Anaemia Flashcards
What are the different types of anaemia
Microcytic - iron deficient
Normocytic - increased blood loss
Macrocytic - B12/ folic acid deficient
What are the different aetiologies of anaemia with age and sex
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
What is the test for clotting
INR, APPT
How do you get the different types of anaemia
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
What are the oral conditions associated with haematinic deficiency
fungal and viral infections oral ulceration (aphthous stomatitis) painful mucosa (burning mouth syndrome)
symptoms of anaemia
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)
What tests do I ask for if haemostasis disorder suspected?
What tests for platelet dysfunction?
What tests for clotting dysfunction?
Full blood count
- Hb, WCC, Platelets
INR
- normal = 1, patient taking warfarin = ~2-4.5
Clotting screen
- problems with coagulation cascade
Liver function test
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?
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
Normal Hb levels for females and males
females - 12-16 grams per decilitre
males - 13-17
What are the causes of anaemia
- reduced production of Hb
- increased losses of Hb
- increased demand for Hb
what are haematinics
things used to make the red blood cells
what are the haematinics
iron
vitamin B12
folic acid (folate)
What are sources of iron
meat
green leafy veg
iron tablets
what is a good way of measuring iron storage
measuring ferritin
What diseases reduce iron absorption
Achlorhydria (lack of stomach acid so no conversion of non-haem iron or may be drug induced)
Coeliac disease (loose surface of endothelial cells
How might you loose iron
anything which makes you bleed
- gastric erosions/ ulcers
- inflammatory bowel disease (Chron’s disease, ulcerative colitis)
- bowel cancer (colonic cancer, rectal cancer)
- haemorrhoids
What are sources of B12
dairy, meat (not really green leafy veg)
we can’t produce B12 ourselves
What is B12 important for?
nerve function
what do you need as well as B12
intrinsic factor
why might someone be deficient in B12
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)
what foods are rich in folic acid
green leafy veg
avacado
beetroot
seeds and nuts
why might someone be deficient in folic acid
lack of intake
absorption failure e.g. jejunal disease, usually seen co-deficient with iron
why is it really important for pregnant women to take folic acid
deficiency is linked to neural tube defects
what is thalassaemia
normal haem production
but
genetic mutation of globin chains (can be alpha or beta mutations)
