13 - Anaemia 1

Question 1

How many RBC are there

Answer 1

24 x10^12 trillion RBC - 1/3 total body cells

Question 2

How much iron should the diet contain

Answer 2

15mg iron/day

Question 3

What is the total body iron

Answer 3

3-5g

1mg absorbed and 1 mg excreted in urine/faeces, hair so balance, 2g iron is in the form of circulating Haemoglobin

Question 4

Where is the majority of the iron absorbed in

Answer 4

duodenum by enterocytes

Iron only taken up as Fe++

Question 5

What enzyme reduces Fe3+ to Fe2+

Answer 5

Ferric reductase

Question 6

What is transferrin

Answer 6

Iron binding blood plasma glycoproteins

Takes iron from inside the enterocyte into the blood to the bone marrow

Question 7

What does transferrin carry iron as

Answer 7

The ferric form FE3+

it can carry 2 irons

Question 8

What takes up iron

Answer 8

Ferritin

Question 9

What does levels of transferrin tell you

Answer 9

The ability of the blood to transfer iron from enterocytes

Question 10

Ferritin

Answer 10

The iron is stored here

= it can release iron in a controlled manner

Question 11

Where is ferritin found

Answer 11

In most tissues

and small amounts in the plasma as a carrier

Question 12

What does plasma ferritin indicate

Answer 12

Indirect marker of the total amount of iron in the body

Question 13

What does serum ferritin indicate

Answer 13

used as a diagnostic test for iron deficiency anaemia

Question 14

What do you do if the Hb is low

Answer 14

History and examination
Full blood count and blood film 
Serum B12, folate and ferritin
Test renal and liver function 
ESR - check if infection

Question 15

What are further tests you can do

Answer 15

Hb electrophoresis

Bone marrow biopsy

Question 16

What is anaemia

Answer 16

Low Hb level

Not a diagnosis

Question 17

What are the levels of hb for an adult male and female

Answer 17

<13.5 g/dl - male

<11.5 g/dl (female)

Question 18

What are the levels of hb for a human of age 6months - 6 y/o

Answer 18

<11 g/dl

Question 19

What are the levels of hb for a human of age 6 y/o to 14 y/o

Answer 19

<12 g/dl

Question 20

What are symptoms of anaemia

Answer 20

Tiredness
Fainting
SOB
palpitations

Question 21

What are signs of anaemia

Answer 21

Pallor
Rapid heartbeat
Bounding pulse
Systolic flow murmur

Question 22

What are causes of anaemia

Answer 22

Decrease in RBC production due to iron, folate, b12 deficiencies, infections, chronic disease
Increased destruction of RBC - haemolytic anaemia
Increase loss of RBC - bleeding

Question 23

What is microcytic anaemia

Answer 23

<76fl
Iron deficiency
Thalassaemia

Question 24

What is normocytic anaemia

Answer 24

76 - 96fl
Recent bleed
Chronic disease
Haemolytic anaemia

Question 25

What is macrocytic anaemia

Answer 25

>96fl B12 or folate def Alcohol/liver disease

Question 26

What are 2 signs of iron deficiency anaemia on a blood film

Answer 26

Microcytic | hypochromatic (reduced hb)

Question 27

Why can you get iron deficiency anaemia

Answer 27

Low iron in diet Reduced RBC synthesis Excess iron loss

Question 28

What factors increase iron absorption

Answer 28

``` Haem irons ferrous salts (Fe2+) Acid ph Pregnancy Hypoxia ```

Question 29

What factors impair iron absorption

Answer 29

``` Non-haem iron (veg) Ferric salts (Fe3+) Alkaline PH Iron overload Inflammatory disorders Proton pump inhibitor ```

Question 30

What are some risk factors for anaemia

Answer 30

``` Sex (Females>Males) Appetite changes Drugs - Aspirin, NSAID Diet - Vegans, elderly Physiological - Pregnancy, adolescence ```

Question 31

How would you confirm iron deficiency anaemia

Answer 31

1) Blood count = Low RBC number 2) Blood film = Microcytic, hypochromatic 3) Serum ferritin - Low 4) Serum iron total binding capacity - Low

Question 32

What is the treatment for iron deficiency anaemia

Answer 32

Replace the iron Improve the diet Use iron tablets (ferrous sulphate)

Question 33

How long do you continue iron supplements once the Hb is normal

Answer 33

3 months

Question 34

What are causes of normocytic anaemia

Answer 34

Acute blood loss Chronic disease Cancer Haemolysis

Question 35

Why does chronic disease cause normocytic anaemia

Answer 35

Inflammation - reduces RBC lifespan - depressed erythropoiesis - poor marrow response to EPO (inflammatory cytokines interfere with EPO production/action)