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Stage 1 Blood > BL Anaemia 2 > Flashcards

BL Anaemia 2 Flashcards

1
Q

What are the 3 classifications of anaemia to do with development?

A

1) Excess loss
2) failure of production
3) excess destruction

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2
Q

what presents as an Fe deficiency anaemia?

A

chronic haemorrhage

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3
Q

What type of anaemias are the following:

1) acute haemorrhage
2) haemolytic anaemias
3) sickle cell anaemia
4) deficiency anaemia (Fe, B12, folate)

A

1) excess loss
2) excess destruction
3) excess destruction
4) excess destruction

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4
Q

What type of anaemias are the following:

1) Marrow disease e.g.aplastic anaemia
2) Leukaemia
3) Thalassaemia

A

1) failure of production
2) failure of production
3) excess destruction

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5
Q

a) what is the average dietary intake of :
b) What is the minium intake:
c) What are the sources:
d) how long are they strored for?
1) B12
2) Folate?

A

a) 1) 20μg/day
2) 250 (400)μg/day
b) 1) 1-2
2) 150
c) 1) animal produce (meat and dairy), marmite
2) liver, vegetables
d) 1) several years
2) few months

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6
Q

What is a cause (s) of :

1) microcytic RBC
2) Normocytic
3) macrocytic

A

1) Fe deficiency
2) acute blood loss, haemolysis, marrow disease
3) B12 deficiency, folate deficiency ( alcoholics)

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7
Q

What nutrients are essential to DNA synthesis?

A

vitamin B12 (cobalamin) and folate

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8
Q

1) How does a folate or vitamin B12 deficiency effect the shape of RBCs?
2) a) How do the blood cells look in the in bone marrow?
b) How do the red blood cells look in the in blood?

3) What other condition can cause this?

A

1) a) erythrocyte precursor cells (in all myloid lines) have asynchronoy between their nucleus and cytoplasm as the cytoplasm and RNA is being produced as normal but the nucleus doesn’t grow in size as the DNA is not able to synthesise and mature.
2) a) This gives the them an appearance of a large cell with a small nucleus
b) enlarged RBC, macrocytic
3) leukemia

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9
Q

1) What is the substance used to make blood?
2) What molecules are used to form it?
3) What else is formed? why is this important?

A

1) dTMP Deoxythymidine-5’-monophosphate
2) 5,10 methylene FH4 and dUMP Deoxyuridine-5’-monophosphate
3) Dihydrofolate (DHF, FH2), this allows the molecule to be recycled

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10
Q

What is the the difference between dTMP and dUMP?

A

dTMP has a methyl group

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11
Q

1)What is the function of vitamin B12 in DNA synthesis? describe the reaction it is involved in:

A

1) it is a cofactor for the enzyme Methionine synthase

the enzyme catalyses the 5-methylFH4 and homocysteine into methionine and tetrahydrofolate (THF, FH4)

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12
Q

1) Decribe the reactions folate is involved in the dUMP cycle:
2) Which of these molecules are recycled?

A

folate then goes to dihydrofolate, then goes to tetrahydrofolate, then 5,10 methylene FH4 then 5- methyl FH4.

2) a) 5,10 methylene FH4 is recycled back into dihydrofolate by reacting it with dUMP
b) 5-methyl FH4 is recycled into tetrahydrofolate (THF, FH4) by reacting it with homocysteine ( involving the enzyme methionine synthase

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13
Q

WHat is megaloblastic anemia classified as?

A

macrocytic anaemia, MCV greater than 90

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14
Q

A)1) What is the consequence of slowed DNA synthesis?(3)

B) what is this condition called?

A

A) 1) prolonged cycling
2) Delayed maturation of the nucleus of erythrocytes and delayed cell division overall =macrocytic cells
3) the enlarged misshaped erythrocytes that enter the circulation have a reduced survival time
B) megaloblastic anemia

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15
Q

1) How much vitamin B12 can be stored in the liver?

2) How long does it take for a deficiency of it to develop?

A

1) 2-3mg

2) 2 years

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16
Q

What are the 2 main problems of a deficiency in B12

A
  1. Lack of coenzyme for fatty acid breakdown, so odd numbered fatty acid chains are incorporated into cell membranes resulting in neurological symptoms (degeneration of spinal cord, position and vibration sense lost, numbness and tingling)
  2. Secondary ‘artificial’ folate deficiency since folate is ‘trapped’ as methyl-FH4. Which leads to a decrease in nucleotide synthesis resulting in megaloblastic anaemia.
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17
Q

Describe the mechanism that lead to problems in DNA synthesis when there is a vitamin B12 deficiency?

A

1) Methionine synthase activity Is reduced /stopped. therefore folate becomes trapped in methyl form

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18
Q

What are the causes of vitamin B12 that are not to do with Gastrointestinal tract?

A

vegan diet, elderly, alcoholic

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19
Q

What are the causes of vitamin B12 that are to do with Gastrointestinal tract diseases?

A

1) Pernicious anaemia

2) Crohn’s disease

20
Q

What are the causes of vitamin B12 that are to do with Gastrointestinal tract surgery?

A

Gastrectomy

21
Q

What causes reduced absorption of vitamin B12?

A

1) Pernicious anaemia
2) Crohn’s disease
3) Gastrectomy

22
Q

How is vitamin B12 absorbed in the diet?

A

1) In the stomach parietal cells produce IF,
2) IF has a binding site complementary to B12 they form a complex
3) At the terminal ileim lumen, IF part of the complex binds to mucosal cells lining ileum allowing B12 to be absorbed into the blood stream

23
Q

List the binding sites of IF:

A

Binding site for B12

BInding site for ileal receptors on terminal ileam mucosal cells

24
Q

What do the antibodies bind to that can cause a vitamin B12 deficiency?

A

1) one of the 2 binding sites on IF

2) parietal cells in stomach which leads to increased atrophy (wasting away) and achlorhydia ( lack of HCl)

25
Q

WHat does a symmetrical geographical tongue a symptom of?

2) What other oral symptoms are there of this condition?

A

1) pernicious anaemia

2) erythema (redness of skin) on the cheeks inner lip and tongue (which is you would actually call the geo. tongue

26
Q

What shape are the RBC in a smear test that’s positive for perniculous anaemia?

A

oval, egg shapped

27
Q

A patient has been found with oval shapped RBC and their haematic indicate a low level of vitamin B12 and their autoimmune profile shows a strong positive for antibodies against gastic parietal cells, what further test is required to show what is occurring intrinsically?
2) Why is a further test required and it cannot be assumed the anaemia is caused by leukocytes producing antibodies against their parietal cells?

A

1) Schilling test

2) as other factors can cause a strong psotive for example being aged over 40 and gastritis (inflammation of intestine)

28
Q

1) WHat is the purpose of schilling test?
2) What are the purposes of its stages?
3) What is stage 1?

A

1) to work out cause of vitamin B12 deficiency
2) to rule out or prove a cause
3) Patient is given a radiolabelled vitamin B12 orally and 2 hours later an injection of a large dose of B12 into intrinsic muscles
Then asked to do a 24hr urine collection
4) The injected B12 saturates receptors, so B12 ingested cannot be absorbed and is excreted in blood
5) a) more than 15% is radioactive B12 in urine = normal as radiolabbelled B12 was injested and absorbed in GI, so there are no pathological reasons for deficiency so it a dietary deficiency
b) less than 15% is radioactive B12 in urine= malabsorbtion , continue to stage 2 to check if its IF (perniculous anemia)

29
Q

What is stage 2 of schilling’s test

A

1) Give radiolabbelled B12 and intrinsic factor orally, large does of B12 injected into intrinsic musle then 24hr urine collection, wait 24hr then inspect urine
2) a) more than 15% is radioactive B12 in urine = pernicious anaemia (autoimmune)
b) less than 15% is radioactive B12 in urine= Ileal disease or bacterial overgrowth

30
Q

What is the treatment for perniculous anemia?

A

hydroxycobalamin IM injections.

Then tablets (Vit. B12 and folate- until which one is deficient is confirmed- as you can get false positives) for life/
IM injection getting cheaper.
31
Q

1) How long does it take a folate deficiency to occur?

2) How much folate is stored in liver?

A

1) 2 months

2) 10mg

32
Q

What are the 3 main causes for folate deficiency + e.gs for each:

A

1) decreased intake e.g. poor diet, slimmers, elderly, alcoholic
2) increased requirement e.g. adolescence, infancy or pregnancy
3) malabsorption e.g. GI disease, gut resection, drugs (anticonvulsants)

33
Q

How is folate deficiency diagnosed?

A

1) RBC folate/ serum folate
2) eat daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake.`

34
Q

Failure of production or decreased RBC production is caused by what?

A

Defective RBC or HB synthesis in bone marrow caused by either:

1) marrow disease like Aplastic anaemia or leukaemia
2) Inadequate dietary intake of essential nutrients
35
Q

What is occurring in aplastic

A

HCPS cannot produce functioning myloid stem cell so none of the cell produce from the myloid line are present in adequate quantities, this is called pancytopenia (low RBC, WBC and platelets) although RBC are normocytic and normochromic

36
Q

What are the causes of aplastic anaemia?

A

Genetic-Fanconi’s anaemia (mouth cancer), autoimmune, viral, drugs

37
Q

1) What anaemia is caused by excess destruction?

2) WHat are the 4 sub-groups which cause 1?

A

1) haemolytic anaemia

2) abnormal haemoglobin, abnormal membrane, abnormal enzymes and damage that is acquired

38
Q

What are the causes of abnormal haemoglobin?

A 
sickle cell (inherited)
thalassemia (inherited
39
Q

What are the causes of abnormal membrane?

A

spherocytosis (inherited, spectrin mutation)

40
Q

What are the causes of abnormal enzeymes?

A

lack of glucose-6-phosphate dehydrogenase leads to oxidative stress to do with free radicals (NADP+ from glycolysis) not being abled to be oxidised allowing them to cause damage.

41
Q

What are the causes of damage to RBC leading to excess destruction?

A

Autoimmune
Drug induced
Infection: Ecoli, malaria
Idiopathic (unknown condition or disease)

42
Q

What is the purpose of a full blood count?

A

ascertain Hb Level and RBC indices – important to include a

reticulocyte count

43
Q

What is the purpose of a blood film?

A

demonstrate abnormal forms of RBC (sickle cell)

44
Q

What is the purpose of a Hb electrophoresis?

A

for haemoglobinopathy screening

45
Q

what is haematinics?

A

a test done to show serum Vit. B12,folate and ferritin levels

46
Q

Why is endoscopy useful in the diagnosis of anaemias?

A

identify sources of GI blood loss. A test first for Helicobacter Pylori may detect a
bacterium that can cause ulcers in the GI tract which may be a cause of chronic bleeding.

47
Q

What is the purpose on a bone marrow biopsy?

A

A primary purpose of the biopsy is to find out whether your bone marrow is functioning properly, and if not to determine why.

Stage 1 Blood (7 decks)

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