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Path - Immuno > malabsorption > Flashcards

malabsorption Flashcards

1
Q

list the 3 causes of low MCV anaemia

A

Iron deficiency
Thalassaemia trait
Anaemia of chronic disease

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2
Q

what are the results for the following in iron deficiency anaemia:

Hb
Serum Iron
TIBC or Transferrin
Transferrin saturation
Ferritin
A 
Hb - Low
Serum Iron - low
TIBC or Transferrin - high
Transferrin saturation - low
Ferritin - low
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3
Q

what are the results for the following in Thalassaemia trait:

Hb
Serum Iron
TIBC or Transferrin
Transferrin saturation
Ferritin
A

every thing is normal

Hb may be low or normal

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4
Q

what are the results for the following in Anaemia of chronic disease:

Hb
Serum Iron
TIBC or Transferrin
Transferrin saturation
Ferritin
A

every thing is normal

apart from Hb and serum iron which are both LOW

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5
Q

give examples of red cell morphology that may be seen on blood film in Iron deficiency ?

A

Tear drop cell/poikilocytes
Elliptocyte
Target cells - Codocytes

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6
Q

Basophilic stippling (Aggregated ribosomal material) is visualised in which conditions?

A

Beta thalassaemia trait
Lead poisoning
Alcoholism
Sideroblastic anaemia

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7
Q

what is the characteristic blood film finding for the following:

B12 deficiency
Folate deficiency
Drugs

A

Hypersegmented neutrophil :

Megaloblastic anaemia - reflects impaired DNA synthesis

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8
Q

Target cells - Codocytes may be seen in which conditions?

A

Iron deficiency
Thalassaemia
Hyposplenism
Liver disease

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9
Q

Howell-Jolly bodies - Nuclear remnants visible in red cells, are seen in which condition?

A

Hyposplenism

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10
Q

list the blood film features indicative of Hyposplenism?

A

Howell-Jolly bodies

Target cells - Codocytes

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11
Q

list the causes of hyposplenism?

A

Absent spleen - Therapeutic
- Trauma

Poorly-functioning spleen

		- Inflammatory bowel disease
			- Coeliac disease
			- Sickle cell disease
			- SLE
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12
Q

which deficiencies are seen in the following condition:

Coeliac disease

A

Iron, B12, Folate, Fat, Calcium - all rounder

Vitamin D and Vitamin K deficiency

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13
Q

which deficiencies are seen in the following condition:

Crohn’s disease

A

bile salts, b12

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14
Q

which deficiencies are seen in the following condition:

Pancreatic disease

A

fat, calcium, B12

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15
Q

which deficiencies are seen in the following condition:

Infective/Post-infective

A

fat / folate

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16
Q

what are the genetic associatoins for coeliac disease?

A

90% patients carry HLA DQ2
(DQA10501 and DQB102 alleles)

Other patients carry HLA DQ8

17
Q

what is the mechanism involved in coeliac disease ?

A

gluten allergy - t cell mediated response

  • Peptides from wheat /gliadin are deamidated by tissue transglutaminase (TTG) and presented by APC via their HLA DQ2 or DQ8 receptors
  • CD4 T cells recognise these deamidated peptides and become activated
  • CD4 T cell activation = IFN-g n possibly IL-15 secretion
  • Cytokines -> activation of the intra-epithelial lymphocytes (gd TCR IEL) which kill epithelial cells via their NKG2D receptors

The activation of the intra-epithelial lymphocytes appears to be independent of engagement of their T cell receptor

antigen -> apc -> T cell -> IEL -> cell destruction

18
Q

apart from producing IEL, what are other roles do activated cd4 Lymphocytes play in response to gluten?

A

activate B cell with surface receptors for gliadin and TTG

resulting in b cell maturation and plasma cell formation

leading to productoin of anti-gliadin antibodies and anti-TTG antibodies and anti-endomysial

19
Q

what are the sensitivites of antibodies in coeliac disease?

A

IgA anti-transglutaminase antibody
90-94%

IgA anti-endomysial antibody
85-94%

IgG or IgA anti-gliadin antibody
57-80%

20
Q

what is the First line immunological test for coeliac disease in most laboratories?

A

IgA anti-transglutaminase antibody

21
Q

which antibody may be detectable up to 12 months after institution of gluten-free diet?

A

anti-gliadin

the others dissapear after a few months

22
Q

Is duodenal biopsy necessary to diagnose coeliac disease?

A

Duodenal histology remains the “gold standard”

but should correlate it with serology

23
Q

what would Histopathology of coeliac disease show?

A

Villous height is reduced (atrophy) and crypt thickness is increased (hyperplastic).

In coeliac disease, this is increased to >25 intra-epithelial lymphocytes (IELs) /100 epithelial cells *

*in the proximal small intestine

24
Q

name some Other causes of increased intra-epithelial lymphocytes ?

A

Infections - giardia, H. pylori

Drugs - NSAIDs

Immune conditions - SLE, IgA deficiency

IBD

25
Q

list the complications of coeliac disease?

A 
Malabsorption
Osteomalacia and osteoporosis
Neurological disease
Epilepsy
Cerebral calcification

Lymphoma - increases risk of mortality among coeliac’s*
Hyposplenism

*excess mortality returns to normal after 3-5 years on gluten free diet

26
Q

Coeliac disease is associated with auto-immune and other disorders - which are the most significant ?

A

Dermatitis herpetiformis (prevalence = 100%)
Type 1 diabetes mellitus (prevalence = 7%)
Autoimmune thyroid disease
Down’s syndrome

27
Q

a patient with symptoms or risk factors suggestive of coeliac disease comes in.

An IgA anti-tTG antibody or IgA antiendomysial antibody is positive.

what is the next step?

A

Duodenal biopsy

28
Q

how does coeliac typically present?

A

microcytic anaemia, past or present
feeling tired all the time

diarrhoea, which may smell particularly unpleasant
stomach aches
bloating and farting (flatulence)
indigestion
constipation

unintentional weight loss

family history of coeliac disease

29
Q

what is tropical sprue? idiopathic sprue?

A

malabsorption condition found in tropical regions

idiopathic - unkown cause -> 2nd most common cause of villous atrophy after coeliac

Path - Immuno (11 decks)

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