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CR2 > Erythropoiesis, Introduction To Microcytic Anaemias And Iron Deficiency Anaemia (IDA) > Flashcards

Erythropoiesis, Introduction To Microcytic Anaemias And Iron Deficiency Anaemia (IDA) Flashcards

1
Q

Anaemia

A

Hi level below reference range for that age and sex

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2
Q

What 3 classes can anaemia be placed in based on RBC size

A

Normocytic
Microcytic
Macrocytic

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3
Q

How is RBC size indicated

A

Mean corpuscular volume

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4
Q

Microcytic anaemia

A

RBCs smaller than normal

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5
Q

Hypochromic

A

RBCs paler than normal

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6
Q

5 causes of Microcytic anaemia

A

Thalassaemia
Anaemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anaemia
TAILS

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7
Q

What is the most common cause of anaemia

A

Iron deficiency

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8
Q

What are the main roles of iron in the body

A

Oxygen carriers
Co factors

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9
Q

How is iron toxic to cells

A

Formation of free radicals

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10
Q

Why is it important to regulate iron absorbtion

A

Body has no iron excretion mechanism
Iron is toxic to cells

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11
Q

How is iron removed from the body

A

Lost with skin cell shedding, sweating, etc

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12
Q

How much iron is needed in a day

A

10-15 mg

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13
Q

Where is iron absorbed

A

Enterocytes in Duodenum and upper jejunum

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14
Q

Why is iron absorbed in the duodenum and upper jejunum

A

More acidic

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15
Q

What 2 substances can convert FE3+ to Fe2+

A

Vitamin c
Reductase

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16
Q

What is the only known iron exit protein from enterocytes

A

Ferroportin

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17
Q

What enzyme removes Fe from haem

A

Haem oxygenase

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18
Q

What protein stores iron in cells

A

Ferritin

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19
Q

What molecule transports iron around the body in the blood

A

Transferrin

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20
Q

What does DMT1 do

A

Transports Fe2+ into cells

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21
Q

What molecules can decrease iron absorption in the gut

A

Tannins
Phytates
Fibre
Antacids

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22
Q

How does vitamin c increase iron absorbtion in the gut

A

Prevents formation of insoluble iron compounds
Helps Reduce ferric to ferrous

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23
Q

What molecule is the ‘master iron regulator’

A

Hepcidin

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24
Q

How does hepcidin regulate iron absorption

A

Blocks ferroportin

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25
Q

Why is why is hepcidin released in inflammation

A

Prevent iron being given to bacteria/ pathogens

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26
Q

How is iron taken into cells (excluding enterocytes)

A

Receptor mediated endocytosis

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27
Q

What receptors allow iron to enter cells other than enterocytes

A

Transferrin receptors (fe bound to transferrin)

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28
Q

Which cells have transferrin receptors

A

All

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29
Q

Which organ has the highest amount of ferritin

A

Liver

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30
Q

Low serum ferritin is a diagnostic test for which condition

A

Iron deficiency anaemia

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31
Q

What can serum ferritin indirectly show

A

Total amount of iron stored in body

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32
Q

Which cells take up 90% of iron

A

Myeloid cells in bone marrow

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33
Q

Does erythropoiesis occur in red or yellow bone marrow

A

Red

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34
Q

Haematopoiesis

A

Formation of blood cellular components

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35
Q

Erythropoiesis

A

Formation of RBCs

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36
Q

What stem cells are involved in erythropoiesis

A

Hadmatopoietic stem cells

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37
Q

What are the steps in erythropoiesis

A

Haematopoietic stem cell -> common myeloid progenitor cell -> proerythroblast -> erythroblast -> reticulocyte -> erythrocyte

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38
Q

At what stage of maturation does a RBC lose its nucleus

A

Reticulocyte

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39
Q

Diapedesis

A

Blood cells squeeze through pores in capillary mebranes

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40
Q

How do new RBCs enter the bloodstream

A

Diapedesis

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41
Q

What peptide hormone controls erythropoiesis

A

Erythropoietin

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42
Q

Where is erythropoietin synthesised

A

Kidney interstitial tubules

43
Q

What triggers erythropoietin secreting cells in the kidney interstitial tubules to release erythropoietin

A

Hypoxia

44
Q

Why is erythropoietin synthesised in the kidney interstitial tubules

A

Oxygen levels in/around tubules not effected by blood pressure or exercise

45
Q

How does erythropoietin control erythropoiesis

A

Increases erythroblast maturation speed
Increases proerythrocyte formation

46
Q

How does erythropoietin affect haematocrit

A

Increase

47
Q

Where are RBCs made at the 3rd week of gestation

A

Yolk sac

48
Q

Where are RBCs mainly made at 6 wks gestation

A

Liver

49
Q

Where do RBCs start being made at 8 wks

A

Spleen

50
Q

When does bone marrow start to produce RBCs

A

3 months gestation

51
Q

Which bones produce RBCs in children under 5

A

All bones

52
Q

Which bones produce RBCs in adults over 25

A

Mainly membranous bones

53
Q

How do RBCs make ATP

A

Anaerobic glycolysis

54
Q

Which transporters allow glucose to enter RBCs

A

GLUT-1

55
Q

How does anaerobic glycolysis affect the pH of a RBC

A

Acidifies RBC

56
Q

What happens to lactic acid produced in RBCs by anaerobic glycolysis

A

Pumped into plasma, taken up by liver or muscle cells, and converted back to glucose

57
Q

How long do RBCs live

A

100-120 days

58
Q

What happens to senescent RBCs when they pass through the spleen

A

Removed from blood and engulfed by splenic macrophages in red pulp spleen

59
Q

Why are old RBCs easier to trap

A

More rigid due to failing membrane oumps

60
Q

What process breaks down RBCs

A

Osmotic lysis

61
Q

What happens to iron in broken down RBCs

A

Released from haemoglobin by Haem oxygenase and re enters circulation

62
Q

Reticuloendothelial system

A

Heterogenous population of phagocytise cells that clear immune complexes, bacteria, toxins, and old RBCs

63
Q

What is the structure of the red pulp spleen

A

Sinuses lined by endothelial macrophages and cords

64
Q

In which age group can the tip of the spleen be palpated normally

A

Children

65
Q

Build up of what in the blood causes jaundice

A

Unconjugated bilirubin

66
Q

What is unconjugated bilirubin bound to in the blood

A

Albumin

67
Q

What is bilirubin conjugated with to form bilirubin diglucoronide

A

Glucuronic acid

68
Q

What is bilirubin diglucoronide converted to

A

Urobilinogen
Stercogilin
Urobilin

69
Q

Where is urobilinogen oxidised to urobilin

A

Kidneys

70
Q

What gives faeces it’s brown colour

A

Stercobilin

71
Q

What gives urine its yellow colour

A

Urobilin

72
Q

How is iron lost from the body

A

Skin cell shedding
Sweating
Menstruation
Pregnancy

73
Q

How much iron is stored in the liver

A

1000mg

74
Q

What determines the signs and symptoms of anaemia

A

Hb level
How quickly Hb drops
Co morbidities

75
Q

Anaemia symptoms

A

Shortness of breath
Palpitations
Headaches
claudication
Angina
Weakness
Lethargy
Confusion

76
Q

Anaemia signs

A

Pallor
Tachycardia
Systolic flow murmur
Tachypnoea
Hypotension

77
Q

Claudication

A

Pain

78
Q

What is Koilonychia and what condition is it associated with

A

Spoon shaped nails
Iron deficiency

79
Q

What is angular stomatitis and what is it associated with

A

Inflammation of corners of mouth
Iron deficiency

80
Q

What is glossitis and what is it associated with

A

Inflammation and depopulation of tongue
Vitamin b12 deficiency

81
Q

Why can thalassaemia cause abnormal facial bone development

A

Overactive bone marrow

82
Q

Iron deficiency signs and symptoms

A

Tiredness
Pallor
Reduces exercise tolerance
Angina
Palpitations
Heart failure
Tachypnoea
Headache
Dizziness
Light headedness
Pica
Cold hands and feet
Epithelial changes

83
Q

Pica

A

Cravings for non nutritive substances

84
Q

Anisoctytosis

A

Unequal sized cells

85
Q

Morphology of RBCs in iron deficiency anaemia

A

Microcytic
Anisocytosis
Hypochromic
Decr mean corpuscular volume
Decr mean corpuscular haemoglobin
Decr mean corpuscular haemoglobin concentration

86
Q

Indices of iron status

A

Hb level
Mean cell volume
Mean cell Hb
Serum ferritin
Serum iron
Total iron binding capacity
Transferrin saturation
Serum/ soluble transferrin receptor concentrations

87
Q

Why is iron deficiency common

A

Often in ferric form in food
Low bioavailability
Vegan diets
High needs when toddler, elderly, menorrhagia
Impaired absorbtion
Gastric bypass surgery
GI malignancy

88
Q

How does decreased acid production or antacids decrease iron absorbtion

A

Acid promotes iron absorbtion

89
Q

How man GI malignancies cause iron deficiency

A

Chronic bloodloss

90
Q

When should patients with iron deficiency anaemia be urgently referred

A

Aged 60+
Under 60 and Rectal bleeding

91
Q

Can iron supplementation help anaemia of inflammation

A

No

92
Q

How does inflammation cause anaemia

A

Cytokines increase hepcidin production and inhibit erythropoietin production

93
Q

How does ferritin level vary between iron deficiency anaemia and anaemia of chronic disease

A

<10ug/l in iron deficiency
>100ug/l in chronic disease

94
Q

Causes of iron deficiency

A

Increased demand
Insufficient intake
Pathology
Decreased absorption
Chronic blood loss
Drugs
Genetic

95
Q

When should a diagnostic trial of iron treatment be considered for treatment of iron deficiency anaemia

A

Premenopausal women with menorrhagia or pregnant

96
Q

When should a diagnostic trial of iron treatment not be used for iron deficiency anaemia treatment

A

Men
Postmenopausal women
- find reasom for anaemia first eg malignancy

97
Q

How is iron deficiency anaemia treated

A

1 daily iron tablet

98
Q

What types of iron tablets are available

A

Ferrous sulphate
Ferrous fumarate
Ferrous gluconate

99
Q

When should iron tablets be stopped in iron deficiency treatment

A

3 months after deficiency corrected

100
Q

What are side effects of taking iron supplements

A

Dyspepsia
Constipation

101
Q

What does an elevated sedimentation rate show

A

Inflammation

102
Q

How is inflammation tested

A

Erythrocyte sedimentation test

103
Q

How is inflammation anaemia treated

A

Treat cause of inflammation

CR2 (33 decks)

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