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Anaemia Flashcards

1
Q

anaemia

A

reduction in haemoglobin in the blood

below normal for population

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2
Q

3 causes of low Hb

A
  • reduction production
  • increased losses
  • increased demand
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3
Q

RBC life span

A

120 days

haemoglobin is recycled in that time

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4
Q

what are 2 processes of getting anaemia?

A
  • reduced normal red cells

- normal red cells but reduced Hb

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5
Q

how can reduced normal red cells lead to anaemia?

A

marrow failure

- low RBC count, less Hb present

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6
Q

aplastic anaemia marrow appearance

A

not making cells
acellular
easy to spot problems

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7
Q

what is the appearance of normal marrow?

A

cellular
bone trabecular
cells made by stem cells

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8
Q

how can having a normal red cells count but reduced Hb lead to anaemia?

A

making enough RBC but not enough Hb too go into them

constituents of Hb not made in adequate numbers

  • haem production needs folic acid and vitamin B12
  • globin chain production arises from abnormal genetic code so wrong proteins

deficiency states - Fe, Folate, Vit B12

abnormal globin chains

  • Thalassaemia
  • Sickle Cell

chronic inflammatory disease

  • rheumatoid arthritis supresses ability to make Hb
  • not missing constituents just not forming Hb
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9
Q

haematinics are

A

things used to make red blood cells

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10
Q

what 3 things are heamatinincs?

A
  • iron
  • vitamin B12
  • folic acid (folate)
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11
Q

iron sources

A
  • meat
  • green leafy vegetables
  • iron tablets
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12
Q

what form must iron be in to be absorbed?

A

2+

haem-based iron can be easily absorbed

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13
Q

what is a haem-based iron (2+) source?

A

meat based products

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14
Q

what is iron stored in cell as?

A

ferritin

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15
Q

how is iron transferred from cell to blood?

A

from storage protein ferritin into blood as haem again

many blood transporters e.g. trasnferrin

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16
Q

what is a stable measure of iron store?

A

ferritin

ferritin in blood is proportionally accurate to how much is stored in cells

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17
Q

what disease can reduce iron absorption?

A

achlorhydria

coeliac disease

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18
Q

what is achlorhydria and have can that reduce iron absorption?

A

Lack of stomach acid
- no conversion of non-haem iron (3+ to 2+)

may be Drug induced (Proton Pump Inhibitors)
- get rid of stomach acid

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19
Q

how can coeliac disease reduce iron absorption?

A
  • Lose villi on endothelial of small intestine

- Flattening of intestinal lining - less SA

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20
Q

how can someone have iron loss? (4)

A

anything that makes you bleed - internal and external

Gastric erosions and ulcers
- Acid, ulceration expose connective tissue

Inflammatory Bowel disease

  • Crohn’s disease
  • Ulecerative colitis

Bowel Cancer
- Colonic cancer
- Rectal Cancer
Small amount of bleeding over time

Haemorrhoids
- Notice as not passed through GI so still red

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21
Q

vitamin B12 sources

A

animal products mainly

also marmite, green leafy veg

cannot be made by humans - need to obtain through diet as made only by bateria

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22
Q

how vitamin B12 absorbed?

A

Intrinsic factors combine with vitamin B12 to be absorb form GI
- need both

Receptors end of ileum that pick up intrinsic factor

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23
Q

what can be given if vitamin B12 deficient?

A

injections

not taken via GI tract so can be absorbed readily

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24
Q

what does folic acid do?

A

combines with iron

needed for DNA synthesis for RBC

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25
if there is a deficiency in iron and vitamin B12 then there is...
problem in absorption
26
if only iron or vitamin B12 then there is...
problem in diet
27
vitamin B12 deficiency can be due to (3)
Lack of intake – strict vegans Lack of intrinsic factor - Autoimmune stomach disease (Pernicious anaemia) - Gastric disease Disease of terminal Ilium - Crohn’s disease
28
folic acid sources
green leafy vegetables
29
folic acid deficiency can be due to (2)
Lack of intake - Peculiar diet habits Absorption failure - Jejunal disease – coeliac disease - Usually seen co-deficient with iron
30
what can folic acid deficiency lead to?
Neural Tube defect in foetus - Cannot be fixed – permanent defect Fails to close properly - Spinal column as fails to close Nerves below not formed correctly – lower limb, bowels etc
31
why is folic acid important?
Needed for nerve maturation - spina bifida deficiency in pregnancy
32
how to test for haematinic deficiencies?
blood tests - ferritin (iron) - vitamin B12 - folate can be haematinic deficient before anaemic as Hb as 120 day life span
33
what is thalassaemia?
normal haem production but genetic mutation of globin chains - alpha chains (alpha thalassaemia) - beta chains (beta thalassaemia) run in populations
34
what are the possible clinical effects of thalaessmia?
Mild – no effects - Their normal is having a low Hb – new homeostasis Chronic anaemia Marrow hyperplasia (skeletal deformities) - Bone marrow having to make more globin - Need more as only some used, change in structure Splenomegaly - Spleen removes from blood e.g. wrong RBC due to wrong globin structure - Spleen gets bigger as higher workload Cirrhosis - Too much iron in blood, as over making haem as lack of correct globin - Haem is no use in excess – storage issue Gallstones - Due to more haem for recycling
35
management of thalassaemia
Best left if not a big issue to patient Blood transfusions - Need to give more haemoglobin as not making enough themselves but Prevent iron overload - Issue as normal haem so giving excess so too much iron --> cirrhosis and gallstone
36
what is sickle cell anaemia?
abnormal globin chains, so change in way globin behaves when O2 levels are reduced in RBC
37
what occurs to RBC in low O2 in sickle cell anaemics?
change in shape - from flat disc to bent disc shape cannot fit through capillaries - blockage - no blood flow - serious --> hypoxia and tissue ischaemia
38
what does someone have if they are heterozygous sickle cell anaemic?
sickle cell trait but not disease
39
what does someone have if they are homozygous sickle cell anaemic?
sickle cell disease
40
how can RCC and HCT losses occur for normal red blood cells?
bleeding usually GI bleeding - no source of outside bleeding unexplained anaemia (scope down to find source)
41
how can RCC and HCT losses occur for abnormal red blood cells?
autoimmune hereditary - SICKLE, G6PD, spherocytosis - Cells have reduced life span (<120 days) [Abnormal in RBC shape and duration; May need to make RBC faster to keep level] - can lead to lower RBC as life span been reduced as removed by the spleen
42
cases when there is an increase demand of RBC so higher chance if becoming anaemic
- after pregnancy (if blood doesn't physiologically adapt during to increase volume with fewer but proportional RBC) - malignant disease (tumours)
43
3 types of RBC mean cell volumes (MCV)
microcytic macrocytic normocytic
44
microcytic
small RBC - Fe def , lack of ability to make haem (anaemia and Thalassaemia) shrunk too far as reduced cellular content
45
macrocytic
large RBC - B12/folate def., Retics RBC start big and decrease in size with maturation between RBC precursor and when they should enter circulation - not shrunk enough so larger than normal expected size
46
normocytic
normal RBC | - shrunk to normal expected size
47
what are reticulocytes?
almost mature RBC (appear bigger as still immature RBC)
48
why do we have reticulocytes in circulation sometimes?
Released early into the circulation to replace losses - E.g. after donation, sudden recent blood loss - Replace loss quickly Fluid replaced easily - Bone marrow released immature RBC to try and replace cellular content
49
what will reticulocytes do to MCV?
increase MCV | - still have cellular parts to them
50
3 stages to run through in anaemia diagnosis
what is the Hb? - Normal or not normal - determine degree of anaemia what are the RCC and HCT? - cell deficiency (right number RBC or reduced) or Hb formation deficiency ``` What is the MCV? - Is there a deficiency picture? - What is the likely deficiency? (Small cells – iron deficiency, Thalassemia Big cells – B12, folic acid deficiency) ```
51
3 stereotypical signs of haematinic deficiencies (do not base diagnosis off)
Pale mucosa – more likely if anaemic. Smooth tongue – iron deficiency ‘beefy’ tongue – vitamin B12 deficiency
52
anaemia signs
Pale Tachycardia - Faster HR as pumping RBC more as same volume of oxygen is carried by fewer RBC Rarely: enlarged liver and spleen
53
anaemia symptoms
- Tired & weak - Dizzy - Short of breath - Palpitations (Awareness of increase in HR)
54
6 investigations for anaemia
HISTORY FBC (Ferritin & RC Folate/vit B12 ) - All cells and Haematinics FOB (Faecal Occult Blood) - Easy – looks for changed haemoglobin - Small sample of stool mixed with chemical agent to ID altered haemoglobin - See if any blood in stool – similar for bowel cancer Endoscopy/Colonoscoopy Renal Function - Kidneys make erythropoirtin – needed for RBC production - normocytic anaemia – correct structure but deficient as not making at all Bone Marrow examination
55
what can GI bleeding in young be due to?
- drink - menstruation - worry
56
what can GI bleeding in older people be due to?
bowel disease and cancer polyp can become malignant
57
3 methods for anaemia treatment
treat the cause Replace haematinics - FeSO4 200mg tds for 3months - 1mg IM vitamin B12 x 6 then 1mg/2 months - 5mg Folic acid daily Transfusions - production failure - If cannot make haemoglobin correctly (Bone marrow failure) - Thalassemia Erythropoietin - production failure - If suffer from Renal disease - Erythropoietin injections can boost haemoglobin levels to normal
58
dental aspects of anaemia
need to correct anaemia before commencing any treatment General Anaesthesia – O2 capacity - Send to hospital not in surgery - Need to go through risk as and benefits - Risk of hypoxia higher Deficiency States - Fe usually - mucosal atrophy - Candidiasis - ROU – recurrent oral ulceration - Dysaesthesia Check Haematinics in mucosal diseases Sickle cell disease - check all patients of negroid background before GA - sickledex test even if no anaemia
59
general anaesthesia risk for anaemics
greater risk of hypoxia
60
iron deficiency oral manifestations
- mucosal atrophy - Candidiasis - ROU – recurrent oral ulceration - Dysaesthesia

BDS2 BAMS (54 decks)

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