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Pathophysiology MEDI212 > anaemia and nutrition > Flashcards

anaemia and nutrition Flashcards

1
Q

(Macrocytic normochromic anaemia)
Macrocytic or megaloblastic refers to

A

unusually large stem cells in the bone marrow (referred to as megaloblasts)

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2
Q

macrocytes refers to unusually ??? erythrocytes (Macrocytic normochromic anaemia)

A

unusually large

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3
Q

Macrocytic normochromic anaemia: Hb content is normal (i.e. concentration is normal, but actual amount of Hb is ???)

A

high

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4
Q

Deficiency of folate or vitamin B12 inhibits ??? and ??? synthesis, impairs DNA synthesis, and causes erythroblast apoptosis, = anaemia from ineffective erythropoiesis

A

purine and
thymidylate synthesis

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5
Q

TRUE or FALSE: if folate or B12 deficient, cells are able to divide normally to become RBCs

A

FALSE: they cannot divide when deficient

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6
Q

pernicious anaemia is from a deficiency in ??? causing impaired erythropoiesis & oxygen transport and in demyelination of peripheral nerves

A

Vit B12

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7
Q

most common cause of B12 deficiency in pernicious anaemia is from ??? due to lack of intrinsic factor (or intrinsic factor antibodies or parietal cells antibodies) or lack of stomach acid

A

malabsoprtion

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8
Q

TRUE or FALSE: vitamin B12 activates folate

A

TRUE

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9
Q

Blood composition: PLAMSA (55%)
–> ??? (90%)
–> protein (8%)
–> other small molecular substances (2%)

A

Water

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10
Q

Blood Composition: BUFFY COAT (<1%)
–> ???
(important in immunity and inflammation)
–> Platelets
(involved in blood clotting)

A

White Blood Cells (leukocytes)

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11
Q

Red Blood Cells (erythrocytes) ???%

A

45%

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12
Q

TRUE or FALSE: RBCs when mature have no nuclei

A

TRUE

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13
Q

TRUE or FALSE: Most blood cells do not divide but are renewed by division of cells in the bone marrow

A

TRUE

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14
Q

Low ??? stimulates kidneys to produce EPO which kickstarts RBC synthesis (erythropoiesis) in bone marrow

A

02

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15
Q

how many days do erythrocytes circulate for?

A

120

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16
Q

the main function of RBCs is to carry oxygen via Hb, but they also carry ??? and ???

A

CO2 and H+

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17
Q

anaemia can be a reduction in number of RBCs, or a decrease in ??? or ??? of RBCs

A

quantity or quality

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18
Q

Which is NOT a symptom of anaemia:
- shortness of breath
- fainting and fatigue
- change in stool colour
- change in urine colour
- angina and heart attack
- spleen enlargement
- muscle pain
- skin yellowing

A
  • change in urine colour
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19
Q

anaemia related fatigue is due to reduced levels

A

reduced O2 levels

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20
Q

Shortness of breath, chest pain, arrhythmia, low blood pressure are from ==> ??? and lower viscosity of the blood = body has to work
harder to deliver the oxygen

A

hypoxia

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21
Q

yellow skin in anaemia is caused by ???

A

reduced O2 delivery

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22
Q

cold sensitivity in anaemia is from competing demands for tissue oxygenation vs decreased ??? to minimise heat losses to the environment

A

decreased blood flow

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23
Q

tachycardia and increase in ??? removed from Hb in tissues are the body compensating for anaemia to get oxygen effectively to the tissues the body

A

increase in O2% removed from Hb in tissues

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24
Q

to cope with anaemia related hypoxia, the body will cause ??? (= heart problems) and increase rate and depth of breathing

A

vessel dilation

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25
Q

anaemia: blood loss –> lowers blood volume –> fluid moves from ??? to blood vessels
–> dilutes the blood (lowers viscosity)
–> blood flows faster (increases turbulent)
–> causing ventricular dysfunction & cardiac dilation

A

fluid moves from interstitium to blood vessels

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26
Q

hypoxia occurs because ???

A

not enough RBCs to carry enough oxygen around body

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27
Q

hypoxia –> arterioles, capillaries & venules ??? –> further increasing blood flow –> more heart problems

A

dilate

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28
Q

sever anaemia presents with symptoms of: ??? (shortness of breath), tachycardia, Dizziness, Fatigue, Pallor even at rest or not?

A

Dyspnoea…
yes, even at rest

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29
Q

what causes anaemia?
1. blood loss
2. ??? erythrocyte production
3. ??? erythrocyte destruction

A
  1. blood loss
  2. impaired erythrocyte production
  3. increased erythrocyte destruction
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30
Q

TRUE or FALSE: In nutrition related anaemias, we do not have hyperchromic anaemias

A

TRUE

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31
Q

PCV (???)
Also known as haematocrit. Refers to the % of whole blood comprised of RBCs

A

Packed Cell Volume

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32
Q

MCV (???)
Mean (average) volume of the RBC
Unit is femtolitre (fL)

A

mean cell volume

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33
Q

a normal MCV lies within the range 77fL - ??? fL

A

95 fL

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34
Q

MCH (???) haemoglobin amount per RBC (pg)

A

mean cell haemoglobin

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35
Q

MCHC (???) – haemoglobin concentration per litre of
blood (g/L)

A

mean cell haemoglobin concentration

36
Q

RCDW: Normal red blood cells have a normal distribution of cell size whereas macrocytic and microcytic anaemias have an ??? in the red cell distribution width

37
Q

poikilocytosis = abnormal variation in size or shape?

38
Q

anisocytosis = abnormal variation in size or shape?

39
Q

TRUE or FALSE: Red cells show mild degree of anisocytosis (slightly uneven size) and poikilocytosis (uneven shape).

A

TRUE they are mostly uniform

40
Q

Is Normocytic normochromic anaemia related to food?

41
Q

is Microcytic hypochromic anaemia related to food? (i.e. Sideroblastic anaemia & Thalassemia)

42
Q

TRUE or FALSE: megaloblastic anaemia causes basophilic normoblasts to be unable to divide further due to being unable to replicate DNA

43
Q

TRUE or FALSE: Irone deficiency anaemia causes polychromatophilic normoblasts to be unable to develop further

44
Q

plasma folate enters cell and converted to tetrahydrofolate with the help of ???

A

Vitamin B12

45
Q

reasons for malabsorption of vit B12, which is odd one out:
* Gastric atrophy & achlorhydria (over 70’s)
* Atrophic gastritis esp elderly
* Stomach surgery, e.g. partial or full gastrectomy
* Resection of ileum
* Disorders that involve the ileum, e.g. Crohn’s diseases
* Poor dietary intake, esp strict vegan diets
* pregnancy

A

pregnancy is incorrect

46
Q

single most important diagnostic test for pernicious anaemia is:

A

low serum vitamin B12

47
Q

pernicious anemia is characterised by what type of RBCs?

A

megaloblastic

48
Q

pernicious anaemia tests for ??? include:
– Schilling test (used to be used)
– Intrinsic factor antibody assay
– Parietal cell antibody assay

A

inability to absorb vitamin B12

49
Q

schilling test: take radioactive vitamin ??? and a dose of nonradioactive vitamin by ??? to impede uptake of the absorbed
radioactive dose by the liver. Proportion of the radioactive dose absorbed is determined by measuring urine radioactivity

A

orally
by injection

50
Q

pernicious anaemia treatment is long term or short term?

A

long term treatment

51
Q

pernicious anaemia treatment includes:
Intra??? or intravenous injections of vitamin B12
ASLO: Adequate dietary intake esp in those without IF deficiency

A

intramuscular

52
Q

TRUE or FALSE: oral megadoses of vit B12 does work for treatment of pernicious anaemia

A

FALSE: NO it does not

53
Q

adequate B12 intake is:
Estimated 2 ug per day
recommended ??? ug per day

A

2.4 ug per day

54
Q

Folate deficiency (megaloblastic anaemia) is a Macrocytic normochromic anaemia similar to vitamin B12 deficiency BUT there are no ??? abnormalities when symptomatic

A

neurological abnormalities

55
Q

TRUE or FALSE: megaloblastic anaemia (folate deficiency) is caused by poor diet with inadequate dietary folate

56
Q

secondary folate deficiency is caused by ??? … as it is a cofactor for the enzyme… ??? Folate deficiency results in slow DNA synthesis and erythrocytes cannot divide

A

B12 deficiency as it is a cofactor for the enzyme methionine synthase which plays a role in DNA synthesis

57
Q

diagnostic measures of folate deficiency:
1. serum folate
2. ???

A

RBC folate

58
Q

TRUE or FALSE: Serum folate
can become low after 3
weeks of poor dietary
intake but IS NOT Influenced by recent dietary intake, or blood
transfusion or alcohol

A

FALSE. It IS influenced by recent dietary intake etc

59
Q

RBC folate shows the index of tissue folate stores and can become high or low after 3-4 months of
folate deficiency?

60
Q

which one is missing:
Who is at risk of Folate deficiency?
* Economically deprived people
* ???
* Alcoholics
* The elderly
* Malabsorption
* Some types chemo (anti-folate)
* Vitamin B12 deficiency (secondary folate deficiency)

A

Pregnant women

61
Q

folate deficiency treatment:
Prophylactic to Increase dietary intake (200-300ug) folate daily in
???
* Active treatment
* Folate supplementation 1000mg daily for 1-4 months

Long term: ???

A

pregnant women

long term: Ensure adequate dietary intake of folate

62
Q

adequate folate intake:
estimated: 320 ug/d
recommended: ??? ug/d

63
Q

Marked increase in serum lactate dehydrogenase released from increased destruction of macrocytes indicates pernicious anaemia or megaloblastic anaemia?

A

megaloblastic anaemia

64
Q

Microcytic hypochromic anaemia: Abnormally small or large (?) erythrocytes with reduced amount and concentration of Hb

65
Q

what is the most common anaemia worldwide?

A

irone deficiency anaemia

66
Q

iron deficiency anaemia is sefined as a progressive loss of iron stores from haemosiderin and ???

67
Q

TRUE or FALSE: coeliac disease can cause iron deficiency anaemia

68
Q

TRUE or FALSE: two types of iron in the diet, haem iron and nonhaem iron which utilise same pathways of absorption

A

False: two separate pathways

69
Q

Serum Ferritin – iron + apoferritin = protein shell packed with iron
molecules and stored ??? in cells
(usually >12ug/L)

A

intracellularly

70
Q

Haemosiderin – insoluble aggregation of ferritin molecules that are stored in the ???

71
Q

Transferrin saturation – index of how much iron is bound to ???
(usually 30% saturation, <15% saturation iron deficiency is likely)

A

transferrin

72
Q

Total Iron Binding Capacity – indirect measure of ??? saturation
(usually < 1umol/L of red blood cells)

A

transferrin

73
Q

What would you expect to see in iron
deficiency anaemia?
Low: ???

A
  • Hb
  • Serum iron
  • Ferritin
  • Transferrin saturation
74
Q

What would you expect to see in iron
deficiency anaemia?
High ???

A

Transferrin

75
Q

Inadequate dietary iron leads to low serum levels and ??? of ferritin stores

76
Q

TRUE or FALSE: Transferrin SATURATION low because spare spaces on the molecule for iron i.e. not saturated

77
Q

Transferrin high because liver has produced more to maximise available ???

78
Q

Stage 1 of iron defic. anaemia:
body’s iron stores are depleted,
Serum ferritin < ???ug/L

A

less than 12ug/L

79
Q

stage 2 of iron defic. anaemia: Insufficient iron is transported to the ??? & iron deficient erythropoiesis begins

80
Q

stage 3 of iron defic. anaemia:
no iron stores, diminished production of ???
(low Hb – microcytic anaemia – low serum iron & low stainable iron seen in bone marrow)

81
Q

Clinical manifestation of iorn deficient anaemia: usually don’t notice until Hb <???-80g/L

82
Q
  • fatigue, weakness, shortness of breath
  • brittle nails
  • pale ear lobes, eyelids & palms
    are all signs of which type of anaemia?
A

iron deficiency anaemia

83
Q

can evaluate iron deficient anaemia through:
- bone marrow biopsy
- indirectly through serum ???transferrin, transferrin saturation, or total iron binding capacity

A

serum ferritin

84
Q

an indicator for haeme synthesis = amount of free erythrocyte protoporphyrin in erythrocytes in which type of anaemia?

A

iron deficiency anaemia

85
Q

adequate dietary intake of iron:
estimated: 6-8mg/d
recommended: 8-???mg/d

Pathophysiology MEDI212 (14 decks)

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