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Clinical pathology specialities: Haematology > Haematology: The Nutritional Anaemias > Flashcards

Haematology: The Nutritional Anaemias Flashcards

1
Q

What is Anaemia?

A
  • A condition in which the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body’s physiological needs
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2
Q

What haemoglobin level is considered anaemic for men, non-pregnant women

A
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3
Q

What things are essential for the maturation of red blood cells?

A
  • Vitamin B12 & folic acid - important for DNA synthesis
  • Iron - important for Haemoglobin synthesis
  • Vitamins
  • Cytokines (erythropoeitin)
  • Healthy bone marrow environment
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4
Q

What are the different mechanisms responsible for anaemia?

A
  • Failure of production (hypopoliferation) - Can be identified as cause of anaemia if person is reticulocytopenic (person has a low amount of reticulocytes)
  • Ineffective Erythropoiesis
  • Decreased Survival - Occurs due to sudden blood loss
    • Haemolysis (rupture or destruction of red blood cells) and reticulocytosis (Increased production of reticulocytes) occur in response
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5
Q

Why can reticulocytopenia be used to identify that the cause of anaemia is due to a lack of production of red blood cells?

A
  • Reticulocytopenia is an abnormal decrease of reticulocytes
  • Reticulocytes are immature red blood cells that develop into mature red blood cells in the blood stream
  • If a person with Anaemia has low reticulocyte levesl you know that person’s bone marrow isn’t producing RBCs at a sufficient level because low levels of reticulocytes mean low levels of maturation into RBCs
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6
Q

If an anaemic person’s red blood cells are microcytic (small) what will the main causes of their anaemia be?

A
  • Iron deficiency (heme deficiency)
  • Thalassamia (globin deficiency)
  • Anaemia of Chronic Disease (anaemia due to chronic diseases and autoimmune diseases)
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7
Q

If an anaemic person’s red blood cells are macrocytic (large) what will the main causes of their anaemia be?

A
  • B12 Deficiency
  • Folate Deficiency
  • Myelodysplasia (deficinecy of bone marrow which leads to immature blood cells not being able to mature)
  • Liver disease
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8
Q

If an anaemic person’s red blood cells are normocytic (normal-sized) what will the main causes of their anaemia be?

A
  • Anaemia of Chronic Disease
  • Aplastic Anaemia (autoimmune disease in which body fails to produce blood cells in sufficient numbers)
  • Chronic Renal Failure
  • Sickle cell disease
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9
Q

What is nutritional anaemia?

A
  • Anaemia caused by nutritional deficiencies e.g. Iron deficiency, Vitamin B12 deficiency or Folate deficiency
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10
Q

What is the most abundant trace element in the body?

A
  • Iron
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11
Q

What are the 2 types of iron source we can obtain from our diet?

A
  • Heme iron sources e.g. meat and seafood
  • Non-heme iron sources e.g. vegetables and nuts
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12
Q

What states can iron be found as within the body?

A
  • Ferric state (Fe3+)
  • Ferrous state (Fe2+)
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13
Q

Where is most of the iron found within our body? What other

A
  • Most iron is in body as circulating Haemoglobin found in developing erythroid precursors and mature red cells
  • The remainder of our iron is found in storage and transport proteins ferritin and haemosiderin found in the cells of the liver, spleen and bone marrow
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14
Q

What are the different cells/proteins that regulate iron absorption from the duodenum into the blood plasma?

A
  • Hepcidin (main source of regulation)
  • Duodenum & proximal jejunum
  • GI mucosal cells
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15
Q

Explain how hepcidin is able to regulate the absorption of iron into the blood plasma

A
  • Hepcidin causes internalization and degradation of ferroportin receptors found on enterocytes (columnar epithelial cells that line inner surface of small and large intestines).
  • This decreases the amount of iron transfer into blood plasma from the duodenum
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16
Q

What is it that regulates the activity of hepcidin?

A
  • Activity regulated by iron concentrations in the plasma and the liver
  • Also regulated by rate at which new red blood cells are produced as all new red cells will need iron to mature (erythropoietic demand)
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17
Q

What role do reticuloendothelial macrophages have in iron absorption?

A
  • Reticuloendothelial macrophages ingest senescent red cells and break down haemoglobin to scavenge iron.
  • They then transfer the iron into blood plasma, specifically plasma transferrin, for reuse.
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18
Q

What happens to iron once it has been absorbed into the blood plasma?

A
  • Iron attaches to transferrin and is then transported to bone marrow where the transferrin binds to transferrin receptors on RBC precursors
  • Transferrin also transported to hepatocytes and to muscle cells where iron binds to myoglobin
  • If iron is in excess in blood plasma it’s stored as ferritin
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19
Q

What mechanisms result in iron excretion in the body?

A
  • Sloughing (shedding/removal) of mucosal cells
  • Menstruation
  • Other types of blood loss
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20
Q

What are some of the tests used to directly or indirectly measure iron levels?

A
  • Measurement of serum iron
  • Measurement of ferritin - primary storgae protein of iron. Part of immune system so levels may increase in responnse to infection rather than increase in iron
  • Measurement of transferrin saturation - tells you % of transferrin binding sites that have been occupied by iron
  • Measurement of transferrin - Made by liver, Production inversely proportional to iron stores
  • Total iron binding capacity - Measurement of the capacity of transferrin to bind iron
21
Q

What results would you expect to see for the different iron tests if a person was anaemic due to iron deficiency?

A
  • Ferritin - low
  • Transferrin saturation - low
  • Total iron binding capacity - high
  • serum iron - low/normal
22
Q

What are some of the causes of iron deficiency?

A
  • Causes if somebody isn’t getting in enogh iron:
    • Poor Diet
    • Malabsorption
    • Increased physiological needs e.g. during pregancy
  • Causes if somebody is losing too much iron:
    • Blood loss
    • Menstruation
    • GI tract loss
    • Paraistes
23
Q

What is the most common nutritional deficiency?

A
  • Iron deficiency
24
Q

What is the most common cause of iron deficiency in pre-menopausal women?

A
  • Excessive menstrual blood loss
25
Q

What is the most common cause of iron deficiency in men and post-menopausal women?

A
  • Blood loss from the GI tract
26
Q

What are some of the symptoms of iron deficiency anaemia?

A
  • Fatigue
  • Lethargy
  • Dizziness
27
Q

What are some of the signs of iron deficiency anaemia?

A
  • Pallor (paleness) of mucous membranes
  • Heart pumps harder
  • Smooth tongue
  • koilonychias (spoon nails)
28
Q

What type of anaemia is associated with iron deficiency?

A
  • Microcytic anaemia
29
Q

What type of anaemia is associated with both B12 and folate deficiency?

A
  • Macrocytic anaemia
30
Q

What are the two types of macrocytic anaemia? Name some of the causes for each type

A
  • Megaloblastic macrocytic anaemia (low reticulocyte count)
  • Causes:
    • Vitamin B12/Folic acid deficiency

Drug-related causes

  • Non-megaloblastic macrocytic anaemia
  • Causes:
    • Alcoholism
    • Hypothyroidism
    • Liver disease
    • Reticulocytosis (due to haemolysis)
31
Q

What is another name for vitamin B12?

A
  • Cobalamin
32
Q

What are the features of the blood film of a person who has macrocytic anaemia due to vitamin B12/folate deficiency?

A
  • Macrocytes (large red blood cells)
  • Ovalocytes (oval shaped red blood cells)
  • Hypersegemented neutrophils
33
Q

Why is folate important for DNA synthesis?

A
  • Folate is necessary for Adenosine, guanine and thymidine triphosphate synthesis
34
Q

What are some of the causes of folate deficiency?

A
  • Deficiency due to increased demand:
    • Pregnancy/breast feeding
    • Infancy and growth spurts
    • Haemolysis and rapid cell turnover e.g. sickle cell disease
  • Deficiency due to decreased intake:
    • Poor diet
    • Elderly
  • Deficiency due to increased absorption:
    • Medication (folate antagonists)
    • Jejunal resection
35
Q

What functions does vitamin B12 have within the body?

A
  • Essential co-factor for methylation in DNA and cell metabolism
  • Can be converted into 2 active coenzymes necessary for the homeostasis of methylmalonic acid (MMA) and homocysteine
36
Q

Where within the body is vitamin B12 absorbed?

A
  • Absorbed in the terminal ileum of the small intestine
37
Q

What specific enzyme is needed for the absorption of vitamin B12 into the terminal ileum?

A
  • Intrinsic factor
38
Q

What cells are responsible for producing intrinsic factor?

A
  • Parietal Cells in stomach
39
Q

What are the names of the enzymes that transport vitamin B12 to tissues once it’s been absorbed in the terminal ileum?

A
  • Transcobalamin I
  • Transcobalamin II
40
Q

What are some of the causes of vitamin B12 deficiency?

A
  • Deficiency due to impaired absorption
    • Pernicious Anaemia
    • Gastrectomy or ileal resection
    • Parasites
  • Deficiency due to decreased intake
    • Malnutrition
    • Vegan diet
  • Deficiency due to congenital causes
    • Intrinsic factor receptor deficiency
    • Cobalamin mutation (C-G-1 gene)
  • Deficiency due to increased requirements
    • Haemolysis
    • HIV
41
Q

What is pernicious anaemia?

A
  • Autoimmune disorder in which the body produces antibodies against Intrisic factor or antibodies against gastric parietal cells
  • This results in the body having low lvels of intrinsic factor and so in turn means low levels of vitamin B12 absorption
42
Q

Why do you have to use vitamin B12 injections rather than oral vitamin B12 to a patient with pernicious anaemia?

A
  • You can’t give oral vitamin B12 to a patient with perniciuos anaemia because it wouldn’t be able to be absorbed into the ileum as they don’t have intrinsic factor which is needed for its absorption
  • With vitamin B12 injections there’s no need for absorption as injecting it into the bloodstream means the B12 can get into the tissues via the circulation rather than via absorption
43
Q

What results would you expect to get in regards to a persons MCV, Hb and reticulocyte count if that person has macrocytic anaemia due to B12/folate deficiency?

A
  • Mean cell count (MCV) - Normal or raised
  • Haemoglobin (Hb) - Normal or low
  • Reticulocyte count - Low
44
Q

What are some cognitive disorders that can be caused by anaemia due B12/Folate deficiency?

A
  • Depression
  • Extreme psychosis
45
Q

What are some neurological disorders that can be caused by anaemia due B12/Folate deficiency?

A
  • Myelopathy - compression of the spinal cord
  • Sensory changes
  • Ataxia
  • Subacute combined degeneration of spinal cord (SACDC) - degeneration of the posterior and lateral columns of the spinal cord
46
Q

What are some other disorders that can be caused by anaemia due B12/Folate deficiency?

A
  • Cardiac cardiomyopathy
  • Pancytopenia - reduction in red cells. white cells and platelets
47
Q

How can you treat anaemia due to iron deficiency?

A
  • Change of diet
  • Give oral iron
  • Parenteral iron supplementation
  • Stopping the bleeding - if person losing lots of blood
48
Q

How can you treat anaemia die to Folate deficiency?

A
  • Folic acid oral supplements
49
Q

How can you treat anaemia die to Vitamin B12 deficiency?

A
  • Oral supplements
  • Intramuscular injections

Clinical pathology specialities: Haematology (8 decks)

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