Anaemia

Question 1

What is anaemia?

Answer 1

Reduced haemoglobin in the blood

Question 2

What are the two ways anaemia can present?

Answer 2

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

Question 3

What are haematinics?

Answer 3

Substances required for erythropoiesis (RBC production)

Question 4

List the haematinics

Answer 4

Iron
Folate
Vitamin B12

Question 5

What are the sources of iron?

Answer 5

Green leafy vegetables
Meat
Tablets

Question 6

How are iron levels tested?

Answer 6

Testing the ferritin levels - more stable so give predictable measurements

Question 7

What form of iron is absorbed the most readily?

Answer 7

Haem based iron

non-haem varies in efficiency

Question 8

What causes a reduction in iron absorption?

Answer 8

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.

Question 9

What causes iron loss?

Answer 9

GI bleed from gastric erosion and ulcers.

Haemorrhoids swollen veins in the anus that can bleed.

Cancer (colon and rectum)

IBS: Crohns and UC

Question 10

Vitamin B12 cannot be produced within the body; what are its sources?

Answer 10

Meat - liver
Chicken
Eggs
Dairy

Question 11

How is vitamin B12 absorbed?

Answer 11

By binding to intrinsic factor

Question 12

What is vitamin b12 used for?

Answer 12

Maintaining the health of RBC and nerves.

Assist in production of DNA

Question 13

What causes Vitamin B12 deficiency?

Answer 13

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

Question 14

What are the sources of folic acid?

Answer 14

leafy green vegetables
Brocoli
Asparagus
Cauliflower

Question 15

What causes a folic acid deficiency?

Answer 15

Lack of intake

Absorption failure - coeliac disease

Question 16

What is folic acid usually co-deficicent with?

Answer 16

iron

Question 17

What can a deficiency in folate cause?

Answer 17

Spina bifida

Question 18

What is thalassaemia?

Answer 18

Genetic mutation to the alpha and beta chains of haemoglobin which lead to abnormal haemoglobin levels.

Question 19

In thalassaemia; what racial group is likely to have an alpha mutation? (common)

Answer 19

Asians

Question 20

In thalassaemia; what racial group is likely to have a beta mutation? (uncommon)

Answer 20

Mediterraneans

Question 21

What are the clinical effects of thalassaemia?

Answer 21

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

Question 22

How do you manage thalassaemia?

Answer 22

Blood transfusions

Prevent iron overloading

Question 23

What is sickle cell anaemia?

Answer 23

In low oxygen environments RBC change shape and are unable to flow through capillaries.

Question 24

What is the consequence of sickle cell anaemia?

Answer 24

Tissue ischamia

= pain and necrosis

Question 25

What causes sickle cell anaemia?

Answer 25

Abnormality in the globin chains

Question 26

What are the two types of sickle cell anaemia?

Answer 26

Homozygous (disease)

Heterozygous (traits - doesn’t show sever symptoms)

Question 27

In anaemia; how is loss of cells determined

Answer 27

Via a decrease in RCC or HCT - ratio of cells to liquid.

Question 28

In anaemia; how is deficiency determined?

Answer 28

Mean cell volume test;
are the cells…
Microcytic - patient has thalassaemia or iron deficiency
Macrocytic - patient has Folate or vitamin b12 deficiency.

Question 29

What are reticulocytes?

Answer 29

Immature RBC that are released into circulation early in response to loss.

Question 30

How do reticulocytes counteract loss of blood?

Answer 30

Reticulocytes are larger than normal RBC so increase the mean cell volume.

Question 31

How do you diagnose anaemia?

Answer 31

Check haemoglobin levels.

Check RCC and HCT (check if low levels from loss)

Check mean cell volume (check if low levels from deficiency)

Question 32

What are the signs of anaemia?

Answer 32

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

Question 33

What are the symptoms of anaemia?

Answer 33

Tired
Weak
Dizzy
Short of breath 
Heart palpitations.

Question 34

What are the relevant dental signs/symptoms of iron deficiency?

Answer 34

Smooth tongue

Question 35

What are the relevant dental signs/symptoms of vitamin b12 deficiency?

Answer 35

Beefy tongue

Question 36

What investigations can you carry out to diagnose anaemia?

Answer 36

History - signs/symptoms and some types of anaemia are inherited.
Endoscopy/colonoscopy - bleeding? 
FBC 
Faecal occult blood sample - bleeding?
Bone marrow examination - thalassaemia?

Question 37

How do you treat anaemia?

Answer 37

Blood transfusions
Replace haematinics - addresses deficiency
Give the patient erythropoietin - addresses loss

Question 38

In terms of dental treatment, what impact does anaemia have?

Answer 38

Caution with general anaesthetic - limited oxygen capacity.

** sickle cell

Question 39

In terms of dental relevance; what is commonly found in those with iron deficiency?

Answer 39

Smooth tongue
Mucosal atrophy
Dysaesthesia - change to sensation
Candidiasis