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BDS2 BAMS Diseases of the blood > Anaemia > Flashcards

Anaemia Flashcards

1
Q

What are the different types of anaemia

A

Microcytic - iron deficient
Normocytic - increased blood loss
Macrocytic - B12/ folic acid deficient

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2
Q

What are the different aetiologies of anaemia with age and sex

A

microcytic - not enough iron in diet

normocytic - females = menstruation, males = GI bleed

macrocytic - not enough B12 or folic acid in diet

pernicious anaemia - also B12 deficient but comsume enough just can’t absorb

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3
Q

What is the test for clotting

A

INR, APPT

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4
Q

How do you get the different types of anaemia

A

microcytic - not enough iron in diet

normocytic - females = menstruation, males = GI bleed

macrocytic - not enough B12 or folic acid in diet

pernicious anaemia - also B12 deficient but comsume enough just can’t absorb

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5
Q

What are the oral conditions associated with haematinic deficiency

A 
fungal and viral infections
oral ulceration (aphthous stomatitis)
painful mucosa (burning mouth syndrome)
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6
Q

symptoms of anaemia

A 
Fatigue
Pale
Breathless
High heart rate
Recurrent oral ulcerations
Candida infections
- Prescribe antifungal
Angular colitis - candida particularly in elderly
Smooth tongue (Fe deficient)
Beefy tongue (B12 deficient)
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7
Q

What tests do I ask for if haemostasis disorder suspected?

What tests for platelet dysfunction?

What tests for clotting dysfunction?

A

Full blood count
- Hb, WCC, Platelets

INR
- normal = 1, patient taking warfarin = ~2-4.5

Clotting screen
- problems with coagulation cascade

Liver function test

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8
Q

How do I plan treatment if there is anticoagulation or antiplatelet drug use?

What are high bleeding risk procedures

What are low bleeding risk procedures

How would I plan haemostasis in each?

A

We don’t generally tell them to stop taking aspirin for extractions cause it wont affect clotting for a while (the lifespan of a platelet)

Warfarin (blood thinner)

  • Take if prone to DVT or had a heart valve replacement
  • Abnormal heart rhythm
  • Tested with INR
  • Taking teeth out: get INR check within 24 hrs, warfarin interacts with lots of food and other medications, safe INR for taking tooth out <4, newer anticoagulants don’t need as much monitoring
  • extractions = high risk

To stop bleeding:

  • Av time is a couple of mins
  • Apply pressure for at least 5 mins
  • Inject with LA with adrenaline (vasoconstrictor)
  • Surgicel packs socket
  • Suture
  • Smaller number of extractions
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9
Q

Normal Hb levels for females and males

A

females - 12-16 grams per decilitre

males - 13-17

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10
Q

What are the causes of anaemia

A
  • reduced production of Hb
  • increased losses of Hb
  • increased demand for Hb
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11
Q

what are haematinics

A

things used to make the red blood cells

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12
Q

what are the haematinics

A

iron
vitamin B12
folic acid (folate)

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13
Q

What are sources of iron

A

meat
green leafy veg
iron tablets

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14
Q

what is a good way of measuring iron storage

A

measuring ferritin

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15
Q

What diseases reduce iron absorption

A

Achlorhydria (lack of stomach acid so no conversion of non-haem iron or may be drug induced)

Coeliac disease (loose surface of endothelial cells

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16
Q

How might you loose iron

A

anything which makes you bleed

  • gastric erosions/ ulcers
  • inflammatory bowel disease (Chron’s disease, ulcerative colitis)
  • bowel cancer (colonic cancer, rectal cancer)
  • haemorrhoids
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17
Q

What are sources of B12

A

dairy, meat (not really green leafy veg)

we can’t produce B12 ourselves

18
Q

What is B12 important for?

A

nerve function

19
Q

what do you need as well as B12

A

intrinsic factor

20
Q

why might someone be deficient in B12

A

lack of intake e.g. vegans

lack of intrinsic factor e.g. autoimmune stomach disease (pernicious anaemia)
e.g. gastric disease

disease of terminal ilium e.g. Chrons disease (as that’s where B12 is absorbed)

21
Q

what foods are rich in folic acid

A

green leafy veg
avacado
beetroot
seeds and nuts

22
Q

why might someone be deficient in folic acid

A

lack of intake

absorption failure e.g. jejunal disease, usually seen co-deficient with iron

23
Q

why is it really important for pregnant women to take folic acid

A

deficiency is linked to neural tube defects

24
Q

what is thalassaemia

A

normal haem production
but
genetic mutation of globin chains (can be alpha or beta mutations)

25
Q

What are the clinical effects of thalassaemia

A 
chronic anaemia
marrow hyperplasia
splenomegaly
cirrhosis
gallstones
26
Q

how is thalassaemia managed

A

blood transfusions

prevent iron overload

27
Q

What is sickle cell anaemia

A

abnormal globin chains

change shape in low oxygen environments

  • prevents RBC from passing through the capillaries
  • stick in tissue leading to hypoxia
  • tissue ischaemia

heterozygous (sickle cell trait)
homozygous (sickle cell disease)

28
Q

How might anaemia happen due to RCC and HCT losses

A

bleeding (usually GI bleed)

abnormal red cells

  • autoimmune
  • hereditary (sickle, spherocytosis - cells have reduced life span, removed by spleen)
29
Q

How might anaemia happen due to RCC and HCT increased demand

A

pregnancy

malignant disease

30
Q

what is anaemia called when you have small RBCs? causes?

A

microcytic anaemia (reduced Hb so cell shrinks further)

Fe def
thalassaemia

31
Q

what is anaemia called when you have large RBCs? Causes?

A

macrocytic anaemia

B12/folate def
retics

32
Q

what is anaemia called when you have normal sized RBCs? causes?

A

macrocytic anaemia (RBC hasn’t shrunk enough)

bleed, renal, chronic disease

?????normocytic

33
Q

what are reticulocytes

A

almost mature RBCs. These are released early into the circulation to replace losses

will raise MCV

34
Q

what are the questions to consider when making an anaemia diagnosis

A

what is the HB?
- degree of anaemia

what are the RCC and HCT
- cell deficiency or Hb formation deficiency

What is the MCV

  • is there a deficiency picture
  • what is the likely deficiency?
35
Q

what are the physical signs of anaemia

A

pale mucosa
tachycarida

smooth tongue- iron
beefy tongue - B12

36
Q

what are the physical symptoms of anaemia

A

tired and weak
dizzy
SOB
palaitations

37
Q

how is anaemia investigated

A 
history
Ferritin and RC folate/vit B12
FOB (faecal occult blood)
endoscopy/colonoscopy
renal function 
bone marrow investigation
38
Q

what is the treatment for anaemia

A

depends on the cause

  1. replace haematinics
    - FeSO4 200mg tds for 3 months
    - 1mg IM vitB12 x6 then 1mg/2 months
    - 5mg folic acid daily
  2. transfusions - production failure
  3. erythropoetinin - production failure (renal disease)
39
Q

what are the dental aspects of anaemia

A

General anaesthesia - oxygen capacity

Deficiency states (Fe usually)

  • mucosal atrophy
  • candidiasis
  • ROU
  • dysaethesia

sickle cell disease
(check all patients of negroid background before GA, test even it no anaemia)

40
Q

pointers for exam…

A
  • know how to differentiate deficiency from bleeding (RCC, HCT, MCV)
  • know how to tell what type of an anaemia (MCV)
  • know about iron deficiency anaemia
  • know about folate/b12 deficiency
  • know common causes of blood loss

BDS2 BAMS Diseases of the blood (3 decks)

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