Nutritional Anaemia

Question 1

What is anaemia (according to WHO)?

Answer 1

Condition in which the number of RBCs (and their oxygen carrying capacity) is insufficient to meet the body’s physiologic needs

Question 2

What does maturation of RBCs need?

Answer 2

Vitamin B12 and folic acid
DNA synthesis
Iron
Haemoglobin
Vitamins
Erythropoeitin
Healthy bone marrow environment

Question 3

What are the mechanisms of action of anaemia?

Answer 3

Failure of haemoglobin production
Ineffective erythropoeisis
Decreased survival

Question 4

What does a failure of haemoglobin production cause?

Answer 4

Hypoproliferation and reticulocytopenia

Question 5

What is reticulocytopenia?

Answer 5

Not enough baby RBCs

Question 6

What causes ineffective erythropoiesis?

Answer 6

Enough ingredients but wrong instructions

Question 7

What causes decreased survival of RBCs?

Answer 7

Blood loss
Haemolysis
Reticulocytosis

Question 8

What does MCV stand for?

Answer 8

Mean cell volume

Question 9

What does MCV mean?

Answer 9

Average size of RBCs

Question 10

What does microcytic mean?

Answer 10

Small MCV

Question 11

What does normocytic mean?

Answer 11

Normal MCV

Question 12

What does macrocytic mean?

Answer 12

Large MCV

Question 13

Which anaemias are microcytic?

Answer 13

Iron deficiency
Thalassaemia
Chronic disease anaemia

Question 14

Which anaemias are normocytic?

Answer 14

Anaemia chronic disease
Aplastic 
Chronic renal failure
Bone marrow infiltration
Sickle cell disease

Question 15

Which anaemias are macrocytic?

Answer 15

B12 deficiency
Folate deficiency
Myelodysplasia
Alcohol induced
Drug induced
Liver disease
Myxoedema

Question 16

Which is the most abundant trace element in the body?

Answer 16

Iron

Question 17

What is your daily requirement for iron?

Answer 17

Depends on gender and physiological needs

Question 18

How much iron is absorbed from the duodenum every day?

Answer 18

1-2mg/day

Question 19

What is plasma transferrin?

Answer 19

Iron transport protein

Question 20

Where does most of the iron in the body sit?

Answer 20

In RBCs, bone marrow and spleen

Question 21

How do you loose iron?

Answer 21

Sloughed mucosal cells in the duodenum or menstruation

Question 22

When does iron regulation happen?

Answer 22

Absorption stage

Question 23

What are the stable form(s) of iron?

Answer 23

Ferric (3+)

Ferrous (2+)

Question 24

What mechanism is iron absoption regulated by?

Answer 24

Negative feedback of GI mucosal cells and hepcidin

Question 25

What is hepcidin?

Answer 25

Iron regulatory protein

Question 26

How does hepcidin work?

Answer 26

Causes the internalisation and degredation of ferroportin, which decreases iron transfer into the blood plasma from the duodenum

Question 27

What does iron do in plasma?

Answer 27

Attaches to transferrin and then transported to bone marrow | Binds to transferrin receptors on RBC precursors

Question 28

What will iron deficiency do to ferritin/transferrin?

Answer 28

Reduced ferritin stores and increased transferrin

Question 29

What does ferritin do?

Answer 29

Primary storage protein and providing reserve, water soluble

Question 30

What does the transferrin saturation show you?

Answer 30

Ratio of serum iron and total iron binding capacity - revealing % of transferrin binding sites that have been occuptied by iron

Question 31

What is transferrin produced by?

Answer 31

Liver

Question 32

What is transferrin production inversely proportional to?

Answer 32

Fe stores

Question 33

What is total iron binding capacity?

Answer 33

Measurement of the capacity of transferrin to bind iron Indirect measurement of iron

Question 34

Why is the ferritin test so unreliable?

Answer 34

Ferritin is also involved in immune response, so infection may artificially increase ferritin

Question 35

With infection, how can you diagnose low ferritin?

Answer 35

Increased transferrin

Question 36

What are the causes of iron deficiency?

Answer 36

Poor diet Malabsorption Increased physiological needs Loosing too much blood

Question 37

What can cause you to loose too much blood?

Answer 37

Menstruation GIT loss Parasites

Question 38

How can you investigate iron deficiency?

Answer 38

FBC, iron studies, blood film

Question 39

What are the symptoms of iron deficiency anaemia?

Answer 39

``` Fatigue lethargy Dizziness Pale mucus membrane Bounding pulse ```

Question 40

What are the lab signs of B12 and folate deficiency?

Answer 40

Low Hb, high MCV with a normal MCHC

Question 41

What does megoblastic mean?

Answer 41

Low reticulocyte count

Question 42

What causes megaloblastic macrocytic anaemia?

Answer 42

Vitamin B12/folic acid deficiency | Drug related

Question 43

What causes nonmegaloblastic macrocytic anaemia?

Answer 43

``` Alcoholism Hypothyroidism Liver disease Myelodysplastic syndromes Reticulocytosis ```

Question 44

What is a source of vit B12?

Answer 44

Animal and dairy produce

Question 45

What is a source of folate?

Answer 45

Vegetables and liver

Question 46

What is the adult daily requirement of vit B12?

Answer 46

1-2 mcg

Question 47

What is the adult daily requirement of folate?

Answer 47

100-150mcg

Question 48

Where is vit B12 absorbed?

Answer 48

Ileum via intrinsic factor

Question 49

Where is folate absorbed?

Answer 49

Duodenum and jejunum

Question 50

What are vit B12 and folate important for?

Answer 50

RBC maturation DNA synthesis Thymidine triphosphate synthesis

Question 51

What are megaloblastic cells characterised by on the peripheral smear?

Answer 51

Macrovalocytes and hypersegmented neutrophils

Question 52

What are the causes of folate deficiency?

Answer 52

Increased demand, decreased intake, decreased absorption

Question 53

What can cause increased folate demand?

Answer 53

``` Pregnancy/breastfeeding Infancy and growth spurts Haemolysis and rapid cell turnover Disseminated cancer Urinary losses ```

Question 54

What can cause decreased intake of folate?

Answer 54

Poor diet Elderly Chronic alcohol intake

Question 55

What can cause decreased folate absorption?

Answer 55

Medication Coeliac Jejunal resection Tropical sprue

Question 56

What is vitamin B12 important for?

Answer 56

Cofactor for methylation in DNA and cell metabolism

Question 57

Where is vitamin B12 sourced from?

Answer 57

Fish, meat and dairy

Question 58

What does vitamin B12 require the presence of to be absorbed into the terminal epithelium?

Answer 58

Intrinsic factor

Question 59

Where is intrinsic factor made?

Answer 59

Parietal stomach cells

Question 60

What molecules transport vitamin B12 to tissues?

Answer 60

Transcobalmin I and II

Question 61

What causes impaired vit B12 absorption?

Answer 61

Pernicious anaemia Gastrectomy or ileal resection Zollinger-ellison syndrome Parasites

Question 62

What causes decreased vit B12 intake?

Answer 62

Malnutrition | Vegan diet

Question 63

What are some congenital causes of vitamin B12 deficiency?

Answer 63

Intrinsic factor receptor deficiency | Cobalamin mutation CG1 gene

Question 64

What causes the increased vit B12 requirements?

Answer 64

Haemolysis HIV Pregnancy Growth spurts

Question 65

What medication causes vitamin B12 deficiency?

Answer 65

Alcohol NO PPI, H2 antagonists Metformin

Question 66

What is pernicious anaemia?

Answer 66

Autoimmune disorder

Question 67

What does pernicious anaemia cause?

Answer 67

Lack of vit B12 absorption or intrinsic factor

Question 68

Where is pernicious anaemia most prevelant?

Answer 68

Low income areas

Question 69

What are the clinical consequences of pernicious anaemia?

Answer 69

``` Brain: cognition, depression, psychosis Neurology: sensory changes, spasticity, ataxia Infertility Cardiac cardiomyopathy Tongue: glossitis, taste impairment Blood: pancytopenia ```