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Module 5 - Haematology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What can MCV of RBCs tell us?

A

Can give a clue to the CAUSE of anemia.

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2
Q

What is spina bifida? Cause?

A

NEURAL TUBE DEFECT cause y vitamin B12 deficiency during pregnancy.

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3
Q

Name two causes of folic acid deficiency.

A
  1. lack of intake.
  2. Absorption failure
    - JEJUNAL disease – COELIAC disease.
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4
Q

What are the 2 causes of hemoglobin problems?

A
  1. Inability to make HAEM –> usually due to iron deficiency.
  2. Inability to make CORRECT GLOBIN CHAINS –> thalassemia, sickle cell anemia, hemoglobinopathies.
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5
Q

How is Vitamin B12 absorbed in the body?

A
  • Secretion of INTRINSIC FACTOR by GASTRIC PARIETAL CELLS.
  • Binding of intrinsic factor to vitamin B12 and passing to the TERMINAL ILEUM to be absorbed by a transporter system.
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6
Q

What does thalassemia cause?

A
  • Normal HAEM production, GENETIC MUTATION OF GLOBIN CHAINS.
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7
Q

Define anemia

A

Anemia is a REDUCTION IN HEMOGLOBIN in the blood from the NORMAL VALUES in that population.

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8
Q

Where can folate be found in the diet?

A

green leafy vegetables.

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9
Q

What is sickle cell disease?

A

ABNORMAL GLOBIN CHAINS which behave NORMALLY AT NORMAL OXYGEN LEVELS.

  • Change in shape at LOW OXYGEN ENVIRONMENT, thus RBCs cannot pass through narrow capillaries causing ischemia, pain and necrosis.
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10
Q

What can cause an decrease in hemoglobin production?

A
  • Reduced number of RBCs due to BONE MARROW FAILURE.
  • If normal number of RBCs:
  • haematinic deficiency, abnormal globin chains (hemoglobinopathies - thalassemia, sickle cell anemia).
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11
Q

A patient is deficient in folic acid? What could this also mean?

A

Usually seen CO-DEFICIENT WITH IRON.

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12
Q

What are two diseases that can cause ABNORMAL GLOBIN CHAIN PRODUCTION?

A

Thalassemia, sickle cell anemia.

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13
Q

Name 3 causes of vitamin B12 deficiency?

A
  • Strict vegans (lack of intake)
  • Lack of intrinsic factor (ex. autoimmune stomach disease – pernicious anemia, gastric disease).
  • Disease of terminal ileum (ex. Crohn’s disease).
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14
Q

What is a key sign/ finding when diagnosing coeliac disease?

A

Iron deficiency anemia.

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15
Q

give two examples of hemoglobinopathies?

A

Thalassemia, sickle cell anemia.

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16
Q

What are the 3 major causes of anemia?

A
  • Increased hemoglobin DEMAND
  • Increased hemoglobin LOSS
  • Reduced hemoglobin PRODUCTION/ PRODUCTION FAILURE.
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17
Q

What conditions lead to a lower MCV?

A

Iron deficiency, thalassemia

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18
Q

where is hemoglobin made prenatally?

A

liver and spleen

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19
Q

What can folic acid deficiency cause in pregnancy? How can this be prevented?

A

Can lead to NEURAL TUBE DEFECT IN FETUS, ex. SPINA BIFIDA.

  • if mother has low folic acid level, start folic acid supplements at least a month in advance of pregnancy.
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20
Q

What are the two types of iron?

A
  • Heme iron
  • Non heme iron (Fe 2+ and Fe 3+).
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21
Q

Name 2 diseases that reduce iron absorption

A
  • Achlorhydria
  • Coeliac disease
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22
Q

What conditions lead to a higher MCV?

A

Folate deficiency, Vitamin B12 deficiency.

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23
Q

What is the function of instrinsic factor?

A

Binds to vitamin B12 to help its absorption by the terminal ileum.

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24
Q

What is a drawback of iron overload?

A

Liver cirrhosis.

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25
Q

What is pernicious anemia?

A

is an autoimmune condition that prevents your body from absorbing vitamin B12.

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26
Q

Name 4 causes of iron loss

A
  • Gastric ulcers and erosions.
  • Inflammatory bowel disease (Crohn’s and ulcerative colitis).
  • Bowel cancer (colonic and rectal).
  • Hemorrhoids.
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27
Q

How are the two types of iron absorbed?

A
  • Heme iron: absorbed through a TRANSPORTER system in the INTESTINAL CELL WALL.
  • Non-heme iron: Fe 3+ and Fe 2+. Fe 3+ must be converted to Fe2+ and then absorbed via a TRANSPORTER in the INTESTINAL CELL WALL.
28
Q

What are hematinics?

A

Products used to make RBCs, important for normal hemoglobin production.

Ex. Iron (measured via ferritin), folate/ folic acid, vitamin B12.

29
Q

What are 5 clinical effects of thalassemia?

A
  • chronic anemia
  • marrow hyperplasia(marrow expands to produce more globin  skeletal deformities especially in SKULL)
  • splenomegaly (RBCs recycled more often because abnormal)
  • cirrhosis (due to high iron levels)
  • gallstones (increased pigment chemicals passing through liver).
30
Q

How is iron stored in cells?

A

as FERRITIN

31
Q

What can cause a decrease in intrinsic factor production (2).

A
  • autoimmune stomach disease – pernicious anemia
  • gastric disease
32
Q

What are the two types of sickle cell ?

A
  • Heterozygous = sickle cell TRAIT
  • Homozygous = sickle cell disease.
33
Q

What is the management of thalassemia?

A
  • Blood transfusion of normal RBCs however must be careful or iron overload.
34
Q

Name 3 hemoglobin types and when they are produced.

A
  • Alpha hemoglobin produced both during prenatal and postnatal age.
  • Beta hemoglobin mainly produced postnatally.
  • Gamma hemoglobin mainly produced in PRENATAL age as It is more efficient at removing oxygen from the maternal circulation.
35
Q

What can cause an increase in hemoglobin demand?

A

o Increase in tissue metabolism rate OR increase in amount of tissue present in the body

36
Q

Where can vitamin B12 be found in the diet?

A

Dairy, meat.

37
Q

What is the relationship between number of RBCs and anemia?

A

Anemia is NOTHING TO DO WITH NUMBER OF RBCs, can happen with too many/ too few RBCs.

38
Q

What is achlorhydria? What may cause it?

A
  • LACK of stomach acid.
  • Difficult to absorb NON HEME iron.
  • May be drug induced –> PPIs.
39
Q

Where can iron be found in the diet?

A

meat, green leafy vegetables, iron tablets.

40
Q

Where is hemoglobin made after birth?

A

BONE MARROW.

41
Q

What is the normal lifespan of a RBC?

A

120 days

42
Q

What results in MACROCYTIC cells?

A

o RBCs shrink as they mature, thus macrocytic cells have likely NOT SHRUNK ENOUGH and not grown in size. Thus a measure of IMMATURITY.

43
Q

What are 2 characteristics of RBCs in anemic patients that may be seen under microscope?

A
  • HYPOCHROMIC (pale/less red due to less hemoglobin)
  • ANSIOCYTIC (exagerrated differences in size).
44
Q

What is normocytic anemia?

A

Normal RBC size yet reduces total amount of hemoglobin in the blood due to a BLEED, RENAL, CHRONIC DISEASE.

45
Q

What are reticulocutes? When are they seen? What is their effect on the blood?

A
  • Almost mature RBCs (all organelles have not yet been removed by bone marrow).
  • Released early into the circulation to replace losses.
    o Ex. patient has lost blood (trauma, blood donation) and is rapidly trying to replace oxygen capacity.
  • Will raise MCV (as cells are still immature).
46
Q

What are 2 common and 2 rare signs of anemia?

A
  • Common: tachycardia, pale.
  • Rare: liver and/or spleen enlargement.
47
Q

What is a sign?

A

things the clinician can SEE on examining/ investigating the patient.

48
Q

What is a symptom?

A

things the patient will complain ABOUT.

49
Q

What are two signs that could suggest iron deficiency?

A
  • Smooth tongue.
  • angular cheilitis.
50
Q

What sign could suggest vitamin B12 deficiency?

A

beefy tongue

51
Q

What are 4 symptoms of anemia?

A
  • Tired and weak.
  • palpitations
  • dizzy
  • shortness of breath
52
Q

What is the test used to investigate whether there is hidden GI bleeding?

A

Fecal Occult Blood

53
Q

What triggers RBCs? Where is that produced?

A

Erythropoietin in the KIDNEY

54
Q

How could GI bleeding affect the stool?

A

a lot of blood lost in a short amount of time may make stool BLACK.

55
Q

What are 5 investigations which may be undertaken for anemia?

A
  1. History
  2. FBC (+ hematinics sometimes).
  3. GI blood loss (ex. fecal occult blood, endoscopy, colonoscopy).
  4. Renal function (erythropoietin from kidney).
  5. Bone marrow examination (done if no other obvious cause found)
56
Q

What supplement can be given to an iron deficient patient?

A
  • FeSO4 200mg 3 times a day for 3 months.
57
Q

What supplement can be given to a Vitamin B12 deficient patient?

A

1mg IM injection x 6 then 1mg/2 months.

58
Q

What supplement can be given to a folic acid deficient patient?

A

5mg folic acid daily.

59
Q

When are transfusions recommended for anemic patients?

A

for urgent situations or PRODUCTION FAILURE (bone marrow does not produce RBCs).

60
Q

When are erythropoietin IM injections recommended for anemic patients?

A

PRODUCTION FAILURE (RENAL DISEASE – kidney does not produce erythropoietin).

61
Q

What are the dental aspects of anemia?

A
  • general anesthesia and oxygen capacity.
  • deficiency states, usually IRON (mucosal artophy, recurrent oral ulceration, sensory changes, candidiasis).
62
Q

What are the dental effects of iron deficiency anemia (4)?

A

mucosal artophy, recurrent oral ulceration, sensory changes, candidiasis.

63
Q

What is the most common cause of blood loss in the young?

A
  • Upper GI
  • menstruation in women.
64
Q

What is the most common cause of blood loss in the elderly?

A
  • Upper and lower GI.
65
Q

What must be checked when there is mucosal disease?

A

hematinics

Module 5 - Haematology (7 decks)

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