Haematology and Anaemia

Question 1

Iron in meat is present as haem, which is the ferrous form of iron. What is the charge on it?

Answer 1

Fe2+

Question 2

Nonhaem iron is what is absorbed in a vegetarian diet and it is in the ferric state. What charge is iron in the ferric state?

Answer 2

Fe3+

Question 3

Is iron in the ferrous form of ferric state more easily absorbed?

Answer 3

Iron in the ferrous form (Fe2+) is more easily absorbed

Question 4

After uptake into enterocytes, iron is oxidised to the ferric state (Fe3+) and is transported to the circulation by what protein?

Answer 4

Ferroportin

Question 5

What hormone regulates iron transport from enterocytes?

Answer 5

Hepcidin

Question 6

Do higher levels of hepcidin increase or decrease iron absorption?

Answer 6

Higher levels decrease the amount of iron being absorbed as it binds to ferroportin, promoting its degradation. Hepcidin levels are increased when iron levels are high, or in the presence of systemic inflammation or infection.

Question 7

Give an example of 2 types of oral iron supplements

Answer 7

ferrous sulphate
ferrous fumarate
ferrous gluconate

Question 8

Name 5 unwated effects of oral iron

Answer 8

GI disturbance
Nausea
Dyspepsia
Diarrhoea or constipation
Turns stools black

Question 9

What is vitamin B12 called when it is given by IM injection?

Answer 9

hydrococobalamin

Question 10

If someone needs vitamin B12 they are given injections on alternate days for 2wks to replenish stores, how often do they then need injections for maintenance?

Answer 10

Every 3 months

Question 11

If a pt is both deficient in B12 and folic acid, replacement of which supplement should be started first?

Answer 11

B12 (hydroxocobalamin)

Question 12

Give 2 examples of erythropoietin analogues

Answer 12

darbepoetin

epoetin

Question 13

Give 2 examples of therapeutic uses of Epoetin

Answer 13

Anaemia of end-stage renal disease.
To incraese red cell production prior to surgery to allow for autologous blood transfusions.
Anaemia associated with HIV.
Anaemia associated with cytotoxic chemo or nonmyeloid disease.

Question 14

Give two examples of when parenteral iron may be used over oral iron

Answer 14

When oral therapy is unsuccessful because the pt cannot tolerate oral iorn or does not take it reliably.
or
if there is continuing blood loss
or
in malabsorption

Question 15

Give an example of parenteral iron

Answer 15

iron sucrose.
iron dextran.
ferric carbocymaltose
iron isomaltoside 1000

Question 16

Name 5 drugs/drug classes that interact with oral iron and reduce the absorption

Answer 16

Levothyroxine.
Bisphosphonates.
Ciprofloxacin.
Tetracyclines
Calcium and zinc salts

Question 17

What advice should you give to someone if they are taking oral iron supplements but are also taking something that reduces its absorption e.g. levothyroxine?

Answer 17

Advise that they take the interacting medication at least 2hrs before taking the oral iron.

Question 18

What is the recommended therapeutic dose of oral iron to prescribe?

Answer 18

200mg orally three times a day

Question 19

how long should oral iron supplements be continued for after the Hb concentration has restored?

Answer 19

3 months to replenish tissue iron stores.

Question 20

What vitamin should pregnant women take to avoid neural tube defects developing in their growing foetus?

Answer 20

folic acid supplements

Question 21

are folic acid and folate the same thing?

Answer 21

folate is water-soluble vitamin B9 that occurs naturally in some foods, whereas folic acid is the synthetic form of folate that is found in supplements and added to fortified foods.

Question 22

What foods do you find folate in?

Answer 22

beef, liver, leafy green vegetables, oranges, legumes

Question 23

What is the recommended dosing of folic acid for females of childbearing potential who are at a low risk of conceiving a child with a neural tube defect?

Answer 23

400 micrograms daily to be taken before conception and until week 12 of pregnancy.

Question 24

what is the recommended dosing of folic acid for females who are in the high-risk group of getting neural tube defects?

Answer 24

5mg daily to be taken before conception and until week 12 of pregnancy.

Question 25

What makes a woman at high risk of having a baby with a neural tube defect?

Answer 25

Prior children with NTD or those taking anticonvulsants e.g. valproate, carbamazepine

Question 26

What is the folic acid dosing regimen for females with sickle cell disease who want to try for a baby?

Answer 26

5mg daily before conception and continue throughout the whole of pregnancy

Question 27

What causes sub acute combined degeneration of the cord?

Answer 27

vitamin B12 deficinecy

Question 28

What are the clinical presenting features of sub acute combined degernation of the cord?

Answer 28

loss of vibration adn proprioception in hands and feet.
eventual progression to sensory loss of all modalities, sensory gait ataxia, distal muscle weakness.
features of dementia may become apparent.