Week 3 - Anaemia Flashcards
What does low Red Blood Cell Count (RCC) indicate?
Anaemia
Low RBC count levels can result from what 5 things?
- Blood loss
- Increased red cell destruction e.g. haemolysis
- Decreased red cell production e.g. renal disease
- Nutritional deficiencies of Iron, Folate, Vitamin B12 or Vitamin B6
- Overhydration (e.g., from IV fluids) can dilute the blood
Haemoglobin transports _______ and ________ _________ in the blood.
Oxygen and Carbon Dioxide
When would we see decreased or low Hb?
Vitamin and Mineral deficiencies
When would we see elevated Hb?
Dehydration
Name 3 things decreased Haematocrit (Hct) may indicate:
- Anaemia
- Dehydration
- Increased RBC breakdown in the spleen
When we categorise ‘chromic’ e.g. hypochromic, we are referring to the concentration of what?
Mean Cell Haemoglobin Concentration (MCHC)
Which is a measure fo the average concentration of Hb in a single RBC
MCHC can be categorised as…
(3 things)
Hypochromic = low MHCH
Normochromic = normal MCHC
Hyperchromic = high MHCH
What does MCV refer to?
Mean Cell Volume.
THe average volume of a single RBC
MCV can be categorised as….
(3 things)
- Microcytic (Low MCV, small cell size) - often defective heme or globin synthesis
- Normocytic (normal MCV)
- Macrocytic (high MCV, large cell size) - often impaired DNA synthesis leading to myeloblastosis
Which ONE of the following can be used to describe a low average concentration of haemoglobin per red blood cell?
a) Microcytic
b) Hypochromic
c) Macrocytic
d) Hyperchromic
b) Hypochromic
What three things could lead to iron deficiency anaemia?
- Nutritional deficiency
-Malabsorption
-Increased iron requirements
What are some common symptoms of Iron deficiency?
Shortness of breath, fatigue, dizziness, tachycardia
Why is serum iron NOT considered a reliable indicator of iron deficiency?
Changes throughout the day - can fluctuate based on our recent dietary iron intake. It also doesn’t reflect our body’s total iron stores
Which is the main lab test do we use for iron deficiency?
Serum Ferritin Levels - although these can be elevated in inflammation or liver disease, so not conclusive. Also test transferrin and FBC
When examining an FBC, what are the indicators of iron-deficiency anaemia?
RBC count: low
Hb: Low
MCHC: hypochromic (low)
MCV: microcytic (low)
When examining an FBC, what are the indicators of iron-deficiency anaemia?
RBC count: low
Hb: Low
MCHC: hypochromic (low)
MCV: microcytic (low)
TRUE OR FALSE
Increasing dietary intake of iron IS NOT sufficient to correct iron deficiency anaemia
TRUE
Name two routes iron can be given to treat iron deficiency anaemia
- Orally
- Parenterally (intra-muscular or IV)
List one pro and con for both oral iron and parenteral iron in treating deficiency
Oral iron pro: safe, cheap
Oral iron con: GI ADRs e.g. constipation
Parenteral iron pro: rapid replacement of iron
Parenteral iron con: potential for permanent skin staining
What vitamin is often given concurrently with iron to optimise its absorption?
Vitamin C
What are some circumstances where oral iron would not be appropriate?
- Patients who have had a gastrectomy (can’t absorb oral iron)
- Celiac disease (due to damage to the mucosa, which decreases absorption from diet)
- Given IV iron instead
What is the range of elemental iron in oral supplementation (mg daily)?
100-210mg daily
What role does Vitamin B12 play in the body?
Important for DNA synthesis and RBC formation
TRUE OR FALSE:
Vit B12 deficiency may lead to demyelination of neurons (neuropathy, dementia)
TRUE
What are some symptoms of Vit B12 deficiency?
Tiredness, easy bruising and bleeding, bowel upset
How long does it usually take to correct haematological VitB12 deficiency?
Haematologic abnormalities are usually corrected within 6 weeks.
What are the FBC indicators of B12-deficiency? hint: MCV and MCHC
MCV high - macrocytic
MCHC normal - normochromic
What is the importance of folic acid in the human body?
Important for DNA synthesis and amino acid metabolism
What are causes of Folic Acid Deficiency we need to know?
-Increased metabolic need (e.g. pregnancy)
-Drugs (i.e. trimethoprim, methotrexate and sulfasalazine)
What is the treatment regime of folic acid deficiency?
Treatment: 5mg/d orally for at least 4 months or until complete haematological recovery. (Take on empty stomach for max bioavailability)
What is an example of when we would supplement folic acid deficiency for prevention?
If patient is on long-term drug treatment that would decrease folic acid levels e.g. methotrexate
What are the FBC indicators of folic acid deficiency? hint: MCV and MCHC
MCV high - macrocytic
MCHC normal - normochromic
Which of the following is recommended for a patient who is trying to conceive and has a close family history of neural tube defects?
a) 0.5mg/day of folic acid taken before conception and for the first 12 weeks of pregnancy
b) 5mg/day of folic acid taken before conception and for the first 12 weeks of pregnancy
b) 5mg/day of folic acid taken before conception and for the first 12 weeks of pregnancy
If a patient has low folate levels, which of the following drugs is most likely to have caused this?
a) methotrexate
b) metformin
c) calcium
d) esomeprazole
a) methotrexate
Which of the following is used at high doses to treat Wernicke’s encephalopathy?
Thiamine (VitB1)
TRUE OR FALSE:
Hazardous alcohol use can be a risk factor for both Vitamin B12 and Vitamin B1 deficiency
TRUE
Vitamin K can reverse the effect of which Vitamin K antagonist?
Warfarin
What is a sign/symptom of Vitamin K deficiency?
Prolonged bleeding.
This is because Vit K is an essential cofactor for the synthesis of clotting factors.
