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MEH > Anaemia, Vit B12, Folate > Flashcards

Anaemia, Vit B12, Folate Flashcards

1
Q

Define Anaemia

A

A Hb concentration lower than the normal range

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2
Q

State 4 symptoms of Anaemia

State 4 signs of Anaemia

A

Symptoms;

  • Breath shortness
  • Headaches
  • Confusion
  • Weakness and lethargy

Signs;

  • Tachycardia
  • Tachypnoea
  • Hypotension
  • Pallor (Unhealthy pale appearance)
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3
Q

Give reasons why Anaemia might develop in relation to;

  1. Bone marrow (3 reasons)
  2. RBCs (4 reasons)
  3. Removal of RBCs (1 reason)
A
    • Reduced/ abnormal erythropoiesis
    • Abnormal Haem synthesis
    • Abnormal Globin chain synthesis
    • Abnormal structure
    • Mechanical damage
    • Abnormal metabolism
    • Excessive bleeding
    • Increased removal by Reticuloendothelial system
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4
Q

In reduced/ abnormal erythropoiesis, how can anaemia develop in 4 ways

A
  1. Lack of response in haemostatic loop
  2. Marrow can’t respond to Erythropoietin
  3. Myelofibrosis (Marrow infiltrated by cancer cells/ fibrous tissue)
  4. Iron not available to marrow
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5
Q

How can Abnormal RBC structure lead to Haemolytic Anaemia in 3 steps

A
  • Inherited mutations in genes that code for structural proteins
  • Cells becomes less flexible and more easily damaged
  • Removed faster by Reticuloendothelial System
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6
Q

How can Mechanical Damage cause a Haemolytic Anaemia in 4 ways

A
  • Shear stress as RBCs pass through defective heart valve
  • Cells snag on Fibrin strands in vessels where clotting has occurred
  • Heat damage from burns
  • Osmotic damage
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7
Q

In an RBC Metabolism defect, suggest 2 ways an Anaemia can develop

A
  1. G6PDH deficiency-> Low NADPH->Low GSH-> Oxidative stress damages Hb-> Heinz bodes-> Cells removed
  2. Pyruvate Kinase deficiency-> Low ATP in RBC-> Haemolysis
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8
Q

Suggest 2 ways bleeding can cause anaemia

Which is most common, give 4 examples of this

A

Acute blood loss

Chronic bleeding (Small amount over a long time)- Most common

E.g:

  • Heavy menstrual bleeding
  • Repeated nosebloods
  • GI bleeding
  • Kidney/ bladder tumours (Blood lost in urine)
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9
Q

What are the 2 types of damage in Haemolytic Anaemia

What is Autoimmune Haemolytic Anaemia

A

Intravascular anaemia: Damage within vessels
Extravascular anaemia: Damage within RES system

Antibodies bind to RBC membrane proteins, causing them to be Phagocytosed by macrophages

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10
Q

What 2 features can help work out the cause of anaemia

A
  • RBC size

- Presence/ absence of reticulocytosis

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11
Q

What does it mean if there is an increased reticulocyte during anaemia

What does it mean if there is not an increase

A

Is an increase: Bone marrow functioning normally

No increase: Bone marrow functioning abnormally

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12
Q

What is a Macrocytic Anaemia

What are the 3 types?

A

Anaemia where MCV is raised

Megaloblastic Anaemia
Macronormoblastic erythropoiesis
Stress erythropoiesis

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13
Q
  1. Describe Megaloblastic Anaemia
  2. Compare nucleus development to cytoplasm maturation
  3. How does this lead to increased MCV

Give 2 causes

A
  1. Interference with DNA Synthesis during erythropoiesis
  2. Nucleus development is slow in relation to cytoplasm maturation
  3. Delayed division, RBCs grow to form Megaloblasts which give rise to larger RBCs

Vit B12/ Folate deficiency
Drugs that interfere with DNA synthesis

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14
Q

Describe Macronormoblastic Erythropoiesis

Give 2 causes

A

Erythroblasts are larger than normal, so larger RBCs formed (Normal Nucleus-Cytoplasm relationship)

Liver disease
Alcohol toxicity

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15
Q

Describe Stress Erythropoiesis

Give 2 causes

A

Associated with a High Reticulocyte Count

  • Recovery from blood loss due to haemorrhage
  • Recovery from haemolytic anaemia
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16
Q
  1. In what kinds of food are Folate particularly abundant
  2. Where is absorption mainly from
  3. What organ is it taken up by, why?
A
  1. Green leafy vegetables
  2. Duodenum and Jejunum
  3. Taken up by liver to act as a store
17
Q

Identify 5 causes of Folate deficiency

A
  • Dietary deficiency
  • Increased requirements
  • Disease of Duodenum/ Jejunum
  • Methotrexate( Drug inhibits dihydrofolate reductase)
  • Liver disease/ Heart failure—> Urinary loss of folate
18
Q

What does normal Hb conc. name depend on per patient

Describe 4 signs associated with anaemia
Which is rare and why

A

Age
Sex
Ethnicity
Hospital

Koilonychia: Spoon shaped nails
Angular stomatitis: Inflammation of corners of mouth
Glossitis: Inflammation and depapillation of tongue

Abnormal Facial Bone Development: Can be prevented with early diagnosis

19
Q

Identify 5 symptoms of folate deficiency

What other symptoms are possible

A
  • Reduced sense of taste
  • Diarrhoea
  • Numbness + tingling in feet and hands
  • Muscle weakness
  • Depression
  • Those related to anaemia
20
Q

When should folic acid be taken to prevent defects in babies, which defects are prevented

A

Before conception and during Weeks 1-12 of pregnancy

Majority of neural tube defects are prevented

21
Q

What organisms make Folate

What organisms make Vit B12

A

Bacteria + Plants

Bacteria (Foods of animal origin)

22
Q

Outline B12 absorption in 5 steps

A
  1. B12 binds to Haptocorrin in stomach for protection
  2. Complex digested in Small Intestine by Pancreatic Proteases, released B12 binds to Intrinsic Factor
  3. Intrinsic factor-B12 complex taken into enterocyte
  4. B12 exits through MDR1 and binds to Transcobalamin in blood
  5. Most B12 is stored in liver (Enough for 3-6 years)
23
Q

Identify 7 causes of B12 deficiency

A
  • Dietary deficiency
  • Lack of Intrinsic Factor-> Pernicious anaemia
  • Ileum diseases
  • Lack of Transcobalamin
  • Chemical inactivation of B12
  • Parasitic infestation can trap B12
  • Some drugs can Chelate Intrinsic Factor
24
Q

Identify 5 symptoms of B12 defciency

What others are there

A
  • Glossitis
  • Diarrhoea
  • Paraesthesia
  • Disturbed vision
  • Irritability
  • Those related to anaemia
25
Q

How can Folate/ B12 deficiency affect the Nervous System

A
  1. Neural tube defects (Folate)/ Demyelination (B12)
  2. B12 deficiency often results in a Reversible neuropathy
  3. Can cause Subacute Combined Degeneration of the Cord (Degeneration of posterior and lateral columns of spinal cord)
26
Q

Describe the B12/ Folate link and why they’re needed for DNA synthesis

A

A deficiency in one causes a deficiency in the other, as their pathways are linked

They are both needed to make Tetrahydrofolate which is needed to make Thymidine for DNA Synthesis.

27
Q

Why do B12/ Folate deficiency lead to Megaloblastic anaemia

A

Thymidine not produced normally, so Uracil is used to make DNA

DNA repair enzymes detect and repair these errors

-> Asynchronous maturation between nucleus and cytoplasm

28
Q

Identify 5 Megaloblastic features in a Blood Film

A 
Anisopoikilocytosis
Tear drop shaped RBCs
Ovalocytes 
Hypersegmented neutrophils 
Macrocytic RBCs
29
Q

What are 3 symptoms of Subacute Combined Degeneration of the Cord

A

Gradual onset weakness
Numbness and tingling in arms, legs, trunk
Changes in mental state

30
Q

How is B12 deficiency treated

Why is it done in this way rather than orally

A
  • Hydroxycobalamine given by Intramuscular injection

- B12 wouldn’t be absorbed if deficiency in Intrinsic Factor

31
Q

What is the treatment for Folate deficiency

What do you check first and why

A

Dietary advice and Oral folic acid

B12 levels, as improvement due to treatment can mask B12 deficiency, allowing neurological disease to develop

MEH (20 decks)

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