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Haematology > The nutritional anaemia > Flashcards

The nutritional anaemia Flashcards

1
Q

What condition is anaemia?

A

Anaemia is a condition in which the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body’s physiological needs

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2
Q

What is insufficient oxygen carrying capacity due to?

A

Insufficient oxygen carrying capacity is due to reduced haemoglobin concentration as seen with insufficient RBCs

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3
Q

What is Haemoglobin?

A

An Iron containing oxygen transport metalloprotein

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4
Q

What does normal erythropoiesis involve?

A
  • Maturation of RBCs
  • DNA synthesis
  • Hb synthesis
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5
Q

What does maturation of RBC’s require?

A

Maturation of RBCs require:

  • Vitamins
  • Cytokines (erythropoietin)
  • Healthy bone marrow environment
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6
Q

What does DNA synthesis require in erythropoiesis?

A
  • Vitamin B12

- Folic Acid

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7
Q

What does Hb synthesis produce?

A

Iron

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8
Q

What are the mechanism of action for anaemia?

A

Failure of production: -hypoproliferation reticulocytopenic

  • Ineffective erythropoiesis
  • Decreased survival: blood loss, haemolysis, reticulocytosis
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9
Q

What is anaemia caused by a lack of?

A

Anaemia caused by lack of essential ingredients that the body acquires from food sources

  • Iron deficiency
  • Vitamin B12 deficiency
  • Folate deficiency
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10
Q

What is Iron essential for?

A

Essential for O2 transport

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11
Q

What does recommended iron intake assume?

A

Recommended intake assumes 75% of iron is from haem iron sources (meats, seafood)

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12
Q

What is Iron an essentia component of?

A

Iron is an essential component of cytochromes, oxygen-binding molecules (i.e., haemoglobin and myoglobin), and many enzymes

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13
Q

Where is dietary iron absorbed predominantly?

A

Dietary iron is absorbed predominantly in the duodenum

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14
Q

What are Fe3+ ions bound to and what form do they accumulate in the cell in?

A

Fe3+ ions circulate bound to plasma transferrin and accumulate within cells in the form of ferritin

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15
Q

How much Iron do men have?

A

Adult men normally have 35 to 45 mg of iron per kilogram of body weight

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16
Q

Why do postmenopausal women have lower iron stores?

A

Premenopausal women have lower iron stores as a result of their recurrent blood loss through menstruation

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17
Q

What is more than 2/3 of the body’s iron content incorporated into?

A

More than two thirds of the body’s iron content is incorporated into haemoglobin in developing erythroid precursors and mature red cells

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18
Q

Where is 1/3 of the body iron content found?

A

Most of the remaining body iron is found in hepatocytes and reticuloendothelial macrophages, which serve as storage deposits

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19
Q

What do reticuloendothelial macrophages do and for what?

A

Reticuloendothelial macrophages ingest senescent red cells, catabolise haemoglobin to scavenge iron, and load the iron onto transferrin for reuse

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20
Q

How is Iron metabolism controlled?

A

Iron metabolism is unusual in that it is controlled by absorption rather than excretion

21
Q

What is iron absorption regulated by?

A

Regulated by GI mucosal cells and hepcidin

  • Duodenum & proximal jejunum
  • Via ferroportin receptors on enterocytes
  • Transferred into plasma and binds to transferrin
22
Q

What is the iron regulatory hormone and and its receptor and what do they control?

A

iron-regulatory hormone hepcidin and its receptor and iron channel ferroportin control the dietary absorption, storage and tissue distribution of iron

23
Q

What does Hepcidin cause and decrease?

A

Hepcidin causes ferroportin internalization and degradation
-Decreases iron transfer into blood plasma from the duodenum from macrophages involved in recycling senescent erythrocytes and from iron-storing hepatocytes

24
Q

How is hepcidin regulated?

A

Hepcidin is feedback regulated by iron concentrations in plasma and the liver and by erythropoietic demand for iron

25
Q

Where is iron transported from and to where and what happens if there’s excess iron?

A

Iron transported from enterocytes and then either into plasma or if excess iron stored as ferritin

26
Q

Iron deficiency causes?

A 
Not enough in: 
-Poor diet  
-Malabsorption  
-Increased physiological needs  
Losing too much:  
-Blood loss 
-Menstruation  
-GI tract loss  
-Parasites
27
Q

What are the stages in development of iron deficiency anaemia?

A
  • Before anaemia develops, iron deficiency occurs in several stages
  • Serum ferritin is the most sensitive lab indicators of mild iron deficiency
  • -Stainable iron in tissue stores is equally sensitive but is not performed in clinical practice
  • The percentage saturation of transferrin with iron and free erythrocyte protoporphyrin values do not become abnormal until tissue stores are depleted of iron
  • The reticulocyte count is inappropriately normal, since we would expect the bone marrow to compensate the anaemia by producing more new red cells
28
Q

What is the most common cause of IDA in men and postmenopausal women?

A

Blood loss from the GI tract is the most common cause of IDA in adult men and postmenopausal women

29
Q

What is the cause of IDA in premenopausal women?

A

Excessive menstrual losses

30
Q

What are the symptoms of anaemia?

A
  • Fatigue
  • Lethargy
  • Dizziness
  • Signs
  • -Pallor of mucous membranes
  • -Bounding pulse,
  • -Systolic flow murmurs,
  • -Smooth tongue, koilonychias
31
Q

What can B12 and folate deficiency be found together as?

A

Can be found together of as isolated pathologies

32
Q

What type of anaemia does B12 and folate deficiency cause?

A

Macrocytic anaemia

33
Q

What are the symptoms of macrocytic anaemia?

A
  • Low Hb
  • High MCV
  • Normal MCHC
34
Q

What is megaloblastic macrocytic anaemia caused by?

A

Megaloblastic: low reticulocyte count

  • Vitamin B12/Folic acid deficiency
  • Drug-related
    - (interference with B12/FA metabolism)
35
Q

What is non-megaloblastic macrocytic anaemia caused by?

A

Nonmegaloblastic

  • Alcoholism ++
  • Hypothyroidism
  • Liver disease
  • Myelodysplastic syndromes
  • Reticulocytosis (haemolysis)
36
Q

What is macrocyctic anaemia caused by?

A
  • Vitamin B12 = cobalamin

- Folic acid

37
Q

Why are both vitamin B12 and folic acid important?

A
  • Both important for the final maturation of RBC and for synthesis of DNA
  • Both needed for thymidine triphosphate synthesis
38
Q

MEGALLOBLASTIC vs. NON MEGALOBLASTIC

A
  • Megaloblastic changes of blood cells are seen in B12 and Folic Acid deficiency
  • They are characterized on the peripheral smear by macroovalocytes and hypersegmented neutrophils
39
Q

What is folate necessary for?

A

Folate necessary for DNA Synthesis: Adenosine, guanine and thymidine synthesis

40
Q

What are the causes of folate deficiency?

A
  • Increased demand like pregnancy
  • Decreased intake from diet
  • Decreased absorption due to medication
41
Q

What is vitamin B an essential co factor for?

A

Essential co-factor for methylation in DNA and cell metabolism

42
Q

Why is the intracellular conversion to 2 active coenzymes necessary?

A

Intracellular conversion to 2 active coenzymes necessary for the homeostasis of methylmalonic acid (MMA) and homocysteine

43
Q

What does vitamin B12 require in order to be absorbed and where?

A

Requires the presence of Intrinsic Factor for absoprtion in terminal ileum

44
Q

Where is intrinsic factor made?

A

IF made in Parietal Cells in stomach

45
Q

What transports vitamin B12 to tissues?

A

Transcobalamin II and Transcobalamin I transport vitB12 to tissues

46
Q

What are the clinical consequences of anaemia?

A 
Brain:
-Cognition 
-Depression 
-Psychosis  
Neurology:  
-Myelopathy  
-Sensory changes  
-Ataxua 
-Spasticity (SACDC) 
Infertility  
Cardiac cardiomyopathy 
Tongue: glossitis, taste impairment 
Blood: Pancytopenia
47
Q

What is pernicious anaemia?

A

Autoimmune disorder

48
Q

What is pernicious anaemia due to a lack of?

A 
Lack of IF  
Lack of:  
-B12 absorption 
-Gastric Parietal cell antibodies 
-IF antibodies
49
Q

What are the treatments for anaemia?

A
  • Iron – diet, oral, parenteral iron supplementatin, stopping the bleeding
  • Folic Acid – oral supplements
  • B12 – oral vs intramuscular treatment

Haematology (6 decks)

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