Anaemia Flashcards
what is anaemia?
a reduction in haemoglobin in the blood (below normal for the population)
does anaemia mean a reduction in red blood cells?
not necessarily
what are the 3 causes of anaemia?
- reduced production
- increased losses
- increased demand
what is meant by marrow failure?
marrow is not able to make RBCs that package haemoglobin
what are haematinics?
things used to make RBCs
give examples of haematinics?
- iron
- folate
- vit B12
what are some sources of iron?
- meat
- green leafy vegetables
- iron tablets
how is haem iron dissolved?
dissolved specifically through a transporter system direct in the intestinal wall
how does NON-HAEM IRON differ from HAEM IRON?
• non-haem must be converted from Fe3+ to Fe2+ before being absorbed
what is iron stored as inside the cell?
FERRITIN
what iron is easier to deal with?
haem iron?
what are some diseases that reduce iron absorption?
- achlorhydria
* coeliac disease
what is achlorhydria?
- lack of stomach acid
- so no conversion of non-haem iron
- may be drug induced
what drugs can cause achlorhydria?
proton pump inhibitors
what is coeliac disease?
a disease that affects intestinal villi so absorption is affected
what can iron loss be caused by?
- gastric errors and ulcers
- inflammatory bowel disease
- bowel cancer
- haemorrhoids
why does inflammatory bowel disease and bowel cancer cause iron loss?
both cause GI tract bleeding
how is vitamin B12 absorbed?
- intrinsic factor is secreted by gastric parietal cells
- intrinsic factor binds to vitamin B12 (taken in through diet)
- absorbed in the intestine
where specifically is vitamin B12 absorbed?
the ILEUM
what organ stores a lot of vitamin B12?
the liver
how can vitamin B12 deficiencies occur?
- lack of intake
- lack of intrinsic factor
- disease of terminal ileum
what autoimmune disease causes a lack of intrinsic factor?
pernicious anaemia
what foods are rich in vitamin B12?
- meat
- dairy
- eggs
what foods are rich in folate?
leafy green vegetables
how can folic acid deficiencies occur?
- lack of intake
* absorption failure
what can folic acid deficiency result in in pregnancy?
neural tube defect in foetus
what diseases cause abnormal globin chains?
- thalassaemia
* sickle cell
describe the haem production of thalassaemia:
normal haem production
what are some clinical effects of thalassaemia?
- chronic anaemia
- marrow hyperplasia
- splenomegaly
- cirrhosis
- gallstones
what is marrow hyperplasia?
bones expand producing skeletal abnormalities (normally seen in skull)
how can thalassaemia be managed?
- blood transfusions
* prevent iron overload
describe RBCs in a patient with sickle cell anaemia?
RBCs have curled up edges & are no longer able to squeeze through capillaries
what is a microcytic cell?
small RBC
what is a macrocytic cell?
large RBC
what do large RBCs normally indicate ?
immature red blood cells are large
what is a hypochromic cell?
RBCs are pale/lack colour due to less haemoglobin
what is meant by ansiocytic cells?
red cell size range is very large (very big cells & very small cells)
what is a red blood cell that is ALMOST mature?
reticulocytes
what are some signs of anaemia?
- pale
- tachycardia
- enlarged liver (rare)
- enlarged spleen (rare)
what are the symptoms of anaemia?
- tired & weak
- dizzy
- shortness of breath
- palpitations
what are some physical traits of anaemia?
- pale mucosa
- smooth tongue
- beefy tongue
how could you investigate a potential anaemia?
- check history of patient
- full blood count
- check for GI blood loss
- bone marrow examination
what are the treatments for anaemia?
- replace haematinics
- transfusions
- provide erythropoietin
how are haematinics replaced?
- 1mg IM vitamin B12 every 2 months
* 5mg folic acid daily
what are the dental implications of anaemia?
- lower O2 capacity related to general anaesthesia
- mucosal atrophy
- candidiasis
- recurrent oral ulceration
- sensory changes
