dietry aspects of anemia

Question 1

what type of anaemia results from iron deficiency

Answer 1

hypochromic microcytic anameia

Question 2

what type of anaemia results from folate/B12 deficiency

Answer 2

megaloblastic anaemia

Question 3

what is the most widespread nutritional problem in the world

Answer 3

iron deficiency

Question 4

what demographic groups have the highest percentage of Hb below threshold

Answer 4

girls 11-18; adult women; men >65 (generally secondary cause e.g. colon cancer)

Question 5

how much iron is recycled in the body daily and from where

Answer 5

20-25mg recycled from red cell destruction

Question 6

4 risk factors for iron deficiency anaemia

Answer 6

H.pylori (use iron for own growth); long-term use of PPIs; blood loss (menstrual, frequent donation); pregnancy

Question 7

what vitamin increase iron absorption

Answer 7

vitamin C

Question 8

what are 2 dietary factors that decrease iron absorption and where r they found

Answer 8

phytate (in whole grain cereals); tannins (in fruit, veg, tea)

Question 9

how much meat is recommended per day

Answer 9

no more than 70g of red/processed meat

Question 10

4 fucntions of vit B12 (cobalamin)

Answer 10

1. development/myelination/function of CNS;
2. DNA synthesis (and thus RBC formation);
3. co-factor methionine synthase
4. L-methylmalonyl-CoA-mutase

Question 11

why might serum ferratin levels be artificially high

Answer 11

it is an acute phase protein and so does not reflect iron stores when there is infection/inflammation present

Question 12

how much iron needs to be absorbed per day

Answer 12

1-2mg

Question 13

what are the 3 main reasons for iron deficency in industrialised countries

Answer 13

1. low bioavailability;
2. sedentary lifestyle;
3. lower micronutrient density

Question 14

what is the majority of B12 deficiency caused by

Answer 14

impaired absoprtion (pernicious anaemia) due to lack of intrinsic factor

Question 15

long term use of what kind of drugs can result in B12 deficiency and why

Answer 15

PPIs (and other drugs that affect gastric acid production) -> gastric acid needed to release B12 bound to proteins in food

Question 16

what can inadequate B12 in children result in

Answer 16

stunted brain growth and intellectual development

Question 17

where is Vit B12 found in the diet

Answer 17

products of animal origin - meat (esp liver), poultry, fish, dairy, eggs;
fermented foods e.g. sauerkraut (due to bacteria);
fortified cereals

Question 18

folate vs folic acid

Answer 18

Folate - natural form of vitamin B9 in food
folic acid -synthetic form

Question 19

what enzyme deconjugates folic acid in the small intestine

Answer 19

glutamate carboxypeptidase II

Question 20

what increases folate/folic acid requirements

Answer 20

alcohol consumption

Question 21

what demographics are vulnerable to nutritional anaemias

Answer 21

infants/chidlren (high requirements); vegans; pregnant women; elderly (malabsorption and poor diet); low income; ethnic minorities

Question 22

4 symptoms of iron deficiency in infants

Answer 22

poor weight gain; frequent infections; developemental delay; behavioural disorders

Question 23

why might an infant develop iron deficiency at 6 months old

Answer 23

inappropriate weaning

Question 24

how much does iron absorption increase by in pregnancy

Answer 24

x1.5 in second trimester and x4 in third

Question 25

what 2 mutations cause increased risk of
neural tube defect in the foetus

Answer 25

Methyl tetrahydrofolate reductase (MTHFR) and methionine synthetase reductase (MTRR) mutations

Question 26

why is anaemia common in the elderly (8)

Answer 26

1. Higher risk of nutritional deficiencies
2. Impaired absorption (particularly vitamin B12)
3. Dental problems – restricted food choice
4. Poor quality meals in institutions
5. Lower socio-economic status
6. Less mobile – restricted shopping
7. Mental problems – dementia, depression
8. Lower physical activity requires lower energy intake

Question 27

management for folate deficiency

Answer 27

5mg folic acid supplement OD; eat folate rich foods e.g broccoli, Brussels sprouts, asparagus, peas, chickpeas, and brown rice

Question 28

elevate what can be a sign of folate deficicency

Answer 28

homocystein levels (with normal methylmalonyl-coenzyme A)

Question 29

6 causes of splenomegaly

Answer 29

1. haematological malignancy (lymphoma, leukemia, mylofibrosis);
2. haematological conditions (chronic haemolytic anaemia);
3. infection (EBV, maralia, leishmaniasis);
4. liver disease (cirrhosis results in increased portal hypertension);
5. sarcoidosis, SLE etc.
6. glycogen storage disorders (gaucher’s etc.)