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Haematology > The Nutritional Anaemia's > Flashcards

The Nutritional Anaemia's Flashcards

1
Q

1.What type of protein in Hb?

A

Metalloprotein

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2
Q
  1. What is Erythropoiesis?
A

The development of red blood cells

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3
Q
  1. What are 3 main causes of Anaemia?
A
  • Failure of production
  • Ineffective Erythropoiesis
  • Decreased survival (Blood loss)
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4
Q
  1. What do the terms :
    -Hypoproliferation
    -Reticulocytopenic
    -Haemolysis
    -Reticulocytosis
    mean?
A 
Hypoproliferation= bone marrow produced inadequate numbers of RBC's
Reticulocytopenic = Decrease in reticulocytes (new immature RBC's)
Haemolysis= Rupture or destruction of RBCs
Reticulocytosis= Increase in reticulocytes (usually to make up for loss of RBC loss)
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5
Q
  1. How would you investigate for anaemia?
A

You would do an mean corpuscular volume test (MCV) to test erythrocyte levels

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6
Q
  1. How would you interpret an MCV test?
A

First categorise the value into either microcytic (LOW mcv), normocytic (NORMAL mcv ) or macrocytic (HIGH mcv)
MCV- mean corpuscular volume ie size of red blood cell
If:
Microcytic : Its an iron deficiency eg Thalassamia or anaemia of a chronic disease

Normocytic:

  • Anaemia of chronic disease
  • Aplastic Anaemia
  • Chronic renal failure
  • Bone marrow infiltration
  • Sickle Cell disease

Macrocytic:

  • B12 or folate deficiency
  • Myelodysplasia
  • Liver disease
  • Myxoedema
  • Alcohol and drug induced
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7
Q
  1. What are nutritional anaemias?
A 
-Anaemia caused by lack of essential ingredients that the body acquires from FOOD sources 
eg 
iron deficiency
vitamin b12 deficiency
folate deficiency
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8
Q
  1. What is the most abundant trace element in the body?
A

Iron

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9
Q
  1. Your daily requirement for iron (for erythropoiesis) varies depending on what 2 factors?
A
  • Gender

- Physiological Needs

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10
Q
  1. The recommended intake of iron assumes that 75% of iron is from heme sources, what are heme sources?
    What consequence does this have on vegetarians?
A

Meats, seafood etc

If you’re a vegetarian your iron absorption would be 2-fold greater as non-heme sources have less iron absorption

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11
Q
  1. Briefly describe the distribution of iron in Adults
A

Okay so we get Iron from our diet and this is absorbed by the duodenum which will then transport the iron to the plasma where it will bind to transferin (Which is stored and released from liver) . This bound iron will be utilised for :
-Muscle (myoglobin)
-Bone Marrow
Very little Iron is excreted and when it is it goes to:
-Menstruation
-Sloughed mucosal cells

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12
Q
  1. Where is Iron stored?
A

The Liver

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13
Q
  1. The following questions refer to Iron Metabolism:
    -What are the two states of iron?
    -What does most of the iron in the body circulate as?
    -What is the remainder of iron in
    the body stored as?-give examples and where you would find this
A
  • Ferric states (3+) and Ferrous state (2+)
  • Most Iron is in the body as circulating Hb
  • The remainder of the iron in the body is as storage and transport proteins - eg ferritin and haemosiderin. Found in the cells of the liver,spleen and bone marrow
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14
Q
  1. How is iron absorbed from dietary foods to our body?
    -What regulates this process?
A

Its absorbed mainly by the duodenum and proximal jejunum and then via ferroportin receptors on enterocytes
it is transferred to plasma and binds to transferin
Regulated by GI mucosal cells and hepcidin

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15
Q
  1. What does the amount of Iron absorbed depend on?
A
  1. The type (heme ferrous > absorption that non-heme ferric)
  2. GI Acidity
  3. State of Iron storage levels
  4. Bone marrow activity affect absorption
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16
Q
  1. What percentage of dietary iron does heme iron make up?
A

10-20%

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17
Q
  1. The following questions are about Hepcidin:
    - What does Hepcidin do to ferroportin levels?
    - How does it do this?
    - How is Hepcidin levels regulated?
A
  • It causes ferroportin internalisation (engulfed by the cell membrane and drawn into the cell) and degradation and so decreases from the duodenum to the blood plasma .
  • Does this using macrophages and iron-storing hepatocytes
  • It is feedback regulated by iron conc in the plasma and the liver by erythropoietic (RBC formation) demand for iron
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18
Q
  1. The following questions are about Iron Transport and storage
    - Iron is transported from enterocytes to where?
    - What is excess iron stored as?
    - (In plasma), What does iron attach to?
    - Where does it then go? What does it bind to here?
A
  • Plasma
  • Ferritin
  • Transferin
  • Bone Marrow
  • Transferin receptors on RBC precursors
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19
Q
  1. In a state of iron deficiency what would you see?
A
  • Reduced Ferritin stores

- Increased transferrin

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20
Q
  1. In laboratory iron studies what does the
    -Serum Fe
    -Ferritin
    -Transferrin saturation
    -Transferrin
    -Total Iron binding capacity
    indicate?
A

Serum Fe is hugely variable during the day so doesn’t indicate much

Ferritin is the primary storage protein, it is water soluble. If high-> high Iron

Transferrin saturation is the ratio of serum iron and total iron - gives a % of transferin binding sites that are occupied by iron. If high->High iron

Transferrin is made by the liver and the production is inversely proportional to Fe stores .

Total Iron binding capacity is a measurement of the capacity of transferrin to bind iron. Indirect measurement of transferrin

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21
Q
  1. In a patient with IRON DEFICIENCY Anaemia would the levels be high or low for:
    - Ferritin
    - TF Saturation
    - TIBC
    - Serum Fe
A

Ferritin = LOW (makes sense, you have less Fe so less stores)
TF Saturation = LOW (makes sense, you have less iron- so less iron binding to transferrin)
TIBC = High (makes sense, you have more transferrin on its own remember is Ferritin is low, transferrin is high)
Serum Fe = Low/Normal

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22
Q
  1. What are the two main causes of iron deficiency?
A
  1. Not getting enough Iron in ( eg poor diet, malabsorption, Increased Physiological needs)
  2. Loosing too much Iron ( Blood loss, menstruation, GI tract loss ,parasites)
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23
Q
  1. What tests would you need to do to diagnose a patient with iron deficiency?
A

Full blood count - Hb, MCV, MCH (avg Hb in rbc), Reticulocyte count
Iron studies - Ferritin, Transferrin saturation
Blood film= thin layer of blood smeared on a glass microscope slide and then stained

24
Q
  1. In terms on minorcytic, normocytic, macrocytic and normochromic (Hb levels in RBC in normal but deficiency in RBC)
    What would iron deficiency in anaemia initially be?
A

Normocytic and Normochromic

25
Q
  1. Before anaemia develops a patient would have an iron deficiency, would this occur all at once or would this occur in several stages?
A

In several stages

26
Q
  1. Okay so we’re going to review a case study:
    A patient comes in complaining of fatigue and lack of concentration
    You do a FBC, her Hb level in 9.7 (Normal level is 12-18)
    Her MCV is in 69.7 (Normal level is 80-97)
    MCH is 22.6 ( normal level 27-33)
    MCHC s 32.4 (33.4-35.5) this is the avg conc of Hb in RBCs
    The reticulocyte count is 35x10^9
    What can you deduce from this information
A

Since her Hb is low, she has moderate anaemia
This is proven further because the anaemia is microcytic as MCV is 69.7(smaller than usual) and its slightly hypochromic as MCHC is low
The MCH is also low
All of this info indicates moderate anaemia
The reticulocyte count is inappropriately normal ( this means its normal but it should be higher because the bone marrow should be compensating the anaemia by producing more blood cells, the fact that its not is worrying)

27
Q
  1. Whats the difference between
    MCH, MCV and MCHC?
A

so
MCV is the average size of your red blood cell
MCH is how much Hb in your RBC
MCHC is amount of Hb in your RBC but the difference between MCH and MCHC is that the MCHC measurement takes the volume or size of the red blood cell into account while MCH does not.

28
Q
  1. On a blood film what would you be looking for in moderate anaemia?
A
  • Red cells generally smaller than a neutrophil
  • Anisocytosis (unequal red cell size)
  • Hypochromic (the lil white bit inside the RBC is called the central pallor , this will be larger than normal in hypochromic rbc)
29
Q
  1. What type of red blood cells would you see in moderate anaemia?
A

Microcytic
Hypochromic
Reticulocytopenic (decrease in reticulocytes-immature rbc’s)

30
Q
  1. What is the world’s most common nutritional deficiency?
A

Iron deficiency anaemia

31
Q
  1. Why are premenopausal women at a high risk of developing Iron deficiency ?
A

Excessive menstrual losses

32
Q

32.What’s the most common cause of IDA in POSTmenopausal women and men?

A

Blood loss from the GI tract

33
Q
  1. What are 3 symptoms of iron deficiency anaemia and 5 signs of anaemia?
A 
Symptoms:
1.Fatigue
2.Lethargy
3.Dizziness
Signs:
1.Pallor of mucous membranes - lack of colour in mucous membranes (gums , skin at bottom of eyeball)
2.Bounding Pulse (heart racing)
3.Systolic flow murmurs (irregular heart sounds)
4. Smooth Tongue
5. Koilonychias (thin, flat nails)
34
Q
  1. Why is it hard to differentiate between B12 deficiency and folate deficiency?
A

They have very similar laboratory finding and clinical symptoms
-You can get them together or as isolated pathologies

35
Q
  1. What is characterised in Macrocytic Anaemia?
A
  • Low Hb

- High MCV with normal MCHC

36
Q
  1. What is megaloblastic anaemia?
    - Would you have a high or low reticulocyte count in megaloblastic anaemia?
    - What is the most common cause of megaloblastic anaemia?
    - How can drug-related issues give rise to megaloblastic anaemia?
A

megaloblastic anaemia - large abnormal immature RBC called megaloblasts

  • Low reticulocyte count
  • Most common cause of megaloblastic anaemia is Vitamin B12/Folic Acid deficiency
  • Drugs interfere with Vit B12 and Folic Acid metabolism–>Megaloblastic
37
Q
  1. What is nonmegaloblastic anaemia?

- What diseases does nonmegaloblastic anaemia suggest the patient has?

A

Anaemia where DNA synthesis is not impaired
-Suggests : Alcoholism, Hypothyroidism, Liver diseases, Myelodysplastic syndromes (immature blood cells don’t mature) and reticulocytosis (increase in immature RBC) to compensate for haemolysis (rupture/destruction of RBC)

38
Q
  1. What is the source and absorption site of both vitamin b12 and folate?
A

Vit B12
Source : Animal and Dairy Products
Absorption Site : Ileum via intrinsic factor

Folate:
Source : Vegetables and Liver
Absorption Site: Duodenum and jejunum

39
Q 
39. 
Vitamin B12 (sometimes called cobalamin) and Folic Acid , are important for two things, what are they?
A
  1. Final maturation of RBC and synthesis of DNA

2. Thymidine triphosphate synthesis

40
Q
  1. Megaloblastic changes of blood cells are seen in B12 and folate deficiency, what are these changes characterised by on a peripheral smear?
A 
Macroovalocytes (enlarged oval shaped erythrocytes)
Hypersegmented neutrophils (neutrophils with many nuclei inside them)
41
Q
  1. What is Folate necessary for?
A

DNA synthesis: Adenosine, Guanine and Thymidine synthesis

42
Q
  1. There are many causes of folate deficiency
    This can be separated into three main factors:
  2. Increased Demand
    2.Decreased Intake
    3.Decreased Absorption
    Give examples for each factor :)
A

Increased Demand:

  • Pregnancy/Breast feeding
  • Infancy and growth spurts
  • Haemolysis (rupture of rbc’s) and rapid cell turnover (SCD)
  • Disseminated Cancer ( spread throughout body)
  • Urinary losses: eg heart failure

Decreased Intake:

  • Poor Diet
  • Elderly
  • Chronic alcohol intake

Decreased Absorption:

  • Medication (folate antagonist)
  • Coeliac
  • Jejunal resection (removed)
  • Tropical sprue (malabsorption disease)
43
Q
  1. How long is folate stored in the body for?
A

3-5 months

44
Q
  1. What is Vitamin B12 essential for?
A
  1. Co-factor for methylation in DNA and cell metabolism

2. Intracellular conversion to 2 active coenzymes for homeostasis of MMA and homocysteine

45
Q
  1. List some food sources containing Vitamin B12?
A

Fish, meat , dairy

46
Q
  1. What does Vitamin B12 require to be absorbed in the terminal ileum?
A

Intrinsic Factor

47
Q
  1. Fill in the blank:
    “Intrinsic Factor made in the *** cells in the stomach Transcobalamin II and Transcobalamin I transport Vit B12 to tissues
A

Parietal

48
Q
  1. There are many causes of Vitamin B12, we can separate this into the 5 main groups:
  2. Impaired Absorption
    2.Decreased Intake
    3.Congenital Causes
    4.Increased Requirements
    5.Medication
    Give some examples of each one
A
  1. Increased Absorption
    -Pernicious Anaemia (inability to absorb the vitamin B-12)
    -Gastrectomy or ileal resection
    -Zollinger-Ellison Syndrome (tumours in Pancreas and/or duodenum)
    Parasites
  2. Decreased Intake:
    - Malnutrition
    - Vegan Diet
  3. Congenital Causes:
    - Intrinsic factor receptor deficiency
    - Cobalamin (vitb12) mutation C-G-1 gene
  4. Increased Requirements:
    - Haemolysis
    - HIV
    - Pregnancy
    - Growth Spurts
  5. Medication:
    - Alcohol
    - NO
    - PPI, H2 antagonists
    - Metformin
49
Q
  1. List the changes seen in Vitamin B12 deficiency in:
    - MCV
    - Hb
    - Reticulocyte Count
    - LDH
    - Blood film
    - BMAT
    - MMA
A

MCV = normal or raised
Hb= Normal or low
Reticulocyte count = Low
LDH= Raised (lactate dehydrogenase)
Blood Film = Macrocytes (large rbc) , Ovalocytes , Hypersegmented neutrophils (lots of nuclei)
BMAT= Hypercellular (more cells), megaloblastic (large abnormal immature rbc), giant metamyelocytes
MMA= Increased (not a standard lab test)

50
Q
  1. What are the clinical consequences of Vit B12 deficiency ?
A 
Cognition
Depression
Psychosis
Myelopathy (injury to spinal cord)
Sensory changes
Ataxia (affect co-ordination, balance and speech)
Spasticity (muscles are continuously contracted)
Infertility
Cardiac Cardiomyopathy
Glossitis (inflammation of the tongue)
Taste impairment
Pancytopenia (deficiency of rbc, wbc and platelets
51
Q
  1. What is Pernicious Anaemia?
A

one of the vitamin B-12 deficiency anaemias. It’s caused by an inability to absorb the vitamin B-12 needed for your body to make enough healthy red blood cells.

52
Q
  1. What is pernicious anaemia caused by?
A
  • Autoimmune Disorder
  • Lack of Intrinsic Factor
  • Lack of B12 Absorption
  • Gastric Parietal cell antibodies
  • Intrinsic Factor antibodies
53
Q

54.Define Anaemia?

A

Anaemia is a condition in which the no’ of RBC’s is insufficient to meet the body’s physiologic needs

54
Q
  1. What does normal erythropoesis require?
A
  • Healthy Bone marrow environment
  • Vitamin B12
  • Folic Acid
  • Vitamins
  • Cytokine(Erythropoietin
55
Q
  1. What does normal erythropoiesis require?
A
  • Healthy Bone marrow environment
  • Vitamin B12
  • Folic Acid
  • Vitamins
  • Cytokine(Erythropoietin

Haematology (8 decks)

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