Anaemia Flashcards
How long do RBCs live?
120 days
What hormone stimulates RBC production? Where is it released?
EPO: erythropoietin
Mostly the renal cortex, but 10% comes from the liver
What is a reticulocyte?
What is ferritin?
What is haemosiderin? Which is soluble and which isn’t?
Immature RBCs
Ferritin is protein + iron (soluble)
Haemosiderin is fragmented ferritin
(insoluble)
What is the structure of haemoglobin?
How many oxygen molecules can one Hb carry?
Two alpha chains
Two beta chains
4 Haem groups each containing iron atom
4 oxygen molecules, one on each haem group
Causes of microcytic and macrocytic anaemia?
Microcytic:
Iron deficiency
Chronic disease
Thalassaemia
Macrocytic: B12 deficiency Folate deficiency Alcohol excess Bone marrow failure
What causes iron deficiency anaemia?
Blood loss (GI, gynaecological)
Malabsorption: coeliac disease
High demand: pregnancy
Symptoms of iron deficiency anaemia?
Fatigue Dyspnoea Angina Palpitations Glossitis Pruritus Headache
What investigations would you do for iron deficiency anaemia?
Bloods:
- FBC, ferritin
- blood film
- LFTs
Investigate underlying causes:
- OGD
- Colonoscopy
- Gynae investigations
What would the FBC and blood film show in iron deficiency anaemia?
Microcytic
Hypochromic
Ferritin low
Transferrin high
Management of iron deficiency anaemia?
What are the side effects?
Ferrous sulphate 200mg BD or TDS
Black stools, nausea, reflux
What two types of macrocytic anaemia are there? Explain and give examples.
Megaloblastic: impaired DNA synthesis resulting in bigger cell
- B12 and folate deficiency
Non-megaloblastic: fatty deposits in cell
- alcohol excess
- hypothyroid
What is folate’s other name?
In what foods are B12 and folate found?
Vitamin B9
B12: animal sources, fortified foods
Folate: green veg, cereal
Where and how is B12 absorbed?
Combines with intrinsic factor in the stomach and is absorbed in the terminal ileum
How long does B12 deficiency take to manifest?
What about folate?
B12 takes years
Hepatic stores of B12 take years to empty.
Folate takes months as liver stores are smaller
What causes B12 deficiency?
Pernicious anaemia (80% cases)
IBD
GI surgery
H. pylori
Dietary
What is a serious complication of B12 deficiency?
Subacute spinal cord degeneration
Symmetrical dorsal column loss
- peripheral neuropathy initially
- UMN signs later
- lower limbs more affected
How and where is folate absorbed?
Absorbed in the duodenum / jejunum
What is the link between B12 and folate?
Folate depends on B12 for activation
What causes folate deficiency?
Alcohol excess
Dietary
Malabsorption
Drugs
Your patient has macrocytic anaemia. How can you differentiate between B12 and folate deficiency?
Check folate levels in serum and RBCs
B12 deficiency: LOW red cell folate, NORMAL serum folate
Folate: LOW red cell folate and LOW serum folate
What is pernicious anaemia? What vitamin deficiency does it cause any why?
Autoimmune disease that attacks the parietal cells in the stomach
Parietal cells produce intrinsic factor
So reduced intrinsic factor means reduced B12 absorption
Who gets pernicious anaemia?
Which conditions are associated with pernicious anaemia?
Commonly women over 60
Vitiligo
Hypothyroidism
Addison’s
Type I diabetes
Clinical features of pernicious anaemia?
Anaemia symptoms
- Fatigue
- Anorexia
- Weight loss
Diarrhoea
Dyspepsia
Jaundice
Investigations for pernicious anaemia?
Bloods:
- FBC
- Blood film
- Serum B12 and folate
- anti-IF
- anti-parietal cell
Bone marrow aspirate