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CR 2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

How many red blood cells are present in the body

A

24 trillion

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2
Q

What is total body iron mass

A

3-5g

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3
Q

Where is majority of dietary iron absorbed?

A

In the duodenum by enterocytes

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4
Q

In what forms can dietary iron be absorbed?

A

Fe2+

As part of a protein

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5
Q

How is Fe3+ reduced to Fe2+

A

Ferric reductase enzyme found on brush border of duodenum

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6
Q

What are transferrins

A

Iron binding blood plasma glycoproteins used to control levels of free iron in plasma

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7
Q

How many Fe3+ ions can a transferrin carry

A

2

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8
Q

Where does iron go once its been absorbed

A

Bone marrow

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9
Q

What takes up iron ions once inside the cell

A

Ferritin

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10
Q

How is iron stored

Why?

A

Inside cells in ferritin

Allows iron to be released in a controlled manner and is a buffer against deficiency or overload

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11
Q

What counts as anaemia for a male adult?

A

Hb less than or equal to 13.5g/dl

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12
Q

What counts as anaemia for female adult

A

Hb<11.5g/dl

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13
Q

What counts as anaemia for child 6m-6y?

A

Hb<11g/dl

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14
Q

What counts as anaemia for child 6-14y?

A

Hb<12g/dl

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15
Q

Symptoms of anaemia?

A 
Tiredness
Fainting
Shortness of breath
Worsening angina
Rapid heart
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16
Q

Signs of anaemia

A 
Pallor
Rapid heart 
Bounding pulse
Systolic flow murmur
Cardiac failure
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17
Q

What can cause anaemia by causing decreased production of red cells (5)

A
  • Iron deficiency
  • B12/ folate deficiency
  • Marrow infiltration
  • Chronic disease
  • Infection
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18
Q

What can cause anaemia by causing increased deustruction (haemolytic anaemia)

A
  • Immune destruction
    -Disorders of RBC
    (haemolytic anaemia)
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19
Q

What are the MCV guidelines in terms of categorising anaemia?

A

Microcytic: MCV<76fl
Normocytic: MCV 76-96fl
Macrocytic: MCV>96fl

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20
Q

2 main causes of microcytic anaemia

A

Iron deficiency and thalassaemia

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21
Q

How do red blood cells appear in iron deficiency anaemia?

A

Small/ microcytic
Hypochromic
Presence of pencil cells

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22
Q

Risk factors for iron deficiency anaemia

A

Age (premature/ elderly)
Sex (F>M)
GI (appetitte/ weight changes)
Drugs (aspirin/ NSAIDS)

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23
Q

What is the worldwide most common cause of iron deficiency anaemia

A

Hookwormm

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24
Q

4 most common causes of iron deficiency anaemia in the developed world

A

Reproductive (eg menorrhagia)
GI tract bleeding (ulcers, IB, cancers)
GI tract malabsorption (coeliac, atrophic gastris_
Vegan

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25
Q

What woulld full blood count show in iron deficieny anaemia

A

Low RBC

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26
Q

Main causes of normocytic anaemia

A 
Acute blood loss
Chronic disease
Cancer
Haemolysis
Metastatic cancer (marrow infilitration)
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27
Q

How does chronic disease lead to normocytic anaemia

A
  • Causes reduced red blood cell lifespace leading to depressed erythropoiesis
  • Poor marrow response to EPO as inflammatory cytokines interfere with EPO production/ action
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28
Q

Another name for vitamin B12?

A

Cobalmin

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29
Q

Funtions of vitamin B12?

A

Synthesis of myelin and assists in DNA synthesis

Involved in metabolism of every cell- especially cells with high turnover

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30
Q

Result of prolonged vitamin B12 deficiency?

A

Severe and irreversible nerous system daamge

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31
Q

Is vitamin B12 destroyed by cooking?

A

No

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32
Q

How much B12 is required? How much is stored

A

1mg/d

1000mg

33
Q

Where is B12 absorbed

34
Q

What is another name for vitamin B9?

35
Q

What types of food is B9 found in?

A

Liver, greens, yeast

36
Q

Is B9 destroyed by cooking

37
Q

How much B9 is required

38
Q

How long is B9 stored for

39
Q

Where is B9 absorbed?

A

Duodenum and jejunum

40
Q

What difficulties are presenting in diagnosing B12/ B9 deficiency

A

They are clinically indistinguishable from each other

41
Q

What type of anaemia to B12/ B9 deficiencies lead to

A

Macrocytic anaemia

42
Q

How can B12 deficiency be detected?

A

Measured clinically as increased serum methylmalonic acid

43
Q

To what extent can eating more B9 cure/ solve B12 deficiency?

A

Lack of DNA synthesis can be solved by folate, but the reduced myelin synthesis cannot be

44
Q

Describe how B9/12 deficienies lead to macrocytic anaemia

A
  • Both required for DNA synthesis
  • Reduced/ impaired DNA synthesis
  • Cells fail to divide
  • Overlarge blood cells
45
Q

Where is intrinsic factor produced

A

Produced by parietal cells in the gastric mucosa

46
Q

Describe absorption of vitamin B12?

A

Absorbed by body by ileum after binding to intrinsic factor. Intrinsic factor- B12 complex absorbed by receptors on ileum endothelial cell

47
Q

Where is vitamin B12 released from the protein its bound to?

A

In stomach by acid

48
Q

What would the blood count of a person with B12/B9 deficiency show?

A

Low Hb
High MCV>120
Low WBC and platelets

49
Q

What would the blood film of a person with B12/B9 deficiency show?

A

Oval macrocytes

Hypersegmented neutrophils

50
Q

What would biochem tests of a person with B12/B9 deficiency show?

A

High bilirubin

High lactate dehydrogenase

51
Q

How is pernicious anaemia characterised?

A

B12 deficiency caused by absence or reduction of intrinsic factor
Autoimmune disorder
Occurs due to an antibody against gastric mucosa and intrinsic factor

52
Q

Who does pernicious anaemia most commonly effect?

A

Females with fair hair, blue eyes and group A blood

53
Q

Symptoms of pernicious anaemia

A
  • Glossitis
  • Mild jaundice
  • Dementia
  • Peripheral neuropathy
  • Optic atrophy
  • Insididious
54
Q

How is pernicious anaemia treated?

A

Every 3 months you have an IM B12 injection for life

55
Q

How do symptoms of B12 and B9 differ

A

All same symptoms, but folate deficiency gives no neurological symptoms

56
Q

How is folate deficiency treated

A

Oral folate tablets

57
Q

Examples of intravascular haemolysis

A

Sickle cell
Thalassaemia
Rhesus mismatch
Hereditary spherocytosis

58
Q

Examples in extravascular haemolysis

A

ABO mismatch
Snake bites
Infection

59
Q

How does haemolytic anaemia present

A

Pallour and anaemia
Jaundice
Gall stones
Splenomegaly

60
Q

What will lab investigations show for somebody with haemolytic anaemia?

A
  • Red cell breakdown: increased serum unconjugated bilirubin, increased urinary urobilogen, increased lactate dehydrogenase.
  • Increased RBC production: increased reticulocytes, increased RBCs in marrow
61
Q

3 types of haemolytic anaemia

A

1) Membrane defect
2) Haemoglobin defect
3) Enzyme defect

62
Q

Define spheryocyte

A

Sphere shaped RBC

63
Q

What type of haemolytic anaemia results from hereditary spherocytes?

A

Membrane defect

64
Q

What causes hereditary spherocytosis

A

Defect in protein of red cell cytoskeleton.

Blood cells contracts to its most surface tension efficient/ most flexible form (sphere)

65
Q

Are spherocytes more or less fragile than normal RBC?

A

More fragile (could break when passing through capillaries)

66
Q

What is the result of increased fragility of spherocytes?

A

Break down more- chronic haemolytic anaemia.

Low Hb, high LDH, high unconjugated serum bilirubin

67
Q

What is the inheritance pattern of hereditary spherocytosis

A

Autosomal dominant

68
Q

Example of haemolytic anaemia due to an enzyme defect

A

G6PD deficiency

69
Q

What is the role of G6PD?

A

Prevents/ reverses haemoglobin oxidation

70
Q

Inheritance pattern of G6PD deficiency

71
Q

3 main triggers of G6PD deficiency?

A

Foods (fava beans)
Bacterial/ viral
Drugs

72
Q

Approx how much iron is in 1ml of blood

73
Q

How much blood loss/ day will result in iron deficiency

A

10ml loss/ day

74
Q

What 6 things can enhance absorption of iron

A
  • Haem iron
  • Ferrous salts
  • acidic pH
  • Iron deficiency
  • Pregnancy
  • Hypoxia
75
Q

What 5 things can impair the absorption of iron

A
  • Non-haem iron
  • Ferric salts
  • Alkaline pH
  • Iron overload
  • Inflammatory disorders
76
Q

Name a drug type that can decrease iron absorption

A

Proton pump inhibitors (indigestion)

77
Q

What disorder of the haematopoietic stem cells in bone marrow may lead to macrocytic anaemia

A

Myelodysplasia

78
Q

What conversion reaction are b12 and folate needed for

A

Homocysteine–> methionine

79
Q

What happens in autoimmune haemolytic anaemia

A
  • IgG antibodies present in blood that react with RBC membrane proteins
  • Affects RBC then removed my spleen–> extravascular haemolysis

CR 2 (33 decks)

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