Anaemia

Question 1

Physiology of folate absorption?

Answer 1

• Vitamin B12 is found in meat fish and dairy products but not plants
• B12 absorption requires the prescence of intrinsic factor secreted by the parietal cells of the stomach and is then absorbed in the terminal ileum
• B12 is essential for thymidine and thus DNA synthesis
• There are many causes of B12 anaemia, these include lack of dietary intake and malabsorption but the most common cause is pernicious anaemia

Question 2

Pathophysiology of perniscious anaemia?

Answer 2

an auto immune disorder in which the parietal cells of the stomach are attacked  atrophic gastritis and a lack of intrinsic factor release
o A disease found commonly in the elderly
• Ab are targeted to the parietal cells or intrinsic factors

Question 3

Investigation of perniscious anaemia?

Answer 3

Megaloblastic anaemia and slight raise in bilirubin due to Hb breakdown.
§]
antibodies
anti intrinsic factor antibodies: sensivity is only 50% but highly specific for pernicious anaemia (95-100%)
anti gastric parietal cell antibodies in 90% but low specificity so often not useful clinically

Question 4

Management of perniscious anaemia?

Answer 4

o Replenish B12 with IM Hydroxocobalamin
 1 mg IM hydroxycobalalmin 3 times weekly for 2 weeks, then once every 3 months
• More intense if there are neurological signs ie 1 mg every other day until the symptoms improve
o IF THERE IS ALSO FOLATE DEFICIENCY THEN IT IS KEY TO TREAT THE B12 DEFICIENCY FIRST_
 SUBACUTE COMBINED DEGENERATION OF THE SC.