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Molecular Basis Of Disease > Nutritional Anaemia > Flashcards

Nutritional Anaemia Flashcards

1
Q

Define anaemia

A

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

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2
Q

What is haemoglobin?

A

Iron containing oxygen transport metalloprotein within RBCs

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3
Q

What are the haemoglobin levels bellow which you are diagnosed with anaemia?

A

Women: >120
Men: >130
Pregnant women: >110

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4
Q

What is required for the maturation of red blood cells?

A

Vitamin B12 (to make DNA)

Iron (to make haemoglobin

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5
Q

What are the three causes of anemia?

A

Faliure of production (hypoproliferation, reticulocytopenic)

Ineffective erythropoiesis

Decreased survival (blood loss, haemolysis, reticulocytosis)

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6
Q

What are reticulocytes?

A

Red blood cells that are still developing

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7
Q

What causes low haemoglobin level using MCV?

A

Microcytic (small RBC)
- Iron deficiency (heme deficiency)

Normal
- Sickle cell disease

Macrocytic (large RBC)
- B12 deficiency (folate deficiency)

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8
Q

What is the importance of iron?

A

Essential for oxygen transport

Most abundant trace element in the body

Daily requirement for iron for erythropoiesis varies depending on gender and physiological needs

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9
Q

What is the main source of iron?

A

Meat sources and seafood

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10
Q

Describe the distribution of iron in adults.

A
  1. Dietary iron is consumed
  2. Duodenum produces plasma transferrin
  3. Transferring takes iron to where it’s most needed (bones marrow and muscle and stored in liver)
  4. Iron loss through menstruation and sloughed mucosal cells
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11
Q

How is iron metabolised?

A

Most iron in the body is circulating as Hb

Remain as storage proteins and transport proteins (found in liver, spleen and bone marrow)

Stable forms of iron are:
Ferric states (+3)
Ferrous states (+2)

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12
Q

How is iron absorption regulated?

A

Regulated by

  • GI mucosal cells and hepcidin
  • Duodenum And proximal jejunum
    Via ferroportin receptors on enterocytes
    Transferred into plasma and binds to transferrin
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13
Q

What determines the amount of iron absorbed?

A

Depends on the type ingested

Heme Ferrous (red meat) > non-heme ferric forms

  • Other foods
  • GI acidity
  • State of iron storage levels
  • Bone marrow activity
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14
Q

How does hepcidin regulate iron?

A

Causes ferroportin internalisation and degradation

Thereby increasing iron transfer into blood plasma from the duodenum

Feedback regulates by iron containing concerntion in plasma, liver, and erythropoietin demand for iron.

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15
Q

How is iron stored?

A

Stored as ferritin in liver

A state of iron deficiency will see reduced feratin stores and then increased transferrin

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16
Q

How is iron transported around the body?

A

In plasma: attaches to transferrin and then transported to bone marrow where is binds to receptors on RBC precursors

17
Q

What do laboratory iron studies show?

A

Serum Fe
Ferritin
Transferrin saturation
Transferrin
Total iron binding capacity

18
Q

What laboratory results would indicate anaemia?

A

Ferritin - LOW
transferrin saturation - LOW
TIBC - HIGH
serum iron - LOW/NORMAL

19
Q

What are iron deficiency causes?

A

NOT ENOUGH:
Poor diet
Malabsorption
Increased physiological needs

LOOSING TOO MUCH:
Blood loss
Gi tract loss
Menstruation

20
Q

What are iron deficiency investigations?

A

Full blood count: Hb, reticulocyte count

Iron studies: ferritin, transferrin saturation

Blood film

21
Q

What are the stages in development of iron deficiency anaemia (IDA)?

A

Normal - iron depletion - pre-latent iron deficiency - latent iron deficiency - iron deficient erythropoiesis insist - early iron deficiency anaemia - late iron deficiency anaemia

22
Q

What are some symptoms of anaemia?

A

Tired/fatigue
Dizzy
Pale
Cardio problems

23
Q

What is vitamin B12 and folate deficiency?

A

Both have similar laboratory findings and clinical symptoms
Cause MACROCYTIC ANAEMIA

24
Q

What is macrocytic anaemia?

A

Low Hb
High MCV (mean cell volume)
Normal MCHC (mean cell haemoglobin concerntration)

Megaloblastic: caused by vitamin B12/folic acid deficiency

Non megaloblastic: caused by alcoholism, hypothyroidism, liver disease, reticulocytosis

25
Q

What is the source of B12?

A

Animal and dairy produce

Adult daily intake usually more than required due to average diet

Absorption site: ileum vie intrinsic factor

26
Q

What is the source of folate?

A

Vegetables and liver
Daily adult intake is a bit more then we normal need

Absorption site: duodenum and jejunum

27
Q

What is the function of vitamin B12 (cobalamin) and folic acid?

A

Important for the final maturation of RBCs and for synthesis of DNA

BOTH needed for thymidine triphosphate synthesis

28
Q

What is folate used for?

A

DNA synthesis
Adenosine, guanine and thymidine synthesis

29
Q

What are some causes of folate deficiency?

A

Increased demand:
- pregnancy/ breast feeding
- haemolysis and rapid cell turn over
- infancy and growth spurs

Decreased intake:
- poor diet
- elderly
- chronic alcohol intake

Decreased absorption:
- medication
- coeliac

30
Q

What is the function of vitamin B12?

A

Essential for methylation in DNA and cell metabolism

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

31
Q

What is the source of vitamin B12?

A

Animal sources: fish, meat, dairy

32
Q

How is vitamin B12 absorbed?

A

Requires intrinsic factor for absorption in terminal ileum

IF made in parietal cells in stomach transcobalamin 1+2 transport vitB12 to tissues

33
Q

What are some causes of B12 deficiency?

A

Impaired absorption:
- Pernicious anaemia
- Parasites

Decreased intake:
- malnutrition
- vegan diet

Conginental causes:
- intrinsic factor receptor deficiency
- cobalamin mutation

Increased requirement:
- pregnancy
- growth spurts
- haemolysis
- HIV

Medication
- alchohol
- NO
- metformin

34
Q

What is pernicious anaemia?

A

Autoimmune disorder - antibodies made for intrinsic factor in gastric parietal cells

Lack of Intrinsic factor
Lack of B12 absorption

35
Q

What are the treatments for iron deficiency?

A

Diet
Oral
Stopping the bleeding
Parietal iron Supplementation

36
Q

How is folic acid deficiency treated?

A

Oral supplements

37
Q

How is B12 deficiency treated?

A

Oral
Inter muscular treatment

38
Q

What are the clinical consequences of B12 deficiency?

A

Brain:
- cognition
- depression
- phycosis

Neurology:
- Myelopathy
- Ataxia
- Sensory changes
- spasticity (SACDC)

Infertility

Cardia cardiomyopathy

Tongue:
- taste impairment
- glossitis

Blood: pancytopenia

Molecular Basis Of Disease (32 decks)

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