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GIHEP > L26: Anaemia > Flashcards

L26: Anaemia Flashcards

1
Q

Anaemia is a condition in which a patient has decreased haemoglobin.

What is the numerical value in:

a) Females
b) Males

A

a) Females < 11.5 g/dL

b) Males < 13 g/dL

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2
Q

What does hypochromic mean? (in regards to anaemia)

A

less Hb present in the RBCs

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3
Q

List some of the possible causes of anaemia

A
  • failure to make RBCs
  • lack of haematinics
  • – from diet
  • – autoimmune
  • – malabsorption
  • increased loss of RBCs
  • reduced bone marrow function
  • increased haemolysis
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4
Q

Where is intravascular and extravascular haemolysis done?

A

Intravascular = in peripheral blood

Extravascular = in spleen

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5
Q

Where in the GIT is iron absorbed?

A

stomach + duodenum

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6
Q

Where in the GIT is folate absorbed?

A

duodenum + upper jejunum

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7
Q

Where in the GIT is B12 absorbed?

A

terminal ileum

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8
Q

What is pernicious anaemia?

A
  • autoimmune disorder affecting GIT (antibodies present)
  • causes malabsorption of B12
  • can lead to macrocytic megaloblastic anaemia
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9
Q

Give 2 examples of hypochromic microcytic anaemia

A
  1. Iron Deficiency Anaemia

2. Thalassaemia

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10
Q

List some of the possible causes of IRON-DEFICIENCY anaemia

A
  • lack of iron dietary intake
  • loss of iron in GIT
  • malabsorption
  • — partial gastrectomy
  • — coeliac disease
  • — crohn’s disease
  • any cause of long-standing severe diarrhea
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11
Q

List some of the common clinical features/presentations of IRON-DEFICIENCY anaemia

A
  • mucosal pallor
  • angular cheilitis
  • atrophic glossitis (smooth tongue)
  • brittle nails
  • koilonychia (spoon nails)
  • ice pica
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12
Q

If there is a patient over the age of 50 with iron deficiency anaemia, what MUST be done?

A
  • duodenal biopsy

- upper and lower GI endoscopy

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13
Q

What is the treatment of iron deficiency anaemia?

A

oral Iron (IV if they can’t tolerate it)

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14
Q

Give 2 main causes of megaloblastic anaemia

A
  1. B12 Deficiency

2. Folate Deficiency

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15
Q

What are megaloblasts?

A
  • enlarged RBCs due to retarded RBC synthesis

- nucleus is enlarged compared to cytoplasm

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16
Q

What vitamin is Cobalamin?

A

Vitamin B12

17
Q

Explain the process by which vitamin B12 is absorbed

A
  • intrinsic factor released from gastric parietal cells
  • B12 from diet combines with IF
  • B12-IF complex formed
  • complex absorbed in terminal ileum
18
Q

Pernicious anaemia can cause vitamin B12 deficiency. Which 2 antibodies may be present?

A
  1. Antibody to IF

2. Antibody to Gastric Parietal Cells

19
Q

List some of the possible causes of B12 DEFICIENCY anaemia

A
  • lack of IF
  • – pernicious anaemia
  • – atrophic gastritis
  • – partial gastrectomy
  • malabsorption
  • – Crohn’s disease
  • – loss of terminal ileum
  • blind loop bacteria (compete for B12)
20
Q

List some of the clinical features/complications of B12 deficiency

A
  • peripheral neuropathy
  • subacute combined degeneration of the cord
  • optic atrophy
  • psychiatric disorder
  • atrophic glossitis
21
Q

If a chronic alcoholic presents with a confusion disorder, which anaemia is the most likely cause?

A

B12 Deficiency Anaemia

22
Q

What is the treatment for B12 deficiency anaemia?

A
  1. Parenteral B12 (intramuscular injection)

2. Folate given at same time`

23
Q

List some of the causes of folate deficiency which would cause anaemia

A

Malabsorption:

  • Coeliac disease
  • Crohn’s disease
  • pregnancy*
  • resection of small bowel
  • blind loop syndrome
24
Q

When looking at the histology of a patient with Coeliac disease - what can be seen in their intestines?

A
  • blunting of villi
  • closing off of crypts

impaired villi = decreased absorption

25
Q

List some of the possible causes of “anaemia of chronic disease”

A

anything that causes long-standing inflammation

  • Inflammatory Diseases of the GIT (e.g. Crohn’s Disease)
  • RA
  • SLE
  • Sarcoid
  • Renal Failure
  • Malignant Disease (carcinoma, lymphoma, sarcoma)
26
Q

What is the pathophysiology of “anaemia of chronic disease”?

A
  • inflammation will trigger liver to produce hepcidin
  • hepcidin causes:
    a) decreased iron absorption
    b) decreased release of iron from macrophages
27
Q

What are the 2 effects of hepcidin? What is it associated with?

A
  1. decreases iron absorption
  2. decreases release of iron from macrophages

a/w anaemia of chronic disease

28
Q

List ALL the causes of macrocytic anaemia

A
  • B12 Deficiency
  • Folate Deficiency
  • Alcohol
  • Liver Disease
  • Reticulocytosis
  • Hypothyroidism
29
Q

What is vitamin B12 and folate necessary for?

A

DNA synthesis

30
Q

List the investigations/tests that may be done when investigating anaemia

A
  1. FBC
  2. Blood Film
  3. Bone Marrow Aspirate/Trephine (to see bone marrow activity)
  4. Coombs Test (antibodies against RBCs?)
  5. Upper and Lower GIT Endoscopy ± Biopsies
  6. TTG Antibodies?
  7. Gastric Parietal Cell Antibodies?
31
Q

What is Coombs test and what is it used for?

A
  • direct antiglobulin test (DAT)
  • used to detect antibodies against RBCs
  • indicative of an immune haemolytic anaemia
32
Q

What are tTG antibodies? What disease are they linked to?

A

tTG antibodies = tissue transglutaminase antibodies

detected in Coeliac disease

33
Q

If gastric parietal cell antibodies are present, what type of anaemia is present?

A

pernicious anaemia

34
Q

What do upper and lower GIT endoscopies look for in an anaemic patient?

A

cause of blood loss or malabsorption

GIHEP (24 decks)

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