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Anaemia Flashcards

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1
Q

How many red blood cells are present in the body

A

24 trillion

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2
Q

What is total body iron mass

A

3-5g

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3
Q

Where is majority of dietary iron absorbed?

A

In the duodenum by enterocytes

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4
Q

In what forms can dietary iron be absorbed?

A

Fe2+

As part of a protein

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5
Q

How is Fe3+ reduced to Fe2+

A

Ferric reductase enzyme found on brush border of duodenum

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6
Q

What are transferrins

A

Iron binding blood plasma glycoproteins used to control levels of free iron in plasma

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7
Q

How many Fe3+ ions can a transferrin carry

A

2

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8
Q

Where does iron go once its been absorbed

A

Bone marrow

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9
Q

What takes up iron ions once inside the cell

A

Ferritin

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10
Q

How is iron stored

Why?

A

Inside cells in ferritin

Allows iron to be released in a controlled manner and is a buffer against deficiency or overload

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11
Q

What counts as anaemia for a male adult?

A

Hb less than or equal to 13.5g/dl

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12
Q

What counts as anaemia for female adult

A

Hb<11.5g/dl

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13
Q

What counts as anaemia for child 6m-6y?

A

Hb<11g/dl

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14
Q

What counts as anaemia for child 6-14y?

A

Hb<12g/dl

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15
Q

Symptoms of anaemia?

A 
Tiredness
Fainting
Shortness of breath
Worsening angina
Rapid heart
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16
Q

Signs of anaemia

A 
Pallor
Rapid heart 
Bounding pulse
Systolic flow murmur
Cardiac failure
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17
Q

What can cause anaemia by causing decreased production of red cells (5)

A
  • Iron deficiency
  • B12/ folate deficiency
  • Marrow infiltration
  • Chronic disease
  • Infection
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18
Q

What can cause anaemia by causing increased deustruction (haemolytic anaemia)

A
  • Immune destruction
    -Disorders of RBC
    (haemolytic anaemia)
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19
Q

What are the MCV guidelines in terms of categorising anaemia?

A

Microcytic: MCV<76fl
Normocytic: MCV 76-96fl
Macrocytic: MCV>96fl

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20
Q

2 main causes of microcytic anaemia

A

Iron deficiency and thalassaemia

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21
Q

How do red blood cells appear in iron deficiency anaemia?

A

Small/ microcytic
Hypochromic
Presence of pencil cells

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22
Q

Risk factors for iron deficiency anaemia

A

Age (premature/ elderly)
Sex (F>M)
GI (appetitte/ weight changes)
Drugs (aspirin/ NSAIDS)

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23
Q

What is the worldwide most common cause of iron deficiency anaemia

A

Hookwormm

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24
Q

4 most common causes of iron deficiency anaemia in the developed world

A

Reproductive (eg menorrhagia)
GI tract bleeding (ulcers, IB, cancers)
GI tract malabsorption (coeliac, atrophic gastris_
Vegan

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25
What woulld full blood count show in iron deficieny anaemia
Low RBC
26
Main causes of normocytic anaemia
``` Acute blood loss Chronic disease Cancer Haemolysis Metastatic cancer (marrow infilitration) ```
27
How does chronic disease lead to normocytic anaemia
- Causes reduced red blood cell lifespace leading to depressed erythropoiesis - Poor marrow response to EPO as inflammatory cytokines interfere with EPO production/ action
28
Another name for vitamin B12?
Cobalmin
29
Funtions of vitamin B12?
Synthesis of myelin and assists in DNA synthesis | Involved in metabolism of every cell- especially cells with high turnover
30
Result of prolonged vitamin B12 deficiency?
Severe and irreversible nerous system daamge
31
Is vitamin B12 destroyed by cooking?
No
32
How much B12 is required? How much is stored
1mg/d | 1000mg
33
Where is B12 absorbed
Ileum
34
What is another name for vitamin B9?
Folate
35
What types of food is B9 found in?
Liver, greens, yeast
36
Is B9 destroyed by cooking
Yes
37
How much B9 is required
150mg/d
38
How long is B9 stored for
4 months
39
Where is B9 absorbed?
Duodenum and jejunum
40
What difficulties are presenting in diagnosing B12/ B9 deficiency
They are clinically indistinguishable from each other
41
What type of anaemia to B12/ B9 deficiencies lead to
Macrocytic anaemia
42
How can B12 deficiency be detected?
Measured clinically as increased serum methylmalonic acid
43
To what extent can eating more B9 cure/ solve B12 deficiency?
Lack of DNA synthesis can be solved by folate, but the reduced myelin synthesis cannot be
44
Describe how B9/12 deficienies lead to macrocytic anaemia
- Both required for DNA synthesis - Reduced/ impaired DNA synthesis - Cells fail to divide - Overlarge blood cells
45
Where is intrinsic factor produced
Produced by parietal cells in the gastric mucosa
46
Describe absorption of vitamin B12?
Absorbed by body by ileum after binding to intrinsic factor. Intrinsic factor- B12 complex absorbed by receptors on ileum endothelial cell
47
Where is vitamin B12 released from the protein its bound to?
In stomach by acid
48
What would the blood count of a person with B12/B9 deficiency show?
Low Hb High MCV>120 Low WBC and platelets
49
What would the blood film of a person with B12/B9 deficiency show?
Oval macrocytes | Hypersegmented neutrophils
50
What would biochem tests of a person with B12/B9 deficiency show?
High bilirubin | High lactate dehydrogenase
51
How is pernicious anaemia characterised?
B12 deficiency caused by absence or reduction of intrinsic factor Autoimmune disorder Occurs due to an antibody against gastric mucosa and intrinsic factor
52
Who does pernicious anaemia most commonly effect?
Females with fair hair, blue eyes and group A blood
53
Symptoms of pernicious anaemia
- Glossitis - Mild jaundice - Dementia - Peripheral neuropathy - Optic atrophy - Insididious
54
How is pernicious anaemia treated?
Every 3 months you have an IM B12 injection for life
55
How do symptoms of B12 and B9 differ
All same symptoms, but folate deficiency gives no neurological symptoms
56
How is folate deficiency treated
Oral folate tablets
57
Examples of intravascular haemolysis
Sickle cell Thalassaemia Rhesus mismatch Hereditary spherocytosis
58
Examples in extravascular haemolysis
ABO mismatch Snake bites Infection
59
How does haemolytic anaemia present
Pallour and anaemia Jaundice Gall stones Splenomegaly
60
What will lab investigations show for somebody with haemolytic anaemia?
- Red cell breakdown: increased serum unconjugated bilirubin, increased urinary urobilogen, increased lactate dehydrogenase. - Increased RBC production: increased reticulocytes, increased RBCs in marrow
61
3 types of haemolytic anaemia
1) Membrane defect 2) Haemoglobin defect 3) Enzyme defect
62
Define spheryocyte
Sphere shaped RBC
63
What type of haemolytic anaemia results from hereditary spherocytes?
Membrane defect
64
What causes hereditary spherocytosis
Defect in protein of red cell cytoskeleton. | Blood cells contracts to its most surface tension efficient/ most flexible form (sphere)
65
Are spherocytes more or less fragile than normal RBC?
More fragile (could break when passing through capillaries)
66
What is the result of increased fragility of spherocytes?
Break down more- chronic haemolytic anaemia. | Low Hb, high LDH, high unconjugated serum bilirubin
67
What is the inheritance pattern of hereditary spherocytosis
Autosomal dominant
68
Example of haemolytic anaemia due to an enzyme defect
G6PD deficiency
69
What is the role of G6PD?
Prevents/ reverses haemoglobin oxidation
70
Inheritance pattern of G6PD deficiency
X linked
71
3 main triggers of G6PD deficiency?
Foods (fava beans) Bacterial/ viral Drugs
72
Approx how much iron is in 1ml of blood
0.5mg
73
How much blood loss/ day will result in iron deficiency
10ml loss/ day
74
What 6 things can enhance absorption of iron
- Haem iron - Ferrous salts - acidic pH - Iron deficiency - Pregnancy - Hypoxia
75
What 5 things can impair the absorption of iron
- Non-haem iron - Ferric salts - Alkaline pH - Iron overload - Inflammatory disorders
76
Name a drug type that can decrease iron absorption
Proton pump inhibitors (indigestion)
77
What disorder of the haematopoietic stem cells in bone marrow may lead to macrocytic anaemia
Myelodysplasia
78
What conversion reaction are b12 and folate needed for
Homocysteine--> methionine
79
What happens in autoimmune haemolytic anaemia
- IgG antibodies present in blood that react with RBC membrane proteins - Affects RBC then removed my spleen--> extravascular haemolysis

CR 2 (33 decks)

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