anaemia and nutrition Flashcards by Wynter Dragone

(Macrocytic normochromic anaemia)
Macrocytic or megaloblastic refers to

unusually large stem cells in the bone marrow (referred to as megaloblasts)

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macrocytes refers to unusually ??? erythrocytes (Macrocytic normochromic anaemia)

unusually large

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Macrocytic normochromic anaemia: Hb content is normal (i.e. concentration is normal, but actual amount of Hb is ???)

high

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Deficiency of folate or vitamin B12 inhibits ??? and ??? synthesis, impairs DNA synthesis, and causes erythroblast apoptosis, = anaemia from ineffective erythropoiesis

purine and
thymidylate synthesis

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TRUE or FALSE: if folate or B12 deficient, cells are able to divide normally to become RBCs

FALSE: they cannot divide when deficient

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pernicious anaemia is from a deficiency in ??? causing impaired erythropoiesis & oxygen transport and in demyelination of peripheral nerves

Vit B12

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most common cause of B12 deficiency in pernicious anaemia is from ??? due to lack of intrinsic factor (or intrinsic factor antibodies or parietal cells antibodies) or lack of stomach acid

malabsoprtion

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TRUE or FALSE: vitamin B12 activates folate

TRUE

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Blood composition: PLAMSA (55%)
–> ??? (90%)
–> protein (8%)
–> other small molecular substances (2%)

Water

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Blood Composition: BUFFY COAT (<1%)
–> ???
(important in immunity and inflammation)
–> Platelets
(involved in blood clotting)

White Blood Cells (leukocytes)

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Red Blood Cells (erythrocytes) ???%

45%

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TRUE or FALSE: RBCs when mature have no nuclei

TRUE

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TRUE or FALSE: Most blood cells do not divide but are renewed by division of cells in the bone marrow

TRUE

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Low ??? stimulates kidneys to produce EPO which kickstarts RBC synthesis (erythropoiesis) in bone marrow

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how many days do erythrocytes circulate for?

120

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the main function of RBCs is to carry oxygen via Hb, but they also carry ??? and ???

CO2 and H+

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anaemia can be a reduction in number of RBCs, or a decrease in ??? or ??? of RBCs

quantity or quality

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Which is NOT a symptom of anaemia:
- shortness of breath
- fainting and fatigue
- change in stool colour
- change in urine colour
- angina and heart attack
- spleen enlargement
- muscle pain
- skin yellowing

change in urine colour

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anaemia related fatigue is due to reduced levels

reduced O2 levels

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Shortness of breath, chest pain, arrhythmia, low blood pressure are from ==> ??? and lower viscosity of the blood = body has to work
harder to deliver the oxygen

hypoxia

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yellow skin in anaemia is caused by ???

reduced O2 delivery

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cold sensitivity in anaemia is from competing demands for tissue oxygenation vs decreased ??? to minimise heat losses to the environment

decreased blood flow

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tachycardia and increase in ??? removed from Hb in tissues are the body compensating for anaemia to get oxygen effectively to the tissues the body

increase in O2% removed from Hb in tissues

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to cope with anaemia related hypoxia, the body will cause ??? (= heart problems) and increase rate and depth of breathing

vessel dilation

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anaemia: blood loss --> lowers blood volume --> fluid moves from ??? to blood vessels --> dilutes the blood (lowers viscosity) --> blood flows faster (increases turbulent) --> causing ventricular dysfunction & cardiac dilation

fluid moves from interstitium to blood vessels

hypoxia occurs because ???

not enough RBCs to carry enough oxygen around body

hypoxia --> arterioles, capillaries & venules ??? --> further increasing blood flow --> more heart problems

dilate

sever anaemia presents with symptoms of: ??? (shortness of breath), tachycardia, Dizziness, Fatigue, Pallor even at rest or not?

Dyspnoea... yes, even at rest

what causes anaemia? 1. blood loss 2. ??? erythrocyte production 3. ??? erythrocyte destruction

1. blood loss 2. impaired erythrocyte production 3. increased erythrocyte destruction

TRUE or FALSE: In nutrition related anaemias, we do not have hyperchromic anaemias

TRUE

PCV (???) Also known as haematocrit. Refers to the % of whole blood comprised of RBCs

Packed Cell Volume

MCV (???) Mean (average) volume of the RBC Unit is femtolitre (fL)

mean cell volume

a normal MCV lies within the range 77fL - ??? fL

95 fL

MCH (???) haemoglobin amount per RBC (pg)

mean cell haemoglobin

MCHC (???) – haemoglobin concentration per litre of blood (g/L)

mean cell haemoglobin concentration

RCDW: Normal red blood cells have a normal distribution of cell size whereas macrocytic and microcytic anaemias have an ??? in the red cell distribution width

increase

poikilocytosis = abnormal variation in size or shape?

shape

anisocytosis = abnormal variation in size or shape?

size

TRUE or FALSE: Red cells show mild degree of anisocytosis (slightly uneven size) and poikilocytosis (uneven shape).

TRUE they are mostly uniform

Is Normocytic normochromic anaemia related to food?

is Microcytic hypochromic anaemia related to food? (i.e. Sideroblastic anaemia & Thalassemia)

TRUE or FALSE: megaloblastic anaemia causes basophilic normoblasts to be unable to divide further due to being unable to replicate DNA

TRUE

TRUE or FALSE: Irone deficiency anaemia causes polychromatophilic normoblasts to be unable to develop further

TRUE

plasma folate enters cell and converted to tetrahydrofolate with the help of ???

Vitamin B12

reasons for malabsorption of vit B12, which is odd one out: * Gastric atrophy & achlorhydria (over 70’s) * Atrophic gastritis esp elderly * Stomach surgery, e.g. partial or full gastrectomy * Resection of ileum * Disorders that involve the ileum, e.g. Crohn’s diseases * Poor dietary intake, esp strict vegan diets * pregnancy

pregnancy is incorrect

single most important diagnostic test for pernicious anaemia is:

low serum vitamin B12

pernicious anemia is characterised by what type of RBCs?

megaloblastic

pernicious anaemia tests for ??? include: – Schilling test (used to be used) – Intrinsic factor antibody assay – Parietal cell antibody assay

inability to absorb vitamin B12

schilling test: take radioactive vitamin ??? and a dose of nonradioactive vitamin by ??? to impede uptake of the absorbed radioactive dose by the liver. Proportion of the radioactive dose absorbed is determined by measuring urine radioactivity

orally by injection

pernicious anaemia treatment is long term or short term?

long term treatment

pernicious anaemia treatment includes: Intra??? or intravenous injections of vitamin B12 ASLO: Adequate dietary intake esp in those without IF deficiency

intramuscular

TRUE or FALSE: oral megadoses of vit B12 does work for treatment of pernicious anaemia

FALSE: NO it does not

adequate B12 intake is: Estimated 2 ug per day recommended ??? ug per day

2.4 ug per day

Folate deficiency (megaloblastic anaemia) is a Macrocytic normochromic anaemia similar to vitamin B12 deficiency BUT there are no ??? abnormalities when symptomatic

neurological abnormalities

TRUE or FALSE: megaloblastic anaemia (folate deficiency) is caused by poor diet with inadequate dietary folate

TRUE

secondary folate deficiency is caused by ??? … as it is a cofactor for the enzyme… ??? Folate deficiency results in slow DNA synthesis and erythrocytes cannot divide

B12 deficiency as it is a cofactor for the enzyme methionine synthase which plays a role in DNA synthesis

diagnostic measures of folate deficiency: 1. serum folate 2. ???

RBC folate

TRUE or FALSE: Serum folate can become low after 3 weeks of poor dietary intake but IS NOT Influenced by recent dietary intake, or blood transfusion or alcohol

FALSE. It IS influenced by recent dietary intake etc

RBC folate shows the index of tissue folate stores and can become high or low after 3-4 months of folate deficiency?

low

which one is missing: Who is at risk of Folate deficiency? * Economically deprived people * ??? * Alcoholics * The elderly * Malabsorption * Some types chemo (anti-folate) * Vitamin B12 deficiency (secondary folate deficiency)

Pregnant women

folate deficiency treatment: Prophylactic to Increase dietary intake (200-300ug) folate daily in ??? * Active treatment * Folate supplementation 1000mg daily for 1-4 months Long term: ???

pregnant women long term: Ensure adequate dietary intake of folate

adequate folate intake: estimated: 320 ug/d recommended: ??? ug/d

400 ug

Marked increase in serum lactate dehydrogenase released from increased destruction of macrocytes indicates pernicious anaemia or megaloblastic anaemia?

megaloblastic anaemia

Microcytic hypochromic anaemia: Abnormally small or large (?) erythrocytes with reduced amount and concentration of Hb

small

what is the most common anaemia worldwide?

irone deficiency anaemia

iron deficiency anaemia is sefined as a progressive loss of iron stores from haemosiderin and ???

ferritin

TRUE or FALSE: coeliac disease can cause iron deficiency anaemia

TRUE

TRUE or FALSE: two types of iron in the diet, haem iron and nonhaem iron which utilise same pathways of absorption

False: two separate pathways

Serum Ferritin – iron + apoferritin = protein shell packed with iron molecules and stored ??? in cells (usually >12ug/L)

intracellularly

Haemosiderin – insoluble aggregation of ferritin molecules that are stored in the ???

tissues

Transferrin saturation – index of how much iron is bound to ??? (usually 30% saturation, <15% saturation iron deficiency is likely)

transferrin

Total Iron Binding Capacity – indirect measure of ??? saturation (usually < 1umol/L of red blood cells)

transferrin

What would you expect to see in iron deficiency anaemia? Low: ???

* Hb * Serum iron * Ferritin * Transferrin saturation

What would you expect to see in iron deficiency anaemia? High ???

Transferrin

Inadequate dietary iron leads to low serum levels and ??? of ferritin stores

depletion

TRUE or FALSE: Transferrin SATURATION low because spare spaces on the molecule for iron i.e. not saturated

TRUE

Transferrin high because liver has produced more to maximise available ???

ron

Stage 1 of iron defic. anaemia: body's iron stores are depleted, Serum ferritin < ???ug/L

less than 12ug/L

stage 2 of iron defic. anaemia: Insufficient iron is transported to the ??? & iron deficient erythropoiesis begins

marrow

stage 3 of iron defic. anaemia: no iron stores, diminished production of ??? (low Hb – microcytic anaemia – low serum iron & low stainable iron seen in bone marrow)

Clinical manifestation of iorn deficient anaemia: usually don’t notice until Hb

70-80g/L

* fatigue, weakness, shortness of breath * brittle nails * pale ear lobes, eyelids & palms are all signs of which type of anaemia?

iron deficiency anaemia

can evaluate iron deficient anaemia through: - bone marrow biopsy - indirectly through serum ???transferrin, transferrin saturation, or total iron binding capacity

serum ferritin

an indicator for haeme synthesis = amount of free erythrocyte protoporphyrin in erythrocytes in which type of anaemia?

iron deficiency anaemia

adequate dietary intake of iron: estimated: 6-8mg/d recommended: 8-???mg/d

18mg/d

anaemia and nutrition Flashcards

(85 cards)