anaemia Flashcards
why gaviscon -> anarmia
iron best absorbed in acidic env
what transports Fe into enterocyte
DMT1
what transports Fe from enterocyts into blood
ferroportin
what gets the iron off haem
haem oxygenase
what carries fe in blood
transferrin
which type of Fe can be absorbed ino enterocye
Fe2+
who reduces Fe3+ to Fe2+
reductase or anti ox like vit C
which enzyme blocks ferroportin
hepcidin
where is hepcidin made
liver
what Fe ox state is it carried in by transferrin
3+
how is iron used in normal cells
mitochondria use it in cytochrome enzyems
liver releases ferritin in acute inflammation. what does this mean?
in eg RA, serum ferritin can be high even in anaemia
doctor name for bone marrow
myeloid tissue
where does erythropoiesis happen
red bone marrow
what happens in yellow bone marrow
lymphopoiesis
what controls rate of erythropoiesis
EPO
where EPO made
kidneys interstitial cells near proximal tubules
what causes ++EPO
low oxygen
what does EPO do
increase erythroblast maturation and pro erythroblast formation
where foetal erythropoiesis
You - yolk sac 3-8 wks
Like - Liver 6wk - birth
Split - spleen 8-28 wk
Bonanas - bone marrow18wk to adult
how does reticulocyte get out of BM
diapedesis
what molecule causes colour of faeces
stercobilin
what molecule causes colour of wee
urobilin
what is Haem - Fe2+
unconjugated bilirubin
where does unconjugated bilirubin go?
liver bound to albumin in the blood
what heppens to bilirubin in the liver
gets conjugated with glucoronic acid -> bilirubin diglucoronide
how is bilirubin gotten rid of
secreted in bile
where is erythrocyte destruction
spleen by macrophages
what is glossitis
inlfammation and depapillation of the tongue
what is koilonychia
spoon shaped nails
what is angular cheilitis
swelling at corners of mouth
weird symptom of IDA
pica - eating non-food such as dirt or ice
name 5 tests for IDA
IDA in older adult or younger with no obvious apparent cause
CHECK FOR GI MALIGNANCY
what does haptoglobin do
mop up free haemoglobin in the blood
haemolytic anaemia divided into
DAT +
DAT-
DAT + indicates the presence of immunoglobulin (Ig)G, IgM, IgA or complement (usually C3d) bound to the red cell membrane so basically very likely to be autoimmune condition
DAT - haemoglobinopathies membranopathies
infections
DAT - haemoglobinopathy example
sickle cell
is sickle cell DAT+
no
infection that can cause haemolytic anaemia
malaria
clostridium
how does acute haemolytic anaemia present?
pt is bright yellow
why is patient bright yellow
too much conjugated bilirubin
what testresults in acute haemolytic anaemia
haemoglobinuria
haemoglobinaemia
risk factor for caridac arrest in acute haemolytic anaemia
acute hyperkalemia
jaundice, splenomegally and pigment gallstones are signs of
acute haemolytic anaemia
what is alloimmune haemolytic anaemia
you develop antibodies to transfused blood
Or neonatal - mum’s antibodies start to haemolyse baby blood
3 problem areas in RBC that can lead to haemolytic anaemia
enzymes
membrane
haemoglobin misspelling
what is intravascular haemolytic anaemia
what is extravascular haemolytic anaemia
why splenomegaly in what is intravascular haemolytic anaemia
extramedullary haematopeosis - making rbc in red pulp of spleen
which membrane proteins can go wrong to cause hereditary spherocytosis
Heterogeneous – deficiencies of spectrin (41.5%), ankyrin (1.5%), band 3 (17%), band 4.2 (21.5%)
hereditary spherocytosis mode of inheritance
AD
what is this common inherited maemolytic anaemia
spherocytosis
why pt urine normal in day and black at night
Paroxysmal nocturnal haemoglobinuria
what is cause of Paroxysmal nocturnal haemoglobinuria
problem with RHAG
complement mediated
what is tx for Paroxysmal nocturnal haemoglobinuria? Moa?
eculizumab - binds C5 protein so can’t be activated
sickle cell mutation
point - glu is now val
reticulocyte count in sickle
3-4-500
sickle hallmarks
ischaemia
shortened rbc lifespan
++inflammation
could be pyrexia
vasoocclusion
infection
stroke in children
most common enzymopathy
G6PD
meds to avoid in G6PD
Dapsone. Methylene blue. Nitrofurantoin. Pegloticase. Phenazopyridine. Primaquine. Rasburicase. Tafenoquine.
Chemicals to avoid. Naphthalene (an ingredient found in moth balls)
G6PD mode of inheritance
X linked but female pts are seen
G6PD
