissues of the body.
=> we need to figure out which nutrient is missing. Folate or B12? And why? So that we can address that dietary and absorption in balance to correct the problem.
Megaloblastic Anaemia: Signs & Symptoms
SIGNS & SYMPTOMS:
• General anaemia signs & symptoms.
• Enlarged red sore shiny tongue.
• Neurological symptoms only with B12 deficiency: Tingling, numbness, weakness, loss of co-ordination, burning sensations, tinnitus, depression
=> you can get all strange symptoms within the nervous system when you lack B12. Reason: production and maintenance of the myelin sheath (= fatty cover over the nerve fibres) stops. The neurons stop cross firing, stop communicating with each other.
-> If you don’t have enough B12 you cannot make that protective myelin fatty sheet.
Megaloblastic Anaemis: Treatment
TREATMENT:
• B12 Deficiency: Increase Vitamin B12 with supplements or B12 injection for people with an absorption problem.
• Folate Deficiency: Folate supplementation and rich folate food like green leafy vegetables.
Aplastic Anaemias
• A rare and potentially life-threatening failure of haematopoiesis -> failure of production of all 3 blood types
(Red blood cells, White blood cells and platelets)
=> Result is ‘Pancytopenia’ (lack of all three blood cell types) and hypocellular bone marrow (few or no cells).
Aplastic Anaemias: Causes
• Congenital (condition that you are born with)
“Fanconi’s anaemia”
• Idiopathic (unknown cause).
• Can be secondary to drugs (naproxen, diclofenac etc.), chemicals, radiation, cancer, hepatitis/EBV.
Chemotherapy or radiation therapy for cancer can cause Aplastic Anaemias. These treatments are so heavy on the body that they actually suppress the bone marrow to the point where it is not producing sufficient levels of red blood cells, white blood cells and platelets.
Aplastic Anaemias: Signs and Symptoms
• Anaemia (pallor, headache, dyspnoea (shortness of breath or breathlessness), palpitations etc).
• Multiple infections (due to low white blood cell count)
• Easy bleeding (due to low thrombocyte count).
Most common cause of death is sepsis (blood poisoning), then haemorrhage (heavy blood loss)
Aplastic Anaemias: Treatment
- Treat the cause.
- Bone marrow stem cell transplant.
- Platelet transfusion/blood transfusion: in order to keep blood cell numbers up to prevent these nasty complication.
Haemolytic Anaemias
- Anaemia resulting from excessive breakdown of erythrocytes, when bone marrow activity cannot compensate for the loss of RBC’s.
- Erythrocyte life span can become as low as 5 days.
Haemolytic Anaemias: Causes
- Genetic e.g. sickle cell, thalassemia. Thalassemia is the name for a group of inherited conditions that affect haemoglobin. People with thalassaemia produce either no or too little haemoglobin.
- Rhesus factor incompatibility (blood transfusion problem)
- Malaria: The parasites of Malaria enter the red blood cells and also mature inside the red blood cells. Then the parasites bursts the cells open and damage the cells. Causing the red blood cells to be removed from the circulation. Malaria untreated can lead to Anaemia very quickly.
- Some drugs, chemicals, autoimmune diseases, radiation
Haemolytic Anaemias: Signs and Symptoms
- Same general signs & symptoms of anaemia.
- Jaundice: excess bilirubin production -> when we breakdown red blood cells, we recycle the globin and the iron. We turn the haem into bilirubin which we then conjugate and get rid of through the bile. If there is excessive destruction of red blood cells we are going to get more bilirubin produced then we can easily get rid of. As bilirubin is yellow in colour it can start to generate to yellow colour of the skin and white of the eyes.
- Splenomegaly: excess haemolysis (breakdown of the red blood cells) in the spleen causes it to enlarge, leading to abdominal distention (swollen from internal pressure) and a feeling of fullness quickly whilst eating.
- Gallstones: because of the increase of bilirubin going out in the bile
- Vascular occlusions (complete or partial blockage of a blood vessel): If the Haemolytic Anaemias is characterized by badly shaped red blood cells it is also possible that these might become occlusions. They might become blockages in blood vessels leading to a lack of oxygenated red blood cells in certain areas of the body.
