Anaemia Flashcards
What is anaemia?
Reduced haemoglobin in the blood
What are the two ways anaemia can present?
Reduced red blood cell production;
Cause - Marrow failure
Normal RBC will reduced haemoglobin: Causes: Deficiency (iron, folate, b12) Abnormal globin chains (thalassaemia and sickle cell) Chronic inflammatory disease
What are haematinics?
Substances required for erythropoiesis (RBC production)
List the haematinics
Iron
Folate
Vitamin B12
What are the sources of iron?
Green leafy vegetables
Meat
Tablets
How are iron levels tested?
Testing the ferritin levels - more stable so give predictable measurements
What form of iron is absorbed the most readily?
Haem based iron
non-haem varies in efficiency
What causes a reduction in iron absorption?
Achlorydia:
Lack of stomach acid, unable to convert non-haem iron.
This can be induced by drugs i.e. Proton pump inhibitors.
GI tract disease
i.e. Coeliac disease - villi destruction reduces surface area for absorption.
What causes iron loss?
GI bleed from gastric erosion and ulcers.
Haemorrhoids swollen veins in the anus that can bleed.
Cancer (colon and rectum)
IBS: Crohns and UC
Vitamin B12 cannot be produced within the body; what are its sources?
Meat - liver
Chicken
Eggs
Dairy
How is vitamin B12 absorbed?
By binding to intrinsic factor
What is vitamin b12 used for?
Maintaining the health of RBC and nerves.
Assist in production of DNA
What causes Vitamin B12 deficiency?
Lack of intake - vegans
Gastric disease - leads to lack of intrinsic factor leads to b12 not being able to be absorbed .
Crohn’s disease - reduces the surface area for absorption
What are the sources of folic acid?
leafy green vegetables
Brocoli
Asparagus
Cauliflower
What causes a folic acid deficiency?
Lack of intake
Absorption failure - coeliac disease
What is folic acid usually co-deficicent with?
iron
What can a deficiency in folate cause?
Spina bifida
What is thalassaemia?
Genetic mutation to the alpha and beta chains of haemoglobin which lead to abnormal haemoglobin levels.
In thalassaemia; what racial group is likely to have an alpha mutation? (common)
Asians
In thalassaemia; what racial group is likely to have a beta mutation? (uncommon)
Mediterraneans
What are the clinical effects of thalassaemia?
Chronic anaemia.
Marrow hyperplasia - bone shape changes as marrow chamber enlarger to meet demands.
Splenomegaly - spleen enlarges as it is in greater use, has to remove more from the blood.
Cirrhosis - excess iron production from the overcompensation of haem production irritates the liver.
Gallstones
How do you manage thalassaemia?
Blood transfusions
Prevent iron overloading
What is sickle cell anaemia?
In low oxygen environments RBC change shape and are unable to flow through capillaries.
What is the consequence of sickle cell anaemia?
Tissue ischamia
= pain and necrosis
What causes sickle cell anaemia?
Abnormality in the globin chains
What are the two types of sickle cell anaemia?
Homozygous (disease)
Heterozygous (traits - doesn’t show sever symptoms)
In anaemia; how is loss of cells determined
Via a decrease in RCC or HCT - ratio of cells to liquid.
In anaemia; how is deficiency determined?
Mean cell volume test;
are the cells…
Microcytic - patient has thalassaemia or iron deficiency
Macrocytic - patient has Folate or vitamin b12 deficiency.
What are reticulocytes?
Immature RBC that are released into circulation early in response to loss.
How do reticulocytes counteract loss of blood?
Reticulocytes are larger than normal RBC so increase the mean cell volume.
How do you diagnose anaemia?
Check haemoglobin levels.
Check RCC and HCT (check if low levels from loss)
Check mean cell volume (check if low levels from deficiency)
What are the signs of anaemia?
Pale mucosa
Tachycardia - higher demand for circulating blood as it contains less oxygen than is required for the tissues.
rare:
enlarger liver - inflammation/irritation from the excessive iron?
enlarger spleen - removing more waste from blood
What are the symptoms of anaemia?
Tired Weak Dizzy Short of breath Heart palpitations.
What are the relevant dental signs/symptoms of iron deficiency?
Smooth tongue
What are the relevant dental signs/symptoms of vitamin b12 deficiency?
Beefy tongue
What investigations can you carry out to diagnose anaemia?
History - signs/symptoms and some types of anaemia are inherited. Endoscopy/colonoscopy - bleeding? FBC Faecal occult blood sample - bleeding? Bone marrow examination - thalassaemia?
How do you treat anaemia?
Blood transfusions
Replace haematinics - addresses deficiency
Give the patient erythropoietin - addresses loss
In terms of dental treatment, what impact does anaemia have?
Caution with general anaesthetic - limited oxygen capacity.
** sickle cell
In terms of dental relevance; what is commonly found in those with iron deficiency?
Smooth tongue
Mucosal atrophy
Dysaesthesia - change to sensation
Candidiasis
