Megaloblastic Flashcards
Who is most at risk for folate deficiency
elderly, poor, alcoholics, preganant women.
Labs for folate deficiency
Serum folate levels and homocysteine
What types of birth defects can a lack of folate cause
Spina Bifida and other neural tube defects
What do you look for on a smear
HYPERSEGMENTED NEUTROPHILS. HYPERSEGMENTED polys are always associated with megaloblastic anemia.
Where is B12 absorbed
distal illeum
What does B12 disorder cause that folate does not
neurological problems (lack of sensory awareness in the dark, paresthesia,
What is pernicious anemia
gastric atrophy, loss of IF due to CD4+ recognition of ATPase, Anti-IF Ab, or anti-parietal cell antibodies
Where is most iron in the body found?
Bound to hemoglobin, then storage, then myoglobin, then labile, then transport
1 ml of blood = 1 mg of iron
….
What is the smallest pool of iron?
transferin (transport iron)
Heme iron is absorbed where
proximal duodenum
How is Iron transferred through the body
ferritin
What lets iron gastric epithelia
Ferriportin…this is regulated by hepcidin
What is hepcidin
negative regulator of iron….as levels go up, they degrade ferriportin so that more iron can’t be absorbed.
WHat is important about ascorbic acid and gastric acid
They increase the absorption of non-heme iron
Ferriportin:
Cellular transport of iron into the plasma
Hipcidin
negative regulator of iron uptake
Facators outside the GI tract that increase iron absorption
Hypoxia, anemia, depletion of iron stores, increased rbc production (erythropoiesis)
Iron deficiency causes
GI surgery, non-tropical sprue (celiac), Picca
Bilroth surgery>
Could cut out the proximal duodenum where iron is absorbed so that the pt then could not absor iron anymore.
Other complications of bilroth
sutures could bleed, Blind loop (causes B 12 deficiency when its overgrown by bacteria)
Non -tropical sprue
Celiac, allerfic to gluten. Gluten induced damage to epithelial cells
Tropical sprue?
overgrpowth of coliform in jejunum, results in malabsorption of folate, B12, fat…
PICCA?
Eat iron chelators
GI bleeds are most common?
Peptic ulcer disease, hiatal hernia, chronic gastritis, hemorrhoids, GI surgery, neoplasm
GI bleeds to look out for in kids
milk allergy, meckels diverticulitis
Menstrual cycle abnormalities?
Longer than a week, more than one box of tampons, clots, interfere with daily activities
Hookworm causes what type of deficiency?
Iron
Tapeworm
B12
Does TIBC go up or down in iron deficiency?
Goes up
What about hepcidin in iron deficiency?
Goes way down
What is anemia of chronic disease?
You don’t want bacteria to have access to iron stores, so the body hides tron stores and decreases iron uptake (hepcidin levels go up).
