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Cardiorespiratory 2 PBL > PB1 Mess > Flashcards

PB1 Mess Flashcards

1
Q

what do flecks of blood in stool mean

A
  • this can mean that there is blood in the proximal part of the GIT
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2
Q

what is atrophic glossitis

A

Soreness, burning of the tongue with loss of taste buds

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3
Q

what does angualar stomatitis mean

A
  • these are sores in the corner of the mouth
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4
Q

what are the cut of points of haemoglobin for anaemia for men and women

A

Hb <13.5g/dL(m) or <11.5g/dL(f) + MCV <80fL

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5
Q

what are the signs of microcytic anaemia caused by iron deficiency

A
  • Fatigue,
  • pica (craving non-food substances),
  • koilonychia (spoon-shaped nails),
  • hair loss,
  • glossitis,
  • angular stomatitis
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6
Q

What are the causes of iron deficiency

A

Decreased intake, decreased absorption, increased loss, increased requirements
Not an end diagnosis – must investigate cause

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7
Q

what is an alternative diagnosis of microcytic anaemia

A

thalassemia

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8
Q

what is adult haemoglobin made out of

A

2 alpha and 2 beta

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9
Q

why does low iron cause microcytic anaemia

A
  • iron is needed to make heme - each globin molecules contains a heme moelcule which at its core containins an iorn moelcule
  • iron deficiency means that this molecule does not form properly and therefore you generate a low haemoglobin (hypochromic haemoglobin)
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10
Q

how do you diagnose micoryctic anaemia

A
  • history and clinical examination
  • haemoglobin decreases and MCV decreases
  • peripheral blood smear - this would show small pale red cells, pencil cells (iron deficiency)
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11
Q

how do you diagnose an iron deficiency

A
  • Low serum iron
  • increase in total iron binding capacity
  • transferrin saturation is less than 16%
  • serum ferrtin decreases
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12
Q

what is serum iron

A

Serum iron = the amount of iron circulating in the blood bound to transferrin (the iron carrying molecule).

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13
Q

what is total iron binding capacity

A

Total iron binding capacity = how much ‘room’ there is for iron to bind to transferrin. In iron deficiency anaemia, this is raised as a lot of the transferring is unbound.

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14
Q

what is transferrin sautraiotn

A

Transferrin saturation = the iron carrying molecule in blood. It is not saturated with iron in iron deficiency anaemia.

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15
Q

what is serum ferritin

A

Serum ferritin = the storage molecule for iron in the tissues

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16
Q

what is the management of microcytic anaemia caused by iron deficency

A 
Oral iron (ferrous sulfate, ferrous gluconate, ferrous fumarate)
- +/- asorbic acid for absorption

IV iron replacement

Investigate underlying cause
Patient 1 - colon cancer, diverticulitis etc.

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17
Q

what are the possible things that patient 1 has

A
  • colon cancer

- diverticultiis

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18
Q

what does asorbic acid do for iron deficiency

A

Asorbic acid = increases the absorption of iron. Often recommended to take iron supplement with vitamin C containing foods e.g. orange juice

19
Q

what is the proprable cause of patients 1 microcytic anaemia

A

Colon cancer = given the patient’s age, normal diet and history, her iron deficiency is probably due to increased iron (blood) loss from a colon cancer. It may be invading her colon wall and causing her to bleed, explaining the flecks of blood within the stool.

20
Q

what are hypersegemented neutrophils

A

Neutrophils with 6 or more lobed-nuclei
- Neutrophils normally have 2-3 lobed nuclei

Characteristic of megaloblastic anaemia

21
Q

how many lobes to normal neutrophils have

A

2-3 lobes

22
Q

what is the difference between megalobasltic and non megaloblastic anaemia

A

megaloblastic anaemia
- this is microcytic anaemia that is caused due to the impairment of DNA syntehsis

non megaloblastic anaemia
- anamia forms just macrocytic

23
Q

what is the haemoglobin and MCV in macrocytic anaemia

A

Hb <13.5g/dL(m) or <11.5g/dL(f) + MCV >96fL

24
Q

what are the signs and symptoms of macrocytic anaemia

A

Shortness of breath
fatigue
palpitations - due to cardiovascular strain of providing enough oxygen to her tissues
pallor
bounding pulse- due to cardiovascular strain of providing enough oxygen to her tissues

25
Q

how do you diagnose macrocytic anaemia

A

Hb, MCV, blood film

26
Q

what are the casues megaloblastic anaemia

A

vitamin B12 deficiency,
folate deficiency,
pernicious anaemia

27
Q

what are the causes of non megaloblastic anaemia

A

alcohol abuse
liver disease,
severe hypothyroidism

28
Q

what is causes pernicious anaemia

A

Autoimmune condition with antibodies against parietal cells so intrinsic factor is not produced and B12 cannot be absorbed in the ileum
Causes progressive neurological symptoms as vitamin B12 is an essential co-factor in DNA synthesis

29
Q

describe how B12 is normally absorbed

A

Normal vitamin B12 absorption
Bound to intrinsic factor that is released from gastric parietal cells
Absorbed in terminal ileum

30
Q

what is the management of macrocytic anaemia

A

Vitamin B12 then folate replacement

Diagnosis and treatment of underlying condition

31
Q

why is B12 vitamin replaced before folate

A

Replacing folate will improve the anaemia but will not reverse the lack of DNA synthesis, thus masking the neurological symptoms of the B12 deficiency. Must replace B12 first so that the DNA synthesis pathway can be re-instated properly, thus allowing normal cell and neuronal function.

32
Q

what is B12 a cofactor for

A

methionine synthase

- this is the enzyme that catalyses the conversion of homocysteine to methionine

33
Q

what do you have to have in regulates to haemoglobin and MCV to have normocytic anaemia

A

Hb <13.5g/dL(m) or <11.5g/dL(f) + MCV 80-96fL

34
Q

what are the signs and symptoms of normocytic anaemia

A 
Pallor,
 shortness of breath, exhaustion
jaundice
 bone pain, 
may be none
35
Q

what are the casues of normocytic anaemia

A

Acute blood loss,
haemolytic anaemia,
bone marrow disorder,
anaemia of chronic disease

36
Q

how do you diagnose normocytic anaemia

A

Hb, MCV, iron studies, B12 and folate level, blood film

eGFR and electrolytes

37
Q

what is the pathophysiology in chronic disease that causes normocytic anaemia

A

Pro-inflammatory state upregulates hepcidin (decreases free iron), low erythropoietin (CKD), decreased survival of circulating RBCs

38
Q

how do you manage normocytic anameia

A

Treat underlying condition
RBC transfusion
Erythropoiesis-stimulating agents (e.g. epoetin alfa, darbepoeitin alfa)

39
Q

What is the characteristic morphology of erythrocytes in iron deficiency anaemia?

A

pencil cells

40
Q

What defines megaloblastic anaemia?

A

There is a defect of RBC development in the bone marrow in which the cell’s nucleus develops at a delayed rate to the cytoplasm.

41
Q

What is the role of vitamin B12 in DNA synthesis?

A

B12 is the cofactor for methionine synthase, the enzyme that catalyses the conversion of homocysteine to methionine (a precursor of nucleotide synthesis).

42
Q

How is vitamin B12 absorbed?

A

Bound to intrinsic factor, which is released by gastric parietal cells, then absorbed in the terminal ileum.

43
Q

Where is erythropoietin produced?

A

in the interstitial fibroblasts of the kidney in response to hypoxia detected in the kidney

Cardiorespiratory 2 PBL (10 decks)

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