Blood and nutrition

Question 1

Name 5 drugs with definite risk of haemolytic anaemia in G6PD deficiency?

Answer 1

Nitrofurantoin
Quinolones
Dapsone/sulfones
Sulfonamides 
Rsbirucase

Question 2

What drugs have a possible risk of haemolytic anaemia in G6PD deficiency?

Answer 2

Aspirin (acceptable to 1 day)
Chloroquine
sulfonylureas

Question 3

What is a risk of using EpoBeta and monitoring?

Answer 3

1. Hypertension
2. Skin reactions/SJS
3. thrombus, tumour progressions

Question 4

What are symptoms of iron deficiency anaemia

Answer 4

Pallor
tiredness
SOB
palpitations
pale skin

Question 5

When would you use iron prophylaxis for iron deficiency anaemia

Answer 5

Pregnancy 
malabsorption syndromes, chrons, 
menorrhagia 
gastrectomy 
low birth weight/neonates
haemodialysis

Question 6

what are counselling points for iron?

Answer 6

With food to reduce S/E (better absorbed without but S/E) e.g. diarrhoea/constipation

With orange juice/vit C

Black stools/urine

Continue for 3M after bloods normal

Question 7

What is the MHRA warning regarding ferrinject (IV iron)?

Answer 7

Cautions with every dose due to risk of severe hypersensitivity rxns
Monitor for 30 mins after each injection, resus facilities and trained staff
NO TEST Doses
Higher risk in allergy patients/cross sensitivity-only if benefit>risk
Avoid in pregnancy esp 1st trimester

Question 8

What are symptoms of megaloblastic anaemia and subcategories?

Answer 8

B12 and folate deficiency

• numb/tingling in hands/feet
• numbness
• muscle weakness
• depression
• lethargy

Question 9

What are causes of B12 deficiency?

Answer 9

Diet and malabsoption syndromes

common in vegans

Question 10

How is Vitamin B12 deficiency treated?

Answer 10

Dietary cause: Oral hydroxycobalamin

malabsorption: IM Hydroxycobalamin every 3 months

Question 11

In an emergency - would you give B12 or folate?

Answer 11

BOTH - never give one alone (i.e. never give folate alone) - would cause neuropathy of the spinal cord

Question 12

What are causes of folate deficiency

Answer 12

Poor diet
pregnancy
coeliac, malabsorption

antiepileptics/mtx/trimethoprim /antifolate drugs

Question 13

what is treatment of folate deficiency?

Answer 13

Folic acid daily 4 months

Question 14

What are the 2 different doses for prevention of neural tube defects in pregnancy?

Answer 14

Regular OTC pregnancy dose:400 mcg daily from before/at conception to week 12

Pts at higher risk of NTD: 5mg daily at concption/before to week 12

Question 15

Which pregnant patients are at higher risk of neural tube defects?

Answer 15

diabetics
anti-epileptics
sickle cell 
obesity
anti-malarials
smoking

Question 16

What is the antidote for iron overdose

Answer 16

Dexferrioxamine

Question 17

what is treatment for neutropenia?

Answer 17

Filgrastim

Question 18

What happens to MCV in:

• iron deficiency
• B12
• Folate

Answer 18

Iron: MCV and Hb low
B12: MCV high and HB low
Folat: MCV high and Hb low

Question 19

What foods can you receive

iron, b12 and folate from

Answer 19

Iron: red meat, kidney beans/chickpeas, nuts
B12: eggs, fish, meat, milk, cheese
Folate: leafygeens, brussels/broccoli, chickpeas etc

Question 20

What are the effects of vitamin D deficiency and what is it caused by

Answer 20

Rickets
osteomalacia

• causes:
• lack of sunlight
• lack of dietary intake
• asians eating roti

.

Question 21

What is the effect of vitamin A retinol deficiency ? what are thee sources?

Answer 21

effects: ocular effects - dry eyes, risk of infection, poor night vision, poor skin

Sources- pate, fish oil, raw eggs, oilyfish, milk

Question 22

Which vitamin should be avoided in pregnancy and what foods to avoid

Answer 22

Vitamin A- teratogenic

avoid liver pate etc

Question 23

If a patient had vitamin K deficiency and renal impairment - what is the drug of choice?

Answer 23

Menadiol - water soluble, used in renal impairment and malabsorption syndrome

Question 24

What are the sources of vitamin K

Answer 24

Green leafy veg, veg oils, cereal grains

Question 25

What is vitamin E and its effects?

Answer 25

Tocopherol - antioxidant, healthy skin and eyes protecting against free radicals
sources-plant oils e.g. olive oil, nuts seeds

Question 26

What is effect of deficiency of vitamin E

Answer 26

Neuromuscularr abnomalities

Question 27

What are the effects of vitamin C deficiency

Answer 27

Scurvy, gingival bleeding, peteichae, infections, poor wound healing,

Question 28

What is thiamine B1 important for and what is the deficiency?

Answer 28

Healthy CNS, release of energy from food - common in alcoholics - causes wernickes encephalopathy

Question 29

Which B vitamin can be used to reduce triglycerides and cholesterol in hyperlipidaemia under specialist use?

Answer 29

Niacin B3

Question 30

What is the effect of deficiency of pyridoxine B6?

Answer 30

peripheral neuropathy

Question 31

Which B vitamin is hydroxocobalamin and what is its use?

Answer 31

B12

Use for healthy nervous system, making RBC, processing folic acid