Megaloblastic

Question 1

Who is most at risk for folate deficiency

Answer 1

elderly, poor, alcoholics, preganant women.

Question 2

Labs for folate deficiency

Answer 2

Serum folate levels and homocysteine

Question 3

What types of birth defects can a lack of folate cause

Answer 3

Spina Bifida and other neural tube defects

Question 4

What do you look for on a smear

Answer 4

HYPERSEGMENTED NEUTROPHILS. HYPERSEGMENTED polys are always associated with megaloblastic anemia.

Question 5

Where is B12 absorbed

Answer 5

distal illeum

Question 6

What does B12 disorder cause that folate does not

Answer 6

neurological problems (lack of sensory awareness in the dark, paresthesia,

Question 7

What is pernicious anemia

Answer 7

gastric atrophy, loss of IF due to CD4+ recognition of ATPase, Anti-IF Ab, or anti-parietal cell antibodies

Question 8

Where is most iron in the body found?

Answer 8

Bound to hemoglobin, then storage, then myoglobin, then labile, then transport

Question 9

1 ml of blood = 1 mg of iron

Answer 9

….

Question 10

What is the smallest pool of iron?

Answer 10

transferin (transport iron)

Question 11

Heme iron is absorbed where

Answer 11

proximal duodenum

Question 12

How is Iron transferred through the body

Answer 12

ferritin

Question 13

What lets iron gastric epithelia

Answer 13

Ferriportin…this is regulated by hepcidin

Question 14

What is hepcidin

Answer 14

negative regulator of iron….as levels go up, they degrade ferriportin so that more iron can’t be absorbed.

Question 15

WHat is important about ascorbic acid and gastric acid

Answer 15

They increase the absorption of non-heme iron

Question 16

Ferriportin:

Answer 16

Cellular transport of iron into the plasma

Question 17

Hipcidin

Answer 17

negative regulator of iron uptake

Question 18

Facators outside the GI tract that increase iron absorption

Answer 18

Hypoxia, anemia, depletion of iron stores, increased rbc production (erythropoiesis)

Question 19

Iron deficiency causes

Answer 19

GI surgery, non-tropical sprue (celiac), Picca

Question 20

Bilroth surgery>

Answer 20

Could cut out the proximal duodenum where iron is absorbed so that the pt then could not absor iron anymore.

Question 21

Other complications of bilroth

Answer 21

sutures could bleed, Blind loop (causes B 12 deficiency when its overgrown by bacteria)

Question 22

Non -tropical sprue

Answer 22

Celiac, allerfic to gluten. Gluten induced damage to epithelial cells

Question 23

Tropical sprue?

Answer 23

overgrpowth of coliform in jejunum, results in malabsorption of folate, B12, fat…

Question 24

PICCA?

Answer 24

Eat iron chelators

Question 25

GI bleeds are most common?

Answer 25

Peptic ulcer disease, hiatal hernia, chronic gastritis, hemorrhoids, GI surgery, neoplasm

Question 26

GI bleeds to look out for in kids

Answer 26

milk allergy, meckels diverticulitis

Question 27

Menstrual cycle abnormalities?

Answer 27

Longer than a week, more than one box of tampons, clots, interfere with daily activities

Question 28

Hookworm causes what type of deficiency?

Answer 28

Iron

Question 29

Tapeworm

Answer 29

B12

Question 30

Does TIBC go up or down in iron deficiency?

Answer 30

Goes up

Question 31

What about hepcidin in iron deficiency?

Answer 31

Goes way down

Question 32

What is anemia of chronic disease?

Answer 32

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).