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Medical Studies 1 > 10.6 Anaemia Part 2 > Flashcards

10.6 Anaemia Part 2 Flashcards

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1
Q

MCV (Mean cell volume) in micro/normo/macrocytic anemia:

A

Micro: <80fL
Normo: 100fL
Macro: >100fL

fL = femtolitres

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2
Q

TAILS acronym for causes of microcytic anaemia:

A
  • Thalassaemia
  • Anaemia of chronic disease
  • Iron deficiency
  • Lead poisoning
  • Sideroblastic anaemia
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3
Q

List some causes of normocytic anaemia

A
  • Anaemia of chronic disease
  • Haemolysis
  • Mixed B12/folate/iron deficiency
  • After acute blood loss
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4
Q

What is a megaloblast. What causes their appearance?

A

Large, nucleated, erythroblast; delayed maturation of nucleus

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5
Q

Megaloblastic vs non-megaloblastic macrocytic anaemia

A

Refers to presence/absence of megaloblasts in bone marrow

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6
Q

List some causes of macrocytic anaemia

A
  • B12/folate deficiency
  • Alcohol excess
  • Liver disease
  • Haemolysis (With reticulocytosis)
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7
Q

What is the role of folate in DNA synthesis?

A

Produces purines (adenine and guanine)

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8
Q

Where is vitamin B12 absorbed, and what is it bound to (+where is that made?)

A
  • Absorbed in ileum
  • Must be bound to intrinsic factor
  • IF is made in parietal cells of stomach
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9
Q

Where is folate absorbed?

A

Duodenum and jejunum

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10
Q

True or false: folate plays a role in DNA synthesis during purine production, but B12 has no role in DNA synthesis

A
  • False
  • Both are involved
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11
Q

Can we make vitamin B12 within our microbiomes?

A
  • No
  • We get if from animals, who obtain it from:
    1. Eating bacteria-contaminated food
    2. internal production
    3. Eating food of animal origin
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12
Q

Are there any vegan/vego food sources of B12?

A

Nope. None.

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13
Q

List some dietary sources of folate

A
  • Liver
  • Leafy greens
  • Yeast
  • Breads and cereals (fortified)
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14
Q

Can folate withstand cooking well?

A

No. It is easily destroyed by this.

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15
Q

Nutritional cause of B12 deficiency

A

Veganism

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16
Q

Nutritional causes of folate deficiency

A
  • Old age
  • Institutions
  • Poverty
  • Famine
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17
Q

List some causes of malabsorption which can cause vitamin B12 deficiency

A
  • Pernicious anaemia (no IF)
  • Ileal resection
  • Crohn’s disease
  • gastrectomy
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18
Q

List one way in which malabsorption can cause folate deficiency

A

Coeliac disease

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19
Q

List some conditions under which the body’s folate usage increases

A
  • Pregnancy
  • Haemolytics anaemia
  • Cancer
  • Inflammatory diseases
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20
Q

List one type of drug that can cause folate deficiency

A

Anticonvulsants

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21
Q

What is the mechanism behind pernicious anaemia?

A
  • Autoantibody response attacks stomach
  • Leads do destruction of gastric mucosa -> parietal cells destroyed
  • Cannot secrete intrinsic factor
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22
Q

List some clinical features of megaloblastic anaemia

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A
  • Glossitis
  • Angular stomatitis
  • Malabosorption symptoms (e.g. weight loss)
  • Neuropathy
  • Neural tube defect (in pregnant women)
23
Q

List some broad features of haemolysis of RBCs

Study These Flashcards
A
  • Increased RBC breakdown
  • Increased RBC production to compensate
  • Damaged red cell on films
24
Q

Why can haemolytic anaemia cause macrocytosis? Under what circumstances could it be normocytic?

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A
  • In response to RBC haemolysis, the body produces more erythrocytes
  • This leads to reticulocytosis
  • Since reticulocytes are larger than erythrocytes, this increases MCV
  • If there is not an adequate marrow response, then we see normocytic anaemia, as no reticulocytes are produced
25
Explain intrinsic vs extrinsic haemolytic anaemia
Intrinsic: RBCs are destroyed because they are defective Extrinsic: Destroyed by factors outside the cell itself
26
List some causes of intrinsic haemolytic anaemia
- Membrane defects - Metabolic defects (e.g. G6PD) - Haemoglobin defects (HbS)
27
List some causes of extrinsic haemolytic anaemia
-Autoimmune/alloimmune (e.g. transfusion) conditions - Red cell fragmentation syndromes - Infections - Burns
28
Briefly describe glucose 6 phosphate dehydrogenase deficiency and its role in in intrinsic haemolytic anaema
- G6PD is an enzyme required to produce a compound that protects your RBCs from oxidative stress. Therefore, if you don't have eough, your cells are vulnerable. - You can get bouts of acute haemolytic anaema when the stress increases, such as in stress or eating fava beans. - More common in men (favas)
29
Which gene is mutated in HbS
Beta-globin gene on Chromosome 11 (same as beta thalassaemia)
30
Does HbS have a lower or higher O2 affinity than HbA?
Lower affinity; lets go more easily
31
How would we treat a patient who is struggling with an acute issue relating to HbS?
- Supportive care (treat symptom) - Folic acid - Exchange transfuion - Stem cell transplantation
32
Intravascular vs extravascular haemolytic anaemia
Intra: within vessels Extra: outside of vessels, such as in the spleen or liver
33
Describe the two different kinds of autoimmune haemolytic anaemia. What antibody class is involved in each?
- Warm: 37°C (IgG) - Cold: 4°C (IgM)
34
List the three kinds of immune-mediated haemolysis
- Autonimmune haemolytic anaemia - Alloimmune - Drug-induced
35
True or false: alcohol and liver disease can cause macrocytic anaemia
True
36
Does anaemia always have severe symptoms in well-established cases?
- No - If the onset was slow enough, patients may not notice
37
List some general symptoms and signs of anaemia
- Fatigue - Dyspnoea - Weakness - Lethargy - Palpitations - Cardiac failure - Pallor mucous membranes
38
What type of anaemia is indicated by koilinychia
Iron deficiency
39
What type of anaemia is indicated by jaundice, neuropathy, and angular stomatitis
B12/folate deficiency
40
What type of anaemia is indicated by petechiae and splenomegaly?
Marrow disorders (too many dodgy cells, spleen enlarges to kill them)
41
List four investigations for anaemia
- Iron studies - B12/folate - markers of haemolysis - Haemoglobin electrophoresis
42
What are some indicators of haemolysis?
- LDH - Bilirubin - Reticulocyte count
43
Think of twso haemoglobinopathies than can be detected with Hb electrophoresis
- Sickle cell disease - Thalassaemia
44
Is iron deficiency a diagnosis?
- No - Seek the underlying cause; always consider blood loss
45
Where is most of the iron stored in the body?
- Liver - Spleen - Bone marrow
46
Identify vulnerable demographics for iron deficiency
- Women (menstruation) - Pregnant women - Vegetarians/vegans - Elderly - Children
47
List some iron-rich foods
- Red meats, fish, poultry, eggs - Legumes - Grain products (whole-grain) - Dark, leafy greens and dried fruits
48
What is the efficiency of iron intake?
14% (7mg in per 1mg absorbed)
49
Can the body excrete iron?
No
50
Is divalent or trivalent iron more easily absorbed into the bloodstream?
Divalent; this is why meat iron is easier to absorb than veggie iron
51
What factors can increase iron absorption?
- Stomach Acid - Heme form - High RBC demand - Meat Factor Protein (MFP)
52
What factors can decrease iron absorption (with a dietary focus)?
- Low stomach acid (antacid use) - Dietary fibre (binds to iron) - Oaxilic acid - Polyphenols/tannins in tea/coffee - Excess minerals
53
What factors can increase the absorption of non-haem iron? How does this give rise to food pairing?
- Meat Factor Protein and vitamin C - Therefore, pairing plant iron with foods that contain these can maximise absorption
54

Medical Studies 1 (90 decks)

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