Module 4.2 (Anaemia) Flashcards
What are the symptoms of anaemia?
- Fatigue
- Tachycardia, palpitations
- Pallor
- Light-headedness, vertigo, and tinnitus
- Angina
- Other specific symptoms depending on cause of anaemia
Anaemia lab readings for men and women
- Less than 130g/L for males
- Less than 120g/L for females
What are the types of anaemia?
- Iron Deficiency Anaemia
- Vitamin B12 Deficiency Anaemia
- Folate Deficiency Anaemia
- Other type of Anaemia(s)
What is MCV? What does a low, normal or high MCV mean?
Average volume of the body’s red blood cells (Mean Corpuscular Volume)
- Low MCV (Microcytic cell) – iron deficiency anaemia or anaemia of chronic disease
- High MCV (Macrocytic cell) – B12 and/or folate deficiency anaemia
- Normal MCV – normocytic anaemia or concurrent iron and B12/folate anaemia
What does a normal MCV with a large RDW indicate?
Indicates the presence of microcytes and macrocytes
What is Pack Cell Volume (Haematocrit)? what does a high value or low value mean
Indicates the proportion of blood that is made up of cells
- PCV rises when the number of red blood cells increases or when the total blood volume is reduced
- PCV decrease in anaemia due to decrease in production of red blood cells or increase destruction of red blood cells
What are some causes of iron deficiency anaemia?(microcytic anaemia)
- Microcytic anaemia (low MCV) –> confirm diagnosis with iron studies
- The primary cause of iron deficiency is blood loss
> May be not obvious
> Gastrointestinal blood loss most common
- Inadequate dietary intake is only rarely a cause with the exception of increased requirement (growth spurts, infants, pregnancy)
In iron deficiency anaemia, answer the following low or high for the laboratory tests;
A) MCV
B) RDW
C) RBC
D) Serum iron
E) Total iron binding capacity (TIBC)
F) Transferrin
G) Transferrin saturation
H) Ferritin
A)
- Low
B)
- High
C)
- Low
D)
- Low
E)
- High
F)
- High
G)
- Low
H)
- Low
How much daily iron required in
A) Adolescent males
B) Adolescent females
C) During pregnancy
A)
- 1.8mg
B)
- 2.4mg
C)
- 3-4 mg
What are the S and S of Iron deficiency anaemia?
- Tired and listless
- Pale, inelastic, and dry skin
- Dry and often scanty hair
- Erythema of the tongue, angular cheilitis, and glossitis
- Pearly white or pale blue sclerae
- Flattened and concave nails
- Tachycardia, slight cardiomegaly
What are some of the oral manifestations in severe IDA
- Bilateral angular cheilitis
- Pale coloured lips
- Smooth, bald and inflamed tongue: glossitis
- Craving for ice
- Pica: Eating dirt, paint
Where is vitamin B12 found?
In foods of animal origin –> Meat, fish, liver, milk, cheese, eggs.
Cannot be synthesized by mammalian tissue – dietary intake or supplementation needed
What is the autoimmune disease called where there is no intrinsic factor production and therefore puts a person at risk of developing B12 deficiency anaemia?
Pernicious anaemia
What are some causes of Vitamin B12 deficiency anaemia?
- Alcoholism, elderly, vegan
- Post gastric surgery
- IBD
- Tapeworm infestation
Medications
- PPIs, H2 antagonist –> decrease absorption of vitamin B12
Defective transport
- Transcobalamin II deficiency –> decrease in transport of vitamin B12 to the liver.
In vitamin B12 deficiency anaemia (macrocytic anaemia), indicate whether the following laboratory results will increase or decrease.
A) MCV
B) Vitamin B12
C) Methylmalonic acid (MMA)
D) Homocysteine
A)
- Increased
B)
- Decreased
C)
- Vitamin B12 promotes the conversion of methylmalonyl CoA (a form of MMA) to succinyl Coenzyme A
- Therefore MMA levels will rise if not enough Vit B12
D)
- Common amino acid in the blood
- Levels would rise
What are the signs and symptoms of B12 deficiency anaemia?
- Pallor (pale appearance), slight jaundice
- Anorexia, mild weight loss, diarrhoea
- Difficulty in walking, loss of vibratory sense, incoordination of movements, sense of touch impaired
- Dyspnoea, palpitations, weakness, vertigo, tinnitus
- Personality and mood changes, irritability, memory disturbances, depression, phychosis
- Atrophic glossitis / sore tongue
What are the sources of folic acid?
Found in plant and animal foods
- leafy vegetables (such as spinach, broccoli, and lettuce), okra, asparagus, fruits (such as bananas, melons, and lemons) beans, yeast, mushrooms, meat (such as beef liver and kidney), orange juice, and tomato juice
> The body’s folate reserves lasts for about 4 months
What are the causes of folic acid deficiency anaemia? provide THREE different types
The body’s folate reserves lasts for about 4 months
- Alcoholism
- Nutritional deficiency
Inadequate intake from increased folic acid requirements
- Pregnancy
- Severe hemolysis
Inadequate absorption
- Crohn disease
Drug-induced interference with folic acid metabolism
- The action of DHFR blocked by methotrexate, trimethoprim
- Reduced folate absorption caused by sulfasalazine
If a patient has both Vitamin B12 deficiency anaemia and Folate deficiency anaemia, which one to rule out first?
Rule out vitamin b12 deficiency anaemia first
- If FDA treated first, symptoms of vitamin b12 deficiency anaemia could be masked. Lead to irreversible neurological damage.
S and S of folic acid deficiency anaemia?
Very similar to B12 deficiency except for neurological lesions
What is anaemia of chronic disease (ACD)? How long does it take to develop?
- Moderate anaemia (Hb not less than 90 g/L)
- Also known as anaemia of inflammation
> Most common form of anaemia in the elderly (ACD & IDA can be concurrent)
- RBC size changes in elderly less marked in anaemia
- Develops after one or two months of sustained disease
What are the main causes of ACD?
- Chronic infections
- TB, lung abscess, subacute endocarditis
- Non-infectious inflammatory diseases
- Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE)
- Neoplastic disorders
But does not include all chronic disease e.g. hypertension, diabetes, COPD are not accompanied by anaemia
How to differentiate ACD from IDA through;
A) Transferrin
B) Ferritin
C) Cytokine levels
A)
ACD: Reduced to normal
IDA: Increased
B)
ACD: Normal to increased
IDA: Reduced
C)
ACD: Increased
IDA: Normal
Summmary
- Anaemia is a haematological condition in which there is a deficiency of haemoglobin
- There are different types of anaemia : IDA (microcytic), B12 and folate deficiency anaemia (macrocytic) and others (ACD, anaemia of CKD)
- The different type of anaemia can be differentiated by haematological test parameters (MCV, RDW and the specific test for specific type of anaemia)
