Haem Physio and anaemia

Question 1

What is Haemotopiesis?

Answer 1

production of mature blood cells from precursor stem cells.

Question 2

Primary site of haematoiesis?

Answer 2

is red bone marrow

Question 3

What are red bone marrow replaced with as we age?

Answer 3

replaced with yellow marrow

Question 4

What are common 2 types of precursors from stem cells?

Answer 4

Common myeloid precursor.

Common lymphoid precursor

Question 5

what is the main stimulant of erythropoiesis ?

Answer 5

hypoxia

Question 6

Why is iron essential?

Answer 6

contributes to oxygen and electron transport

Question 7

Why is Fe2+ needed rather Fe3+ ?

Answer 7

Fe2+ will be able to carry out the needed function rather than Fe3+ (commonly converted from 2+ –> 3+ during inflammation / oxidative stress).

Question 8

Where is Iron commonly absorbed?

Answer 8

Jejunum / duodenum

Question 9

What is Hepcidin?

Answer 9

Liver produced protein that controls iron absorption via down regulating ferroportin in response to iron load + inflammation.

Question 10

What transport iron?

Answer 10

transferrin

Question 11

what is iron stored in the body?

Answer 11

Macrophages
bone marrow
liver - > largest parenchymal store
Hb –> largest total store

Question 12

what is used to assess the level of iron present in body?

Answer 12

ferritin

Question 13

What are the causes of iron overload?

Answer 13

Haemochromatosis
Thalassemia
long-term transfusions
sideroblastic anaemia

Question 14

Define Anaemia?

Answer 14

insurfficiencent amount of RBC / Hb

Question 15

What are the causes of microcytic hyochromatic anaemia?

Answer 15

reduced Hb production

Question 16

Causes of LOW level of iron?

Answer 16

Chronic blood loss: Menorriagia, GI bleeds  usually lower.
Malabsorption: coeliac disease, post gastrectomy.
Poor dietary intake: vegan or vegetarian.
Infection: hookwork  most common cause worldwide.

Question 17

Iron studies in patient with iron deficiency?

Answer 17

low iron, ferritin, transferrin saturation

Question 18

What does TIBC during low iron levels?

Answer 18

TIBC tries to compensate for low stores by increasing transferrin + therefore the iron carrying capacity of blood.

Question 19

Management for iron deficiency ?

Answer 19

screen for coeliac 
iron supplements (Ferrous Sulphate or fumerate)

Question 20

if iron therapy not working, consider…

Answer 20

Poor compliance.
Wrong diagnosis.
Continued activity of underlying cause

Question 21

What is macrocytic anaemia?

Answer 21

Cell become large due to defective nuclear maturation + DNA synthesis during haematopoesis.

Question 22

Causes of macrocytosis?

Answer 22

Megaloblastic macrocytic anemia.
Non megaloblastic macrocytosis +/- anemia.
Others: reticulocytosis, cold agglutinins.

Question 23

What are the causes of B12 deficiency ?

Answer 23

Dietary
Pernicious anaemia
Gastrectomy 
PPI
Bacterial overgrowth 
Coeliac disease 
Bowel resection 
Chronic pancreatitis

Question 24

What are causes of folate deficiency ?

Answer 24

Low intake (poverty) 
Coeliac disease 
Tropical sprue 
Increased demand (pregnancy, malignancy, haemolytic anaemia) 
Drugs (immunosuppressants, alcohol).

Question 25

Investigations for B12 / Folate ?

Answer 25

Serum: low B12 / folate.
FBC: low Hb, high MCV, reticulocytes.
Bone barrow biopsy: megaloblasts.
Immunology: anti gastric parietal cells, anti intrinsic factor.
Film: howel jolly bodies, hypersegmented neutrophils.