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MBD/MI (Wothaya) > Nutritional Anaemia > Flashcards

Nutritional Anaemia Flashcards

1
Q

What is anaemia (according to WHO)?

A

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

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2
Q

What does maturation of RBCs need?

A 
Vitamin B12 and folic acid
DNA synthesis
Iron
Haemoglobin
Vitamins
Erythropoeitin
Healthy bone marrow environment
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3
Q

What are the mechanisms of action of anaemia?

A

Failure of haemoglobin production
Ineffective erythropoeisis
Decreased survival

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4
Q

What does a failure of haemoglobin production cause?

A

Hypoproliferation and reticulocytopenia

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5
Q

What is reticulocytopenia?

A

Not enough baby RBCs

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6
Q

What causes ineffective erythropoiesis?

A

Enough ingredients but wrong instructions

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7
Q

What causes decreased survival of RBCs?

A

Blood loss
Haemolysis
Reticulocytosis

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8
Q

What does MCV stand for?

A

Mean cell volume

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9
Q

What does MCV mean?

A

Average size of RBCs

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10
Q

What does microcytic mean?

A

Small MCV

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11
Q

What does normocytic mean?

A

Normal MCV

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12
Q

What does macrocytic mean?

A

Large MCV

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13
Q

Which anaemias are microcytic?

A

Iron deficiency
Thalassaemia
Chronic disease anaemia

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14
Q

Which anaemias are normocytic?

A 
Anaemia chronic disease
Aplastic 
Chronic renal failure
Bone marrow infiltration
Sickle cell disease
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15
Q

Which anaemias are macrocytic?

A 
B12 deficiency
Folate deficiency
Myelodysplasia
Alcohol induced
Drug induced
Liver disease
Myxoedema
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16
Q

Which is the most abundant trace element in the body?

A

Iron

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17
Q

What is your daily requirement for iron?

A

Depends on gender and physiological needs

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18
Q

How much iron is absorbed from the duodenum every day?

A

1-2mg/day

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19
Q

What is plasma transferrin?

A

Iron transport protein

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20
Q

Where does most of the iron in the body sit?

A

In RBCs, bone marrow and spleen

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21
Q

How do you loose iron?

A

Sloughed mucosal cells in the duodenum or menstruation

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22
Q

When does iron regulation happen?

A

Absorption stage

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23
Q

What are the stable form(s) of iron?

A

Ferric (3+)

Ferrous (2+)

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24
Q

What mechanism is iron absoption regulated by?

A

Negative feedback of GI mucosal cells and hepcidin

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25
Q

What is hepcidin?

A

Iron regulatory protein

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26
Q

How does hepcidin work?

A

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

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27
Q

What does iron do in plasma?

A

Attaches to transferrin and then transported to bone marrow

Binds to transferrin receptors on RBC precursors

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28
Q

What will iron deficiency do to ferritin/transferrin?

A

Reduced ferritin stores and increased transferrin

29
Q

What does ferritin do?

A

Primary storage protein and providing reserve, water soluble

30
Q

What does the transferrin saturation show you?

A

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

31
Q

What is transferrin produced by?

A

Liver

32
Q

What is transferrin production inversely proportional to?

A

Fe stores

33
Q

What is total iron binding capacity?

A

Measurement of the capacity of transferrin to bind iron

Indirect measurement of iron

34
Q

Why is the ferritin test so unreliable?

A

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

35
Q

With infection, how can you diagnose low ferritin?

A

Increased transferrin

36
Q

What are the causes of iron deficiency?

A

Poor diet
Malabsorption
Increased physiological needs
Loosing too much blood

37
Q

What can cause you to loose too much blood?

A

Menstruation
GIT loss
Parasites

38
Q

How can you investigate iron deficiency?

A

FBC, iron studies, blood film

39
Q

What are the symptoms of iron deficiency anaemia?

A 
Fatigue 
lethargy
Dizziness
Pale mucus membrane
Bounding pulse
40
Q

What are the lab signs of B12 and folate deficiency?

A

Low Hb, high MCV with a normal MCHC

41
Q

What does megoblastic mean?

A

Low reticulocyte count

42
Q

What causes megaloblastic macrocytic anaemia?

A

Vitamin B12/folic acid deficiency

Drug related

43
Q

What causes nonmegaloblastic macrocytic anaemia?

A 
Alcoholism
Hypothyroidism
Liver disease
Myelodysplastic syndromes
Reticulocytosis
44
Q

What is a source of vit B12?

A

Animal and dairy produce

45
Q

What is a source of folate?

A

Vegetables and liver

46
Q

What is the adult daily requirement of vit B12?

A

1-2 mcg

47
Q

What is the adult daily requirement of folate?

A

100-150mcg

48
Q

Where is vit B12 absorbed?

A

Ileum via intrinsic factor

49
Q

Where is folate absorbed?

A

Duodenum and jejunum

50
Q

What are vit B12 and folate important for?

A

RBC maturation
DNA synthesis
Thymidine triphosphate synthesis

51
Q

What are megaloblastic cells characterised by on the peripheral smear?

A

Macrovalocytes and hypersegmented neutrophils

52
Q

What are the causes of folate deficiency?

A

Increased demand,
decreased intake,
decreased absorption

53
Q

What can cause increased folate demand?

A 
Pregnancy/breastfeeding
Infancy and growth spurts
Haemolysis and rapid cell turnover 
Disseminated cancer
Urinary losses
54
Q

What can cause decreased intake of folate?

A

Poor diet
Elderly
Chronic alcohol intake

55
Q

What can cause decreased folate absorption?

A

Medication
Coeliac
Jejunal resection
Tropical sprue

56
Q

What is vitamin B12 important for?

A

Cofactor for methylation in DNA and cell metabolism

57
Q

Where is vitamin B12 sourced from?

A

Fish, meat and dairy

58
Q

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

A

Intrinsic factor

59
Q

Where is intrinsic factor made?

A

Parietal stomach cells

60
Q

What molecules transport vitamin B12 to tissues?

A

Transcobalmin I and II

61
Q

What causes impaired vit B12 absorption?

A

Pernicious anaemia
Gastrectomy or ileal resection
Zollinger-ellison syndrome
Parasites

62
Q

What causes decreased vit B12 intake?

A

Malnutrition

Vegan diet

63
Q

What are some congenital causes of vitamin B12 deficiency?

A

Intrinsic factor receptor deficiency

Cobalamin mutation CG1 gene

64
Q

What causes the increased vit B12 requirements?

A

Haemolysis
HIV
Pregnancy
Growth spurts

65
Q

What medication causes vitamin B12 deficiency?

A

Alcohol
NO
PPI, H2 antagonists
Metformin

66
Q

What is pernicious anaemia?

A

Autoimmune disorder

67
Q

What does pernicious anaemia cause?

A

Lack of vit B12 absorption or intrinsic factor

68
Q

Where is pernicious anaemia most prevelant?

A

Low income areas

69
Q

What are the clinical consequences of pernicious anaemia?

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

MBD/MI (Wothaya) (57 decks)

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