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Anaemia Flashcards

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1
Q

State the definition of anaemia

A

Reduction in haemoglobin in the blood, not necessarily the red blood cells

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2
Q

List causes of anaemia (3)

A
  1. Reduced production
  2. Increased loss
  3. Increased demand
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3
Q

List how anaemia is caused by a lack of Hb production

A

Reduced normal red cells, reduced Hb

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4
Q

Why would there be reduced normal red cells causing anaemia?

A

Marrow failure

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5
Q

How does aplastic marrow appear histologically?

A

Paler as there are not enough RBCs or normal RBCs with less Hb
Creates empty spaces

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6
Q

List why there could be normal red cells, but reduced Hb causing anaemia (3)

A
  1. Deficiency states
  2. Abnormal globin chains
  3. Chronic inflammatory disease
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7
Q

What deficiencies would result in reduced Hb? (3)

A
  1. Iron
  2. Folate
  3. Vitamin B12
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8
Q

Give some examples of conditions resulting from abnormal globin chains

A
  1. Thalassaemia

2. Sickle cell anaemia

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9
Q

Why does abnormal globin chains result in anaemia?

A

If there is an inability to make normal globin, there is an inability to make normal haem

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10
Q

Give an example of a chronic inflammatory disease that could cause reduced Hb

A

Rheumatoid arthritis- switches off ability to make RBCs

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11
Q

State the definition of haematinics

A

Things used to make the RBCs

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12
Q

List examples of haematinics (3)

A
  1. Iron
  2. Vit B12
  3. Folic acid
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13
Q

What may cause a vitamin B12 deficiency? (3)

A
  1. Lack of instrinsic factor
  2. Problem with parietal cells so intrinsic factor isn’t produced
  3. B12 not absorbed in small intestine- coeliac
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14
Q

List sources of iron (3)

A
  1. Meat
  2. Green leafy vegetables
  3. Iron tablets
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15
Q

List a disease that could reduce iron absorption (2)

A
  1. Coeliac disease
  2. Achlorhydia
    - Absence of HCL acid in gastric secretions
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16
Q

What occurs in achlorhydria?

A

Lack of stomach acid so no conversion of non-haem iron

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17
Q

What can induce achlorydria

A

May be drug induced (proton pump inhibitors)

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18
Q

List causes of iron loss (4)

A
  1. Bowel cancer
  2. Inflammatory bowel disease
  3. Gastric erosions and ulcers
  4. Haemorrhoids
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19
Q

Give the inflammatory bowel diseases that could cause iron loss

A
  1. Ulcerative colitis

2. Crohns disease

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20
Q

Give the types of bowel cancer that could cause iron loss

A
  1. Colonic cancer

2. Rectal cancer

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21
Q

List sources of Vit B12 (6)

A
  1. Milk
  2. Yoghurt
  3. Meat and poultry
  4. Liver
  5. Fish
  6. Eggs
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22
Q

List some ways of causing vitamin B12 deficiency (3)

A
  1. Lack of intake- strict vegans
  2. Lack of intrinsic factor
  3. Disease of terminal ileum (from crohns disease)
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23
Q

Give examples of what could cause a lack of intrinsic factor (2)

A
  1. Autoimmune stomach disease- pernicious

2. Gastric disease

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24
Q

List sources of folic acid (5)

A
  1. Leafy greens
  2. Broccoli
  3. Avocado
  4. Cauliflower
  5. Peppers
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25
List cause of folic acid deficiency
1. Lack of intake | 2. Absorption failure
26
Why may there be folic acid absorption failure?
1. Jejunal disease- coeliac | 2. Usually seen co-deficient with iron
27
What can spina bifida be a result of?
Folic acid deficiency - Spinal cord doesn't close properly - Can affect nerves controlling the legs
28
Can you be deficient in haematinics without an effect on Hb?
Yes but can eventually lead to anaemia so there would be low Hb
29
What occurs in thalassaemia?
Normal haem production | Genetic mutation of globin chains (results in abnormal globin so reduced Hb)
30
What different chains are affected by thalassaemia? (2)
1. Alpha (chain) thalassaemia | 2. Beta (chain) thalassaemia
31
What group is most likely to be affected by: 1. Alpha thalassaemia 2. Beta thalassaemia
1. Asians | 2. Mediterranean
32
List clinical effects of thalassaemia (5)
1. Chronic anaemia 2. Marrow hyperplasia 3. Splenomegaly 4. Cirrhosis 5. Gallstones
33
What can marrow hyperplasia caused by thalassaemia lead to?
Skeletal deformities
34
Why does thalassaemia lead to splenomegaly?
Due to high rate of haemolytic
35
How is thalassaemia managed?
Blood transfusions | Need to prevent iron overload
36
How can a blood transfusion lead to iron overload in someone with thalassaemia?
hey have haem, but no globin | The transfusion would add unnecessary haem
37
What happens in sickle cell anaemia?
Abnormal globin chains (Hb made, but is abnormal) | RBCs change shape in low oxygen environments
38
Why is the changing of RBC shape in sickle cell anaemia a problem
Prevents RBC from passing through the capillaries | Tissue ischaemia- pain and necrosis
39
What kind of mutation causes sickle cell trait?
Heterozygous
40
What kind of mutation causes sickle cell disease?
Homozygous
41
Where in the world is sickle cell disease most common?
Africa + India
42
What RBC issues could cause sickle cell disease? (2)
1. Loss of RBCs through bleeding | 2. Abnormal RBCs
43
What type of bleeding most commonly results in anaemia?
GI bleeding (possibly due to a gastric ulcer - alcohol/meds)
44
What can having abnormal RBCs in anaemia be a result of?
1. Autoimmune | 2. Hereditary
45
What can sickle cell disease lead to?
Anaemia
46
What do abnormal RBCs lack in?
- Reduced life expectancy (less than 120 days) | - Removed by spleen and lost faster
47
When would there be an increased demand for Hb?
1. Pregnancy | 2. Malignant disease
48
Why is anaemia during pregnancy not a major problem?
Hb is normal but dilute | This means less Hb is lost- not a physiological problem as you don't want to lose Hb
49
List some different ways the red cell can change in anaemia.
1. Microcytic 2. Macrocytic 3. Normocytic
50
What causes a microcytic RBC?
Shrinks too much due to low Hb (body not making Hb properly) Can be due to Fe deficiency or thalassaemia Related to diet
51
What causes a macrocytic RBC?
Maturation doesn't happen properly, cell doesn't shrink so it too large There is therefore a shortage of Hb so B12, folate deficiency
52
Define a reticulocyte
An immature red blood cell (macrocytic)
53
What causes a normocytic RBC?
Make normal RBCs but not enough so Hb decreases Can be caused by bleeding, renal problems or chronic disease such as rheumatoid arthritis Caused by blood loss due to trauma
54
How do microcytic RBCs appear histologically?
There is a larger range of sizes- some normal and large but mainly small This means the average cell size is smaller Can also get some paler looking cells- hypochromic
55
How do macrocytic RBCs appear histologically
Cells are larger, no hole
56
Why are reticulocytes released into the circulation?
To replace losses | Raise mean cell volume (average cell size) as they haven't shrunk
57
How do reticulocytes appear histologically?
Still have some organnelles as they haven't matured
58
Steps for an anaemia diagnosis (3)
1. What is the Hb amount? (degree of anaemia) 2. What is the red cell count and haematocrit?- due to cell deficiency (loss- bleeding) or Hb formation deficiency (marrow) 3. What is the mean cell volume?- find out cause
59
List some clinical signs that are not used to specifically diagnose anaemia, and why? (4)
1. Pale mucosa 2. Smooth tongue (iron) 3. Beefy tongue (vit B12) Not used as could be due to other factors and may not always present in anaemics
60
Define a sign
What the clinician finds out to help with the diagnosis
61
List signs of anaemia (4)
1. Pale 2. Tachycardia 3. Burning mouth 4. Rarely enlarged liver and spleen
62
Define a symptom
What the patient complains of
63
List symptoms of anaemia (4)
1. Tired and weak 2. Dizzy 3. Shortness of breath 4. Palpitations (as heart has to work faster)
64
List the investigations that can be used to diagnose anaemia (6)
1. History 2. Full blood count (ferritin and red cell folate/vit B12) 3. Faecal occult blood (FOB) 4. Endoscopy/colonoscopy 5. Renal function 6. Bone marrow examination
65
List the ways of treating anaemia (3)
Treat cause 1. Replace haematinics 2. Blood transfusions (if theres production failure) 3. Erythropoeitin (if theres production failure - renal disease)
66
Give ways of replacing haematinics to treat anaemia
FeSO4 200mg 3 times a day for 3 months 1mg IM vit 12 x 6, then 1mg/2 months 5mg folic acid daily
67
List the dental aspects to be considered with relation to anaemia (6)
1. General anaesthesia- affects O2 capacity 2. Deficiency states- usually Fe 3. Check haematinics in mucosal diseases 4. Sickle cell disease 5. Check patients of negroid background before general anaesthetic 6. Sickledex test even if no anaemia
68
When is anaemia not a major concern with dental treatment?
When caused by deficiency
69
When would anaemia be a concern with dental treatment?
If caused by disease such as leukaemia | So more prone to infection, may have low platelets
70
What dental problems can be caused by iron deficiency? (4)
1. Mucosal atrophy 2. Candidiasis 3. Recurrent oral ulcer 4. Dysaesthesia
71
How may a dentist take anaemia that affects platelets into consideration when performing an extraction? (5)
- Warn patient about increased bleeding time - LA helps as vasoconstrictor- initial step of haemostasis done for you (this can wear off and cause a late bleed) - Would only do 1-2 extractions at a time - Post extraction- bite on gauze for 10 mins as normal bleeding time is 2-9 mins - Can suture socket

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