Anaemia

Question 1

Name 4 haematinics

Haematinics are substances that help in the formation of blood by increasing hemoglobin levels and improving red blood cell (RBC) production. They are commonly used to treat anemia and other blood disorders.

Answer 1

1. Iron (Fe)
   Function: Essential for hemoglobin synthesis in RBCs.

Sources: Red meat, leafy greens, fortified cereals.

Deficiency: Leads to iron deficiency anemia (fatigue, pallor, weakness).

Supplements: Ferrous sulfate, ferrous fumarate, iron sucrose (IV).

**2. Vitamin B12 (Cobalamin)
**Function: Needed for RBC maturation & DNA synthesis.

Sources: Meat, fish, eggs, dairy.

Deficiency: Causes megaloblastic anemia & neurological symptoms.

Supplements: Cyanocobalamin or hydroxocobalamin (oral or injection).

**3. Folic Acid (Vitamin B9)
**Function: Helps in RBC production & prevents neural tube defects in pregnancy.

Sources: Leafy greens, beans, citrus fruits.

Deficiency: Leads to megaloblastic anemia & fetal defects in pregnancy.

Supplements: Folic acid tablets or injections.

4. Erythropoietin (EPO)
   Function: A hormone that stimulates RBC production in the bone marrow.

Used in: Chronic kidney disease (CKD) & chemotherapy-induced anemia.

Supplement: Recombinant erythropoietin (Epoetin alfa, Darbepoetin).

Uses of Haematinics
✅ Iron Deficiency Anemia (e.g., due to blood loss, pregnancy).
✅ Megaloblastic Anemia (B12 or folate deficiency).
✅ Anemia in Chronic Kidney Disease (treated with EPO).
✅ Post-Surgical or Postpartum Recovery (to restore blood levels).

Question 2

Diagnosis of anaemia

Answer 2

surrogate markers:
Haemoglobin (Hb) concentration
Haematocrit‏ (Hct) – proportion of red cells in blood

Assuming steady state anaemia is:
Adult males Hb <130g/L Hct <0.38
Adult females Hb <120g/L Hct <0.37

Question 3

anaemia symptoms

Answer 3

mainly fatigue but, especially if it is chronic, is often
surprisingly asymptomatic.

Other symptoms may include :
weakness,
pale skin,
rapid heartbeat,
shortness of breath.
chest pain,
dizziness,
irritability (in children with anaemia),
coldness in hands and feet.

Question 4

what is MCV
what does a low/high value mean

Answer 4

mean corpuscular volume = average volume of a red blood cell

low MCV (microcytic) consider problems with haemoglobinisation; lack of Iron
high MCV (macrocytic) consider problems with maturation; lack of folic acid / B12

normal MCV (normocytic) : anaemia of chronic disease

Question 5

dietary sources of haematinics

Answer 5

Iron
Animal meat (40% haem iron Fe2+, 60% non-haem iron Fe3+)
Plants (with vitamin C); 100% non-haem iron Fe3+
eg. Beans, lentils, rice, broccoli, spinach, asparagus, nuts

Folate
Leafy greens, beans, peanuts, fresh fruit, whole grains, seafood, eggs

B12
fortified foods (eg breakfast cereals, nutritional yeast), dairy, fish, meat, poultry, eggs

Question 6

Intrinsic Factor (IF) role

Answer 6

glycoprotein secreted by the parietal cells of the stomach

essential for Vitamin B12 (cobalamin) absorption in the small intestine (distal ileum)

Question 7

vitamin B12 is absorbed in the

Answer 7

distal ileum

Question 8

Conditions affecting IF

Answer 8

❌ Pernicious Anemia
* An autoimmune disorder where antibodies attack parietal cells or intrinsic factor.
* Leads to B12 deficiency anemia, causing fatigue, pallor, and neurological symptoms.
❌ Gastric Surgery (Gastrectomy)
* Removal of part/all of the stomach reduces IF production → B12 deficiency.
❌ Chronic Atrophic Gastritis
Chronic inflammation of the stomach lining damages parietal cells, reducing IF secretion.

Question 10

location of folic acid absorption

Answer 10

small intestine (duodenum)

Question 11

another name for folic acid deficiency

Answer 11

Will’s Disease

Question 12

what type of anaemia does F.A. deficiency cause

Answer 12

megaloblastic anaemia

Question 13

wher is IRON absorbed

Answer 13

duodenum + upper jejunum

Question 14

what causes the reduction of Fe3+, thus making iron absorbable?

Answer 14

Vitamin c - ascorbic acid ( secreted in gastric juice)

Question 15

ferrous iron form is x
ferric iron form is x

ferritin is

Answer 15

Fe3+
Fe2+ (the one absorbed)

iron complex with transferrin which is stored in the mucosal cell

Question 16

causes of IDA - iron deficiency anaemia

Answer 16

Dietary
(rare)
Restrictive diets with inadequate veg

Malabsorption
Non-haem iron needs acid environment for absorption;
Chronic gastritis and secondary achlorhydria‏ (pathological lack of acid)
Proton Pump Inhibitor therapy (long term use)
Small bowel disease;
coeliac disease, Crohn’s disease

**Losing iron (blood loss)
**Usually GI bleeding (consider menorrhagia, haematuria)
ulcer (including those caused by Non-Steroidal Anti-Inflammatory Drugs)
neoplasia (colon cancer)
inflammatory bowel disease
angiodysplasia