Wk 3 Haematological Dysfunction

Question 1

What is the most common type of anaemia?

Answer 1

iron deficiency anaemia

Question 2

How does Coeliac disease cause iron deficiency anaemia?

Answer 2

due to malabsorption; lining of stomach is damaged


Question 3

Possible causes of iron deficiency anaemia?

Answer 3

• Inadequate iron intake or absorption
• malabsorption of iron due to coeliac disease
• excessive iron loss (e.g. chronic GI bleeding)
• increased iron requirements (such as during growth)

Question 4

Why is iron deficiency anaemia common in infancy and children?

Answer 4

↑ iron demands

Question 5

How does folate deficiency lead to anaemia?

Answer 5

Folate - an essential vitamin required for DNA production within the developing erythrocyte/RBC

Question 6

What are the general symptoms of anaemia?

Answer 6

Hypoxia, fatigue, feeling cold, pallor, breathlessness, dizziness, jaundice

Question 7

Which anaemia is caused by the lack of intrinsic factor? How does the lack of intrinsic factor cause this anaemia?

Answer 7

pernicious anaemia - intrinsic factor is necessary for
vitamin B12 absorption, which is essential for normal red blood cell development

Question 8

How does chronic kidney failure cause anaemia?

Answer 8

Renal anaemia- insufficient erythropoietin produced by the kidney (EPO stimulates the production of red blood cells)

The kidneys are constantly monitoring for blood pressure changes and in response to low blood pressure, they will secrete erythropoietin to stimulate the red blood cells to produce more cells. If there is chronic kidney failure, the kidneys are not as effective at monitoring for blood pressure changes therefore there is a decline in erythropoietin release which subsequently leads to a decline in red blood cell production which ultimately leads to anaemia

Question 9

Which anaemia shows neurological abnormalities such as numbness, weakness, unsteady gait, and paraesthesia (abnormal sensation)? Why do they get these symptoms (relate to functions of Vit B12)

Answer 9

Pernicious anaemia - Vitamin B12 acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis. It is necessary for growth, cell replication, haematopoiesis, and myelin synthesis.

Question 10

Aplastic anaemia

Answer 10

the failure of the bone marrow to produce blood cells

Question 11

Haemolytic anaemia

Answer 11

the abnormal destruction of erythrocytes

Question 12

How can COPD cause absolute polycythaemia?

Answer 12

due to chronic hypoxia leading to increased erythropoietin secretion –> increased production of erythrocytes

Question 13

How is polycythaemia managed? (3 treatments)

Answer 13

• venesection (phlebotomy)
• immunosuppressive drugs / immunosuppressants
• anticoagulants

Question 14

Mr Smith had a gastrectomy where 80% of his stomach was removed. Several years later he developed signs and symptoms of anaemia. What type of anaemia was he diagnosed with and which supplement should he receive?

Answer 14

pernicious anaemia - Vitamin B12 supplement (Cyanocobalamin)

Question 15

Cyanocobalamin - also what is optimal route of administration and why? (relate to pharmacokinetics)

Answer 15

Vitamin B12 replacement, treatment for pernicious anaemia

parenteral:
- Vitamin B12 binds to the intrinsic factor (IF), produced by parietal cells in the stomach. A vitamin B12-IF complex is formed and passes down the intestine and is absorbed into the systemic circulation.
- People with pernicious anaemia lack intrinsic factor (IF) that is essential for B12 absorption. Therefore B12 supplement is administered parenterally rather than orally in these individuals.

Question 16

Explain why individuals with liver disease may experience Vitamin B12 deficiency by relating to the pharmacokinetics of Cyanocobalamin

Answer 16

Distribution - It is mainly (90%) stored in the liver with some storage in the kidney (severe liver disease> B12 deficiency)

Question 17

Explain why we often see iron-fortified foods advertised to be increasing the ‘energy’ level by relating to the role of iron and general symptoms of anaemia

Answer 17

Iron: Haemoglobin contains four iron
atoms to which oxygen binds.

Symptoms:
- Fatigue
- Feeling cold
- Pallor (being pale)
- shortness of breath (dyspnoea)
- A rapid and pounding heartbeat
- Dizziness and fatigue.

Question 18

Lack of haemoglobin will lead to anaemia with what classification?

(a) Microcytic and hyperchromic (small, pale) + normal red blood cell counts
(b) Microcytic and hypochromic (small, pale) + low red blood cell counts
(c) Macrocytic and hypochromic (small, pale) + low red blood cell counts
(d) Microcytic and hypochromic (small, pale) + high red blood cell counts

Answer 18

(b) Microcytic and hypochromic (small, pale) + low red blood cell counts

Question 19

What is the pathophysiological difference between acute leukaemia and chronic leukaemia

Answer 19

• Acute leukemia is rapid proliferation of immature and undifferentiated blood cells that do not have a function
• Chronic leukemia is slow proliferation of more mature and differentiated blood cells that serve somewhat of a function to the body

Question 20

Distinguish the difference between Leukaemia and Lymphoma

Answer 20

Leukemia and lymphoma are both forms of blood cancer. Leukemia affects the blood and bone marrow, while lymphomas mainly affect the lymph nodes.

Question 21

Malignant lymphomas

Answer 21

• Also known as ‘B-cell’ and ‘T-
  cell lymphomas’
• Lymphomas are a diverse group of neoplasms that develop from the proliferation of malignant lymphocytes in the lymphatic system
• Epstein-Barr virus infections linked to the development of HL/NHL

Classification:
- Over 30 different types
Common:
- Non-Hodgkin’s lymphomas
- Hodgkin’s lymphoma

Question 22

What is Myeloma (Multiple myeloma)?

Answer 22

Multiple myeloma: B cell malignancy of the bone marrow, characterised by the uncontrolled replication (cloning) of plasma cells

Question 23

A 5-year-old male is diagnosed with macrocytic-normochromic anaemia. Which anaemia falls into this category?

Answer 23

Answer: pernicious anaemia (macrocytic [large cells] + normochromic)

Others:
- Haemolytic anaemia (normocytic-normochromic, abnormal destruction of erythrocytes
- Iron deficiency anaemia (microcytic and hypochromic [small, pale + low in number)

Question 24

Which of the following is not a clinical sign of multiple myeloma and what is the pathophysiology behind the others?

a. Hypercalcaemia
b. Impaired renal function
c. Anaemia
d. Hypertension
e. Bone lesions

Answer 24

Answer: d. Hypertension

Patho:
b. Impaired renal function > due to excess antibodies forming casts in distal tubules = renal obstruction
c. Anaemia > due to bone marrow suppression and renal disease
e. Bone lesions > myeloma cells produce several cytokines, one of which stimulates osteoclasts to resorb (break down and dissolve) bone > it also increases calcium in the blood

Question 25

In disseminated intravascular coagulation (DIC), active bleeding occurs after intravascular clotting because:

Answer 25

• clotting factors and platelets are overly consumed and depleted
• microvascular
• bleeding severely but also clotting blood > heparin treats this as it maximises blood flow to organs

Question 26

Recombinant clotting factors

Answer 26

Plasma clotting factor concentrates produced in laboratories (rather than from blood products), used in the treatment of haemophilia.

Question 27

Ferrous Sulfate

Answer 27

treatment for iron deficiency anaemia (low blood haemoglobin level)

Iron supplements (Ferrous Sulfate) are indicated in the prophylaxis and treatment of iron deficiency anaemia, as iron is an essential component in the physiological formation of haemoglobin.