Anaemia Flashcards
What can MCV of RBCs tell us?
Can give a clue to the CAUSE of anemia.
What is spina bifida? Cause?
NEURAL TUBE DEFECT cause y vitamin B12 deficiency during pregnancy.
Name two causes of folic acid deficiency.
- lack of intake.
- Absorption failure
- JEJUNAL disease – COELIAC disease.
What are the 2 causes of hemoglobin problems?
- Inability to make HAEM –> usually due to iron deficiency.
- Inability to make CORRECT GLOBIN CHAINS –> thalassemia, sickle cell anemia, hemoglobinopathies.
How is Vitamin B12 absorbed in the body?
- 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.
What does thalassemia cause?
- Normal HAEM production, GENETIC MUTATION OF GLOBIN CHAINS.
Define anemia
Anemia is a REDUCTION IN HEMOGLOBIN in the blood from the NORMAL VALUES in that population.
Where can folate be found in the diet?
green leafy vegetables.
What is sickle cell disease?
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.
What can cause an decrease in hemoglobin production?
- Reduced number of RBCs due to BONE MARROW FAILURE.
- If normal number of RBCs:
- haematinic deficiency, abnormal globin chains (hemoglobinopathies - thalassemia, sickle cell anemia).
A patient is deficient in folic acid? What could this also mean?
Usually seen CO-DEFICIENT WITH IRON.
What are two diseases that can cause ABNORMAL GLOBIN CHAIN PRODUCTION?
Thalassemia, sickle cell anemia.
Name 3 causes of vitamin B12 deficiency?
- 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).
What is a key sign/ finding when diagnosing coeliac disease?
Iron deficiency anemia.
give two examples of hemoglobinopathies?
Thalassemia, sickle cell anemia.
What are the 3 major causes of anemia?
- Increased hemoglobin DEMAND
- Increased hemoglobin LOSS
- Reduced hemoglobin PRODUCTION/ PRODUCTION FAILURE.
What conditions lead to a lower MCV?
Iron deficiency, thalassemia
where is hemoglobin made prenatally?
liver and spleen
What can folic acid deficiency cause in pregnancy? How can this be prevented?
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.
What are the two types of iron?
- Heme iron
- Non heme iron (Fe 2+ and Fe 3+).
Name 2 diseases that reduce iron absorption
- Achlorhydria
- Coeliac disease
What conditions lead to a higher MCV?
Folate deficiency, Vitamin B12 deficiency.
What is the function of instrinsic factor?
Binds to vitamin B12 to help its absorption by the terminal ileum.
What is a drawback of iron overload?
Liver cirrhosis.
What is pernicious anemia?
is an autoimmune condition that prevents your body from absorbing vitamin B12.
Name 4 causes of iron loss
- Gastric ulcers and erosions.
- Inflammatory bowel disease (Crohn’s and ulcerative colitis).
- Bowel cancer (colonic and rectal).
- Hemorrhoids.
How are the two types of iron absorbed?
- 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.
What are hematinics?
Products used to make RBCs, important for normal hemoglobin production.
Ex. Iron (measured via ferritin), folate/ folic acid, vitamin B12.
What are 5 clinical effects of thalassemia?
- 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).
How is iron stored in cells?
as FERRITIN
What can cause a decrease in intrinsic factor production (2).
- autoimmune stomach disease – pernicious anemia
- gastric disease
What are the two types of sickle cell ?
- Heterozygous = sickle cell TRAIT
- Homozygous = sickle cell disease.
What is the management of thalassemia?
- Blood transfusion of normal RBCs however must be careful or iron overload.
Name 3 hemoglobin types and when they are produced.
- 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.
What can cause an increase in hemoglobin demand?
o Increase in tissue metabolism rate OR increase in amount of tissue present in the body
Where can vitamin B12 be found in the diet?
Dairy, meat.
What is the relationship between number of RBCs and anemia?
Anemia is NOTHING TO DO WITH NUMBER OF RBCs, can happen with too many/ too few RBCs.
What is achlorhydria? What may cause it?
- LACK of stomach acid.
- Difficult to absorb NON HEME iron.
- May be drug induced –> PPIs.
Where can iron be found in the diet?
meat, green leafy vegetables, iron tablets.
Where is hemoglobin made after birth?
BONE MARROW.
What is the normal lifespan of a RBC?
120 days
What results in MACROCYTIC cells?
o RBCs shrink as they mature, thus macrocytic cells have likely NOT SHRUNK ENOUGH and not grown in size. Thus a measure of IMMATURITY.
What are 2 characteristics of RBCs in anemic patients that may be seen under microscope?
- HYPOCHROMIC (pale/less red due to less hemoglobin)
- ANSIOCYTIC (exagerrated differences in size).
What is normocytic anemia?
Normal RBC size yet reduces total amount of hemoglobin in the blood due to a BLEED, RENAL, CHRONIC DISEASE.
What are reticulocutes? When are they seen? What is their effect on the blood?
- 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).
What are 2 common and 2 rare signs of anemia?
- Common: tachycardia, pale.
- Rare: liver and/or spleen enlargement.
What is a sign?
things the clinician can SEE on examining/ investigating the patient.
What is a symptom?
things the patient will complain ABOUT.
What are two signs that could suggest iron deficiency?
- Smooth tongue.
- angular cheilitis.
What sign could suggest vitamin B12 deficiency?
beefy tongue
What are 4 symptoms of anemia?
- Tired and weak.
- palpitations
- dizzy
- shortness of breath
What is the test used to investigate whether there is hidden GI bleeding?
Fecal Occult Blood
What triggers RBCs? Where is that produced?
Erythropoietin in the KIDNEY
How could GI bleeding affect the stool?
a lot of blood lost in a short amount of time may make stool BLACK.
What are 5 investigations which may be undertaken for anemia?
- History
- FBC (+ hematinics sometimes).
- GI blood loss (ex. fecal occult blood, endoscopy, colonoscopy).
- Renal function (erythropoietin from kidney).
- Bone marrow examination (done if no other obvious cause found)
What supplement can be given to an iron deficient patient?
- FeSO4 200mg 3 times a day for 3 months.
What supplement can be given to a Vitamin B12 deficient patient?
1mg IM injection x 6 then 1mg/2 months.
What supplement can be given to a folic acid deficient patient?
5mg folic acid daily.
When are transfusions recommended for anemic patients?
for urgent situations or PRODUCTION FAILURE (bone marrow does not produce RBCs).
When are erythropoietin IM injections recommended for anemic patients?
PRODUCTION FAILURE (RENAL DISEASE – kidney does not produce erythropoietin).
What are the dental aspects of anemia?
- general anesthesia and oxygen capacity.
- deficiency states, usually IRON (mucosal artophy, recurrent oral ulceration, sensory changes, candidiasis).
What are the dental effects of iron deficiency anemia (4)?
mucosal artophy, recurrent oral ulceration, sensory changes, candidiasis.
What is the most common cause of blood loss in the young?
- Upper GI
- menstruation in women.
What is the most common cause of blood loss in the elderly?
- Upper and lower GI.
What must be checked when there is mucosal disease?
hematinics
