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Physiology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

what is anaemia?

A

the oxygen carrying capacity of the blood drops below normal

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2
Q

what is anaemia in men?

A

<130g/L

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3
Q

what is anaemia in women?

A

<120g/L in non-pregnant women

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4
Q

what is anaemia in children?

A

<120g/L

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5
Q

symptoms of anaemia

A 
easily fatigue
low energy
rapid heart beat
SOB
headaches
difficulty concentrating
dizziness
pale skin
leg cramps
insomnia
conjunctival pallor
nail bed pallor
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6
Q

what causes anaemia?

A

decreased haemoglobin content within erythrocytes
decreased erythropoiesis
loss of erythrocytes - early destruction

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7
Q

what is haemoglobin?

A

respiratory pigment of many invertebrates and almost all vertebrates. It interacts with O2 and CO2

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8
Q

how much haemoglobin is there?

A

250 million haemoglobin molecules per erythrocyte

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9
Q

structure of haemoglobin

A

iron sitting below porphyrin ring in haem centre
bound to 1 axial histidine and 1 distal histidine residue of the globulin
4 of these structures - 2 alpha and 2 beta

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10
Q

red blood cells

A

biconcave discs
shape is vital to maintain adequate surface area so there is sufficient oxygen transfer
shape can change remarkable as they squeeze through capillaries
96-100% saturation in all cells

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11
Q

average number of RBCs in women

A

4.7million/mm3

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12
Q

average number of RBCs in men

A

5.2million/mm3

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13
Q

formation of an erythrocyte

A

proerythroblast
basophilic erythroblast
polychromatic erythroblast
normonblast/ orthrochromatic erythroblast
reticulocyte - released from bone marrow into blood and loses the remaining DNA
erythrocyte

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14
Q

what can haemoglobin carry?

A

CO2
NO
CO
O2

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15
Q

What happens in sickle cell anaemia?

A

haemoglobin forms chains in the cell and cause sickling of it.
They cannot move easily through capillaries and so form clots and are eliminated by macrophages in the spleen.
Causes splenomegaly
More RBCs need to be made to keep up with oxygen carrying requirements

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16
Q

Iron deficiency anaemia

A

leads to decreased amounts of haemoglobin

low levels of haemoglobin decreases the production of RBCs

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17
Q

what causes iron deficiency anaemia?

A

blood loss
diet low in iron
poor absorption of iron

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18
Q

pernicious anaemia and B vitamin deficiency

A

RBCs do not develop as they normally would because of a lack of B vitamins which leads to decreased production of RBCs

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19
Q

what are B vitamins?

A

B12 and folate

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20
Q

What are the causes of pernicious anaemia?

A

lack of intrinsic factor
diet low in B vitamins
decreased absorption of B vitamins

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21
Q

Aplastic anaemia

A

bone marrow is unable to produce enough blood cells

life threatening condition

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22
Q

what causes aplastic anaemia?

A

cancer therapy
exposure to toxic substances
autoimmune disorders
viral infections

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23
Q

Haemolytic anaemia

A

RBCs are destroyed faster than the bone marrow can replace them

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24
Q

what causes haemolytic anaemia?

A

inherited causes
sickle cell anaemia
thalassemia

25
Q

anaemia of chronic disease

A

various illnesses over a long time can reduce the production of RBCs

26
Q

what causes anaemia of chronic diseases?

A 
rheumatoid arthritis
kidney disease
diabetes
TB
HIV
27
Q

blood testing for anaemia

A 
full blood count
haemoglobin
mean cell volume
mean corpuscular Hb concentration 
haematocrit
RBC count
mean corpuscular Hb
28
Q

what causes low haematocrit?

A

decrease in RBCs or increase in plasma volume, e.g. in pregnancy

29
Q

what are the different classifications of anaemia?

A

MCV - microcytic/ normocytic/ macrocytic

MCHC - hypochromic/ normochromic

30
Q

siberoblastic anaemia

A

group of blood disorders characterised by an impaired ability of bone marrow to produce normal RBCs
iron inside RBCs is inadequately used to make haemoglobin despite there being normal amounts of iron
therefore iron accumulates in the RBCs, giving a ringed appearance to the nucleus

31
Q

anaemia of chronic disease presentation

A

RBCs are often normochromic normocytic but may show hypochromic microcytic indices similar to the effects of iron deficiency. Iron is stored away and not available for use. The difference is determined by measuring ferritin levels

32
Q

Non-megaloblastic anaemia

A

no impairment of DNA synthesis occurs

includes disorders associated with increased membrane surface area, accelerated erythropoiesis and alcoholism

33
Q

Hepatic disease

A

patients with hepatic disease have macrocytosis that is secondary to raised cholesterol and phospholipids deposited on membranes of circulating erythrocytes which increases the surface area of the erythrocyte

34
Q

Affect of alcohol on anaemia

A

long-term alcohol excess suppresses bone marrow and has a direct toxic effect on developing erythroblasts. Often associated with folate deficiency

35
Q

hypothyroidism

A

can cause anaemia that is usually normocytic or macrocytic because thyroid hormones stimulate the production of erythropoietin and affects haematopoiesis,, a reduction in thyroid hormones production may cause anaemia

36
Q

iron deficiency

A

common cause of microcytic hypochromic anaemia
low iron = low Hb production
iron comes from dietary intake

37
Q

what are the forms of iron?

A
  1. heme - from meat

2. non-heme - from leafy green veg

38
Q

Importance of B12 and folate

A

both important for maturation process of reticulocytes so if there is a deficiency can cause pernicious anaemia. Immature RBCs can be released into the blood or reticulocytes may not mature fully

39
Q

what happens to RBCs as they mature

A

get smaller in size

40
Q

what causes macrocytic anaemia?

A

B12 and folate deficiency

41
Q

B12 and folate deficiency

A

causes macrocytic/ megaloblastic anaemia as the RBCs are not extruded from the bone marrow at the correct time

42
Q

what causes folate deficiency?

A

reduced intake
increased demand
malabsorption
drugs - anti-folates (methotrexate), folate not available for use

43
Q

where does folate come from?

A

green veg
nuts
liver
there is a 4 month long store in the body

44
Q

what causes B12 deficiency?

A

reduced intake - vegan diet
reduced intrinsic factor
reduced absorption
functional deficit

45
Q

where does B12 come from?

A

stores last 4-7 years so it takes a long time for B12 deficiency/ anaemia to present itself
comes from meat, fish, dairy but not plants

46
Q

what are B12 and folate needed for?

A

maturation of RBCs

47
Q

what happens when there is B12 and folate deficiency?

A

immature RBCs are released into the blood prematurely
causes macrolytic anaemia because these cells have not undergone as many divisions
inhibits purine and thymidylate synthesis, impairs DNA synthesis and causes erythroblast apoptosis resulting in anaemia from ineffective erythropoiesis

48
Q

absorption of vitamins

A

absorbed within small intestine by carrier mediated transport or passive diffusion

49
Q

how is folate absorbed?

A

carrier-mediated transport

50
Q

how is B12 absorbed?

A

too large to be absorbed by passive diffusion or carrier-mediated transport
B12 forms an acid-resistant complex with intrinsic factor in the stomach
the complex binds to specific receptors in mucosal cells in the terminal ileum
vitamin B12 is absorbed by endocytosis

51
Q

vitamin B12 malabsorption

A

intrinsic factor secreted by gastric mucosa
atrophic gastric mucosa fails to secrete normal secretions
lack of intrinsic factor from cells of gastric glands
so there is no binding of vit. B12 to intrinsic factor
B12 is not protected from digestion by GI tract enzymes and so does not bind to receptor sites in cells of terminal ileum
failure to absorb vitamin B12 in GIT without intrinsic factor
causes pernicious anaemia

52
Q

what occurs when there is a lack of absorption of B12 in lower ileum

A

no pernicious anaemia but type of B12 deficiency

53
Q

posterior cord syndrome

A

B12 essential for maturation of other cells, e.g. neurons of dorsal column and mucosa in lining of mouth
deficiency causes instability and loss of ability to walk, large tongue, very large RBCs
MRI will show degeneration of dorsal columns

54
Q

what is involved in iron studies?

A 
ferritin - good marker of iron deficiency
serum iron
transferrin
Fe saturation
total iron binding capacity
55
Q

how to treat iron deficiency anaemia?

A

blood transfusion
iron supplements
iron infusion

56
Q

what happens if iron deficiency anaemia is left untreated?

A

heart attack

57
Q

likely diagnosis if RBCs are microcytic?

A

iron deficiency anaemia

check ferritin/ iron studies

58
Q

likely diagnosis if RBCs are macrocytic?

A

B12/ folate deficiency

check serum B12 and folate

59
Q

How to treat anaemia?

A

treat according to underlying cause

Physiology (46 decks)

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