Haem Week 10 Flashcards
(169 cards)
1
Q
Define haematopoiesis
A
Formation of the cellular components of red blood cells
2
Q
Define myelopoiesis
A
Formation of blood cells in the myeloid line (e.g granulocytes, monocytes, erythrocytes and platelets)
3
Q
Define lymphopoiesis
A
Formation of blood cells in the lymphoid cell line (e.g B cells, T cells, NK cells)
4
Q
Outline the haematopoiesis pathway
A
All blood cells are derived from haematopoietic stem cells
This HSCs then differentiate into lymphoid or myeloid lineage by forming common lymphoid or common myeloid progenitor cells
Lymphoid progenitor cells differentiate within the bone marrow (B precursors) and thymus (T precursors, while myeloid progenitor cells on differentiate in the bone marrow only
5
Q
Describe haematopoietic stem cells
A
Precursor cell to blood cells
High self renewal tendency
Located in bone marrow
Pluripotent
Differentiate into progenitor cells
6
Q
Describe progenitor cells
A
Immediate product of HSC differentiation
Located in bone marrow
Limited self-renewal tendency
Differentiate into myeloid or lymphoid cells
Multipotent
7
Q
Where is the site of haematopoiesis in an embryo 0-3mo
A
Yolk sac and then liver
8
Q
Where is the site of haematopoiesis in a foetus 3-7mo
A
Spleen
9
Q
Where is the site of haematopoiesis in a foetus 7-9mo
A
Begins to occur in the bone marrow
10
Q
Where is the site of haematopoiesis from birth to maturity
A
Bone marrow and tibia/femur
11
Q
Where is the site of haematopoiesis in an adult
A
Bone marrow of skull, ribs, sternum
12
Q
Describe primary lymphoid organs
A
Where lymphocytes undergo ontogeny (they are made and develop into mature B and T cells)
13
Q
Describe lymphocytes ontogeny
A
B and T cells make unique B cell receptors (BCRs) and T cell receptors (TCRs)
BCRs and TCRs are tested; cells w receptors that recognise itself are eliminated before further differentiation can occur to prevent autoimmune conditions
Then, mature antigen-responsive lymphocytes are released into circulation
14
Q
Describe secondary lymphoid organs
A
Sites where mature lymphocytes encounter an antigen or differentiate into effector cells
15
Q
What are the primary lymphoid organs
A
Thymus
Bone marrow
16
Q
What are the secondary lymphoid organs
A
Lymph nodes
Spleen
Mucosal-associated lymphoid tissue (MALT)
17
Q
What is the function of the cortex and paracortex of the lymph node structure
A
Cortex contains follicles w B cells
Paracortex contains T cells
Facilitates interactions between immune cells and the initiation of immune response
18
Q
What is the function of follicles in the lymph node structure
A
In cortex of lymph node where B cells proliferate and produce antibodies
19
Q
What is the function of the medulla in the lymph node structure
A
Contains plasma cells that produce antibodies and macrophages that phagocytose pathogens and debris
20
Q
What is the function of sinuses in the lymph node structure
A
Spaces within lymph nodes where lymph circulates and immune cells meet antigens carried by lymph
21
Q
What is the function of afferent vessels in the lymph node structure
A
Bring lymph, along with pathogens and antigens, into the lymph node for filtration and immune response initiation
22
Q
What is the function of efferent vessels in the lymph node structure
A
Carry filtered lymph, including immune cells and antibodies, away from lymph nodes
23
Q
What is the function of trabecula in the lymph node structure
A
Fibrous CT partitions within lymph nodes that provide structural support and contain blood vessels that supply nutrients to lymph node
24
Q
Describe the spleen and its function
A
Responsible for filtering blood-borne antigens
Consists of white pulp for immune responses and red pulp for filtration
T cell area containing dendritic cells which surrounds arterioles as a periarteriolar lymphoid sheath (PALS)
Adjacent to the PALS are follicles in the B cell area
PALS and follicles form a complex that is enveloped by a plexus of veins aka marginal sinus
Marginal zone surrounds marginal sinus
25
What are colony-stimulating factors
CSFs are factors that stimulate certain elements of erythropoiesis, enabling the differentiation of HSCs into monocytes, granulocytes, platelets
26
What are 4 types of CSF
M-CSF
GM-CSF
G-CSF
Thrombopoietin
27
What is the function M-CSF
Stimulates production + differentiation of monocytes and macrophages from HSC
28
What is the function of GM-CSF
Promotes growth + maturation of WBC, including granulocytes and macrophages
29
What is the function of G-CSF
Stimulates production and release of neutrophils from bone marrow
30
What is the function of thrombopoietin
Regulates production + maturation of platelets from megakaryocytes in the bones marrow, maintaining platelet levels in the blood
31
Outline the production pathway of mast cell
HSC
Then, common myeloid progenitor
Then, mast cell
32
What are 4 functions of blood and give a brief description of each
Nutrition - gas exchange, providing oxygen to cells and tissues
Waste removal - regulate homeostasis of pH by removing CO2
Thermoregulation - regulating internal temp of body via vasodilation/constriction
Distribution - of immune cells, cytokines, hormones, immunoglobulins
33
What are 3 major components of blood
Plasma
Buffy coat
Red cells
34
What proportion of blood does plasma comprise
55% of blood volume
35
What proportion of blood does buffy coat comprise
Insignificant proportion of blood volume
36
What proportion of blood does red cells comprise
45% of blood volume
37
Describe the structure of bone marrow
Bony trabeculae - seen as thick pink ‘stripes’ / structure of the bone itself
Active marrow - pink/purple cellular elements of the bone marrow
Dissolved fat - leaves behind gaping white spaces
38
Outline haeme synthesis
Succinyl-CoA and glycine combine to form delta-aminolaevulinic acid (ALA)
Then, ALA is transported into cytoplasm
Then, series of enzymatic reactions in the cytoplasm and mitochondria lead to formation of porphyrin ring, known as porphobilinogen (PBG)
Then, 4 PBG molecules combine to from hydroxymethylbilane (HMB), which is then converted into uroporphyrinogen lll
Then, uroporphyrinogen lll is converted into coproporphyrinogen lll
Then, coproporphyrinogen lll is further modified to form protoporphyrin IX
Then, iron is incorporated into protoporphryin IX to produce haeme
39
Describe the structure of haemoglobin
Tetrameric protein consisting of 4 subunits
These subunits can be divided into 2 alpha-like subunits and 2 beta-like subunits
Each subunit is complexed w a haeme molecule containing iron; the haeme molecule is crucial for binding and transport of O2 in haemoglobin
Iron in the haeme group is capable of binding to O2, allowing haemoglobin to carry and release O2
Haemoglobin’s quaternary structure facilitates cooperative binding and release of O2
40
What are two predominate types of haemoglobin
HbA (adult)
HbF (foetal)
41
Describe HbA
Composed of 2 alpha and 2 beta haemoglobin chains
Present birth onwards
42
Describe HbF
Composed of 2 alpha and 2 gamma haemoglobin chains
Greater affinity to O2 compared to HbA as it allows the foetus to extract O2 from placenta where PO2 is lower
They are present from conception to 6mo-post birth
43
What are 3 key physiological properties of haemoglobin and provide a brief description of each
O2 transport - primary function is to bind to O2 in lungs and release into body tissues
CO2 transport - binds to CO2 aiding in its removal from tissues
Cooperative binding - haemoglobin exhibits cooperativity, meaning that as one subunit binds to oxygen, it increases the affinity of the other subunits for oxygen, hence this enhances oxygen carrying capacity
44
Describe steady state haematopoiesis
Formed elements of blood have high turnover
Due to high turnover of granulocytes, it is estimated that 10^13 myeloid cells are produced per day
Thus bone marrow must have high constant output to maintain normal cell counts
45
Describe stress haematopoiesis
At times of increased demand, output is increased rapidly in the bone marrow
Normal stresses include pregnancy and vigorous exercise/aerobic activity
Abnormal stresses include blood loss and infection
46
Describe haematopoietic growth factors
Glycoproteins that regulate growth, proliferation, differentiation, and function of progenitor cells and blood cells
They act locally or can circulate through bloodstream
Released by T cells, monocytes, and stromal cells
The kidney is a major source of erythropoietin
The liver is a major source of thrombopoietin
47
What four parameters cause a right shift on the oxygen-haemoglobin dissociation curve indicating a decreased affinity for O2
Increased pCO2
Increased H+
Increased temp
Increased 2,3-DPG
48
Describe the structure of the thymus
Small, bi-lobed organ
49
Where is the thymus located
In the anterior mediastinum of the chest, behind the sternum and just above the heart
50
Where is the spleen located
Intraperitoneal in the left upper quadrant of the abdomen, long axis parallel to the 10th rib
51
What is the function of the white pulp in the spleen
Serves as the immune response centre, initiating and coordinating immune reactions against blood-borne pathogens and antigens
52
What is the function of the red pulp
Primarily functions to filter and remove damaged or aged red blood cells from the circulation, as well as to store platelets
53
What is the function of the capsule of the lymph node structure
Outer protective covering of the lymph node
54
What is the function of the subcapsular sinus of the lymph node structure
Drains lymph into the node and filters it
55
Outline the flow of lymph through the lymph node
Lymph enters through the afferent lymphatic vessels, flowing into the subcapsular sinus
Then, lymph flows through the subcapsular sinus where it is filtered
Then, lymph flows into the cortex where B cells in the lymphoid follicles produce antibodies
Then, lymph flows into the paracortex where T cells enable cell mediated immune responses
Then, lymph enters the medulla, where dendritic cells/macrophages process antigens
Then, lymph exists via the efferent lymphatic vessel and returns to circulation
56
The right lymphatic duct collects lymph from…
Upper right side of the body
57
The thoracic duct collects lymph from…
The rest of the body (so everywhere except the upper right side of the body as this is where the right lymphatic duct collects from)
58
The thoracic duct empties into…
The left subclavian vein
59
In the occipital area, what lymph nodes are there (deep and/or superficial)
Superficial - occipital nodes
60
What structures in the occipital area drain into the occipital nodes
Scalp
Posterior neck
61
What lymph nodes are there in the auricular area (superficial and/or deep)
Superficial - Pre-auricular, Post-auricular, Parotid nodes
62
What structures drain lymph into the auricular area
External ear
Temple
Cheek
63
What lymph nodes exist in the cervical area (superficial and/or deep)
Superficial - anterior cervical, posterior cervical, supraclavicular nodes
Deep - deep cervical nodes
64
What structures drain lymph into the cervical area
Head and neck
Superficial structures
65
What lymph nodes exist in the axillary area (superficial and/or deep)
Superficial - pectoral, subscapular, humeral nodes
Deep - central axillary nodes
66
What structures drain lymph into the axillary area
Upper limb
Breast
Superficial thorax
67
What lymph nodes exist in the mediastinal area (superficial and/or deep)
Deep - tracheobroncial, paratracheal nodes
68
What structures drain lymph into the mediastinal area
Lungs
Bronchi
Oesophagus
69
What lymph nodes exist in the inguinal area (superficial and/or deep)
Superficial - superficial inguinal nodes
Deep - deep inguinal nodes
70
What structures drain lymph into the inguinal area
Lower limb
External genitalia
Lower abdominal wall
71
What lymph nodes exist in the coeliac region (superficial and/or deep)
Deep - coeliac nodes
72
What structures drain lymph into the coeliac area
Stomach
Liver
Pancreas
Spleen
Upper duodenum
73
What lymph nodes exist in the external iliac area (superficial and/or deep)
Superficial - superficial external iliac nodes
Deep - deep external iliac nodes
74
What structures drain lymph into the external iliac area
Lower abdominal wall
Perineum
External genitalia
75
What lymph nodes exist in the common iliac area (superficial and/or deep)
Deep - common iliac nodes
76
What structures drain lymph into the common iliac area
Pelvic viscera
Upper thigh
77
What lymph nodes exist in the popliteal area (superficial and/or deep)
Superficial - popliteal nodes
Deep - deep popliteal nodes
78
What structures drain lymph into the popliteal area
Foot
Calf
Posterior knee
79
Generally speaking, which groups of lymph nodes does the head/neck drain into
Occipital, auricular, cervical
80
Generally speaking, which groups of lymph nodes do the upper limbs drain into
Axillary
81
Generally speaking, which groups of lymph nodes does the thorax drain into
Axillary, mediastinal
82
Generally speaking, which groups of lymph nodes does the abdomen drain into
Coeliac, superior mesenteric, inferior mesenteric
83
Generally speaking, which groups of lymph nodes does the pelvis drain into
External iliac and common iliac
84
Generally speaking, which groups of lymph nodes do the lower limbs drain into
Popliteal
85
Describe Fe3+
Obtained from plant products
High solubility
Low O2 affinity
86
Describe Fe2+
Obtained from animal products
Low solubility
High O2 affinity
87
What is DMNT-1
A transporter protein that converts Fe3+ into Fe2+ as Fe3+ has a lower binding affinity to O2
88
What is ferroportin
Transporter protein that enables Fe2+ to travel from enterocytes into the bloodstream
89
What is transferrin
Transporter protein that oxidises iron to the ferric state of Fe3+ thus enabling higher solubility in the blood
When the body needs more iron, like during periods of increased demand or when iron stores are low, the liver produces more transferrin to carry additional iron
90
What is hepcidin
Regulatory protein that is produced by the liver, but actively degrades ferroportin (thus entrapping iron in the enterocytes and preventing uptake into the bloodstream)
91
Outline the iron metabolism pathway
Fe2+ from animal products and Fe3+ from plant products are both converted into Fe2+ by DNMT-1
Then, the Fe2+ is transported from the enterocytes into the bloodstream using ferroportin
Then, transferrin oxides iron into Fe3+ for increased solubility in the blood
92
How does hypoxia affect iron absorption
Increased DNMT-1 leads to decreased hepcidin, which then leads to increased absorption of iron
93
How does increased EPO affect iron absorption
Decreased hepcidin leads to increased release of iron into bloodstream
94
How does inflammation affect iron absorption
Increased hepcidin which leads to decreased release of iron into bloodstream
95
How does haemochromatosis affect iron absorption
Decreased hepcidin, which leads to increased release of iron into bloodstream
96
What is the role of ferritin
It is a globular protein that is common to most living organisms
Its primary role is iron storage (one ferritin molecule carries 4500 elemental units of iron)
Patients w a functional iron deficiency may have high levels of ferritin (this may be due to action of hepcidin)
97
What is apo-ferritin
Empty ferritin
Circulates blood as a key player in acute inflammatory responses
Apo-ferritin levels indicate the amount of full ferritin, which can provide an insight into the demand for ferritin and thus iron
98
What is the role of transferrin
Primary function is to transport iron from the sites of absorption (mainly small intestine) and storage (mainly liver and spleen) to the cells that require iron for various metabolic processes
It helps maintain iron homeostasis by controlling the amount of iron available for cells to use
99
what is the diagnostic anaemic Hb value for males
<130 g/L
100
what is the diagnostic anaemic Hb value for females
<120 g/L
101
what is the diagnostic anaemic Hb value for pregnant females
<110 g/L
102
what is the MCV for macrocytic anaemia
>100 fL/cell
103
what are 3 causes of macrocytic anaemia
B12 deficiency
folate deficiency
alcoholic liver disease
104
what is the MCV for normocytic anaemia
80-100 fL/cell
105
what are 3 causes of normocytic anaemia
renal failure
anaemia of chronic disease
leukaemia
106
what is the MCV for microcytic anaemia
<80 fL/cell
107
what are 2 causes of microcytic anaemia
iron deficiency
anaemia of chronic disease
108
what does mean cell volume (MCV) mean
average size or volume of a RBC
109
what does mean cell haemoglobin (MCH) mean
average amount of Hb in a red cell
110
what does mean corpuscular haemoglobin concentration (MCHC) mean
amount of Hb per unit volume in a red cell
111
what is thalassaemia
reduction or absence of synthesis of a globin chain resulting in an imbalance of alpha and beta globin chains
112
what are haemoglobinopathies
mutations in the Hb genes resulting in changes in the normal amino acid sequence of a globin chain, resulting in an abnormal structure
113
what is alpha+ thalassaemia
reduced or partial production of alpha globin chains
114
what is alpha-0 thalassaemia
absence of production of alpha globin chains
115
what is beta+ thalassaemia
reduced or partial production of beta goblin chains
116
what is beta-0 thalassaemia
absence of production of beta globin chains
117
outline the pathogenesis of anaemia due to thalassaemia
absence of beta globin chains or reduction of beta globin chains leads to excess of alpha globin chains
then, absence of B-globin leads to precipitation in erythroid precursors within bone marrow which results in ineffective erythropoiesis / reduction of B-globin leads to membrane damage to peripheral RBCs which results in hemolysis
then, this results in anaemia
118
what are 4 clinical symptoms associated with thalassaemia
pallor - anaemia and reduced O2 supply
jaundice - due to breakdown of RBC
splenomegaly - resulting from spleen's increased workload filtering abnormal RBC
dyspnea - due to reduced O2 carrying capacity in blood
119
outline the consequence of genetic alterations as a result of alpha and beta thalassaemia on RBCs
both alpha and beta types results in genetic alterations that affect the production of alpha and beta globin chains of Hb, leading to abnormal Hb molecules
this can cause structural changes in RBC, making them fragile and prone to hemolysis
this leads to anaemia, as RBC have shorter lifespan and reduced O2 carrying capacity
120
what is thalassaemia minor
when an individual carries one normal and one mutated gene
121
what is thalassaemia major
when an individual inherits two mutated genes
122
what are 6 consequences of iron overload in beta thalassaemia major and provide a brief description of each
cardiac complications - Fe overload in heart > cardiomyopathy and HF which can be life-threatening
liver damage - Fe deposits in liver > liver fibrosis > cirrhosis > impaired liver fn
endocrine disorders - disrupt hormone regulation > growth and puberty delays, diabetes, thyroid dysfunction
bone marrow suppression - Fe accumulation in bone marrow can interfere w RBC production, exacerbating anaemia
weakened immune system - Fe excess impair immune system fn which increases susceptibility to infections
skin discolouration - bronze or slate-grey hue due to Fe deposits
123
what are 5 causes of iron deficiency anaemia
chronic blood loss
diet
malabsorption
increased iron demand
impaired iron recycling
124
outline the pathophysiology of lack of dietary Fe leading to iron deficient anaemia
lack of dietary Fe
leads to, depleted Fe reserves in the body
leads to, reduced Fe absorption
leads to, Fe deficiency anaemia
125
outline the pathophysiology of chronic blood loss leading to iron deficient anaemia
chronic blood loss
leads to, Fe removal without replenishment
leads to, depleted Fe reserves in the body
leads to, reduced Fe absorption
leads to, Fe deficiency anaemia
126
outline the pathophysiology of increased Fe demand leading to iron deficient anaemia
increase in Fe demand
leads to, Fe removal without replenishment
leads to, depleted Fe reserves in the body
leads to, reduced Fe absorption
lead to, Fe deficiency anaemia
127
outline the pathophysiology of malabsorption/absorption pathologies leading to iron deficient anaemia
absorption pathology e.g coeliac disease
leads to, reduced Fe absorption
leads to, Fe deficiency anaemia
128
outline the pathophysiology of impaired Fe recycling leading to iron deficient anaemia
impaired Fe recycling
leads to, Fe removal without replenishment
leads to, depleted Fe reserves in the body
leads to, reduced Fe absorption
leads to, Fe deficiency anaemia
129
outline the pathophysiology of inflammation causing anaemia
inflammation
leads to, release of cytokines
leads to, increased activity of hepcidin
leads to, inhibited release of recycled iron from macrophages causing functional iron deficiency, thus creating erythroid hypoproliferation
leads to, reduced EPO production
leads to, increased production of myeloid lineage cells
leads to, increased myeloid cells and decreased erythrocytes (due to TNFa inhibiting erythropoiesis and activating macrophages for erythrophagocytosis)
130
what percentage of the global population is anaemic
24.8%
131
what is the highest prevalence of anaemia
pre-school aged children - 47.4%
132
what is the most common cause of anaemia in the world
iron deficiency, comprising ~50% of all cases
133
what are 6 risk factors for anaemia
malnutrition
comorbidities
GI disorders
menstruation
pregnancy
surgery/trauma
134
Describe the role of vitamin B12 in erythropoiesis and what a deficiency can potentially lead to
Plays a role in DNA synthesis, maturation of RBC and health of nerve tissues
A deficiency can result in megaloblastic anaemia and neurological complications, affecting the nerves that control muscle mvmt
135
Where is vitamin b12 found mainly
Primarily in animal-based foods such as meat, fish, dairy products and eggs
It is not naturally present in plant based food which makes it essential for vegetarians and vegans to obtain b12 from fortified food or supplements
136
Describe the role of folate in erythropoiesis and what a deficiency can potentially lead to
Aka vitamin b9 is crucial for DNA synthesis, rapid cell division, and production of RBC
A deficiency can lead to megaloblastic anaemia characterized by large immature RBCs
137
What kind of food sources can folate be obtained from
Variety of foods including leafy greens, legumes, citrus fruits, fortified cereals
Also available in supplement form and is a key nutrient for pregnant women to prevent neural tube defects in foetus
138
Outline the pathogenesis of macrocytic anaemia
Folate deficiency leads to impaired DNA synthesis / B12 deficiency leads to reduced conversion of m-CoA to s-CoA
Leads to, formation of macrocytic cells
Leads to, low Hb concentration
Leads to, macrocytic anaemia
139
What are two megaloblastic causes of macrocytic anaemia
B12 deficiency
Folate deficiency
140
What are 4 non-megaloblastic causes of macrocytic anaemia
Alcohol
Reticulocytosis
Liver disease
Hypothyroidism
141
What is haemolytic anaemia
Anaemia due to premature destruction of RBCs
The reticuloendothelial system (spleen and liver) is operating in overdrive which enables and increased volume of haemolysis
Leads to release of LDH which is a useful measure when diagnosing haemolytic anaemia
142
What does intrinsic haemolytic anaemia mean
Haemolytic anaemia occurring due to abnormalities within the RBCs themselves
143
What does extrinsic haemolytic anaemia mean
Haemolytic anaemia occurring due to abnormalities outside of RBCs
144
What are 2 intrinsic causes of haemolytic anaemia
Thalassaemia
G6PD deficiency
145
What are 3 extrinsic causes of haemolytic anaemia
Stress from mechanical valves
Thrombotic state
Infectious agent
146
Outline the pathophysiology behind stress from mechanical valves causing haemolytic anaemia
Shear force exerted upon RBCs by valves
Leads to, haemolysis
Leads to, decreased RBC count
Leads to, haemolytic anaemia
147
Outline the pathophysiology behind a thrombotic state causing haemolytic anaemia
Shear force exerted upon RBCs by thrombotic state
Leads to, haemolysis
Leads to, decreased RBC count
Leads to, haemolytic anaemia
148
Outline the pathophysiology behind an infectious agent causing haemolytic anaemia
Agent invades RBCs
Leads to, haemolysis
Leads to, decreased RBC count
Leads to, haemolytic anaemia
149
Outline the pathophysiology behind thalassaemia causing haemolytic anaemia
Impaired Hb content
Leads to, haemolysis
Leads to, decreased RBC count
Leads to, haemolytic anaemia
150
Outline the pathophysiology behind G6PD deficiency causing haemolytic anaemia
Exposure to trigger
Leads to, haemolysis
Leads to, RBC count decrease
Leads to, haemolytic anaemia
151
What is intravascular haemolytic anaemia
Haemolysis occurring within the vasculature ie within the bloodstream
152
What is extravascular haemolytic anaemia
Haemolysis occurring outside of the vasculature ie in the reticuloendothelial system
153
Describe sickle cell disease
Caused by specific mutation in the HBB gene, which encodes the beta-globin subunit of Hb
In this mutation, a single base pair change results in the substitution of glutamic acid w valine at position 6 of the beta-globin chain
Inherited in an autosomal recessive manner
Mutation leads to production of abnormal Hb variant call haemoglobin S (HbS) > can polymerise and cause RBC to deformation in characteristic sickle shape, leading to vasoocclusive events and other complications
154
What are 5 physiological consequences of sickle cell disease and provide a brief description of each
Hb structure - abnormal HbS formed due to substitution of valine for glutamic acid W
RBC morphology - HbS polymerisation causes RBC to become rigid and have sickle shape
O2 transport - sickle cells have reduced flexibility and difficulty passing through small vessels therefore impairs O2 delivery to tissues
Haemolysis - sickle cells have shorter lifespan so they are more prone to rupture
Blood viscosity - increase blood viscosity due to sickle cells
155
What are 8 signs and symptoms of anaemia and link them to the underlying pathological process
Fatigue - reduced O2 carrying capacity
Pallor - decreased Hb levels, and hence less O2
Dyspnoea - heart has to work harder resulting in rapid or laboured breathing
Weakness - insufficient O2 to muscles and tissues
Tachycardia - HR increase as compensatory
Jaundice - haemolysis leads to release of bilirubin
Splenomegaly - spleen may enlarge to compensate for anaemia by produce more RBC or filet abnormal ones
Glossitis - inflammation of tongue’s mucous membrane can occur
156
What are 5 investigations that can be done for the diagnosis of anaemia and link it to the aetiology
CBE - classify micro/macro/normocytic
Iron studies - low serum iron or ferritin suggests iron deficiency anaemia
B12/folate - low levels of B12 or folate may indicate megaloblastic anaemia
LDH - high LDH may suggest haemolytic anaemia due to various causes, including hereditary or acquired conditions
Hb electrophoresis - helps diagnose + differentiate types of haemoglobinopathies such as sickle cell disease or thalassaemia
157
What are 5 management options for anaemia
Diet control
Oral iron
IV iron therapy
B12/folate
Blood transfusion
158
What is one indication and one contraindication for use of diet control as a management option for Rx of anaemia
Indication = demonstrated deficiency
Contraindication = non-iron deficient anaemia
159
What is one indication and one contraindication for the use of oral iron as a management option for Rx of anaemia
Indication = severe iron deficiency
Contraindication = malabsorption-based iron deficiency
160
What is one indication and one contraindication for the use of IV iron therapy as a management option for the Rx of anaemia
Indication = unable to receive transfusions
Contraindications = hypersensitivity prone individuals
161
What is one indication and one contraindication for the use of B12/folate as a management option for Rx of anaemia
Indication = demonstrated deficiency
Contraindication = other unrelated causes
162
What is one indication and one contraindication of using blood transfusions as a management option for Rx of anaemia
Indications = anaemia w acute threat
Contraindication = Jehovah’s Witness
163
Describe the recommended follow-up for a Pt w anaemia
Dependent on underlying cause and severity of the anaemia
Frequency of blood tests needed can vary greatly b/w causes and should be assessed on a case-by-case basis
In anaemia due to acute leukaemia, bloods may be needed multiple times per day; in iron-deficient anaemia, every 4 months may be sufficient
164
What are 4 periods in ones lifetime where iron demands increase (vulnerable stages of life to iron dependency)
Infancy - rapid growth and development
Adolescence - growth spurt and increased physical activity
Pregnancy - support growing foetus
Menstruation - monthly blood loss
165
What are 6 food sources of dietary iron
Red meat
Seafood
Fortified cereals
Poultry
Legumes
Dark leafy greens
166
What are 6 factors that affect the bioavailability of iron in different food sources
Fe2+ vs Fe3+ - haeme iron (animal based) more readily absorbed compared to non-haeme iron (plant based)
Vitamin C - enhances the absorption of non-haeme iron
Calcium - inhibit absorption of both haeme and non-haeme iron
Tannins - in tea and coffee > can interfere with iron absorption
GI disorders - e.g coeliac disease and inflammatory bowel disease can affect iron absorption
Cooking method - cooking in iron cookware can increase iron content of food; overcooking can reduce iron content
167
Outline the concept of food pairing to maximise iron absorption
Involves combining foods in a way that enhances the body’s ability to absorb non-haeme iron
Strategies to improve iron absorption include the use of vitamin C and iron cookware, in the absence of calcium and tea/coffee
168
What are 2 causes of B12 deficiency
Nutritional e.g veganism
Malabsorption e.g pernicious anaemia, gastrectomy
169
What are 4 causes of folate deficiency
Nutritional e.g poverty, famine
Malabsorption e.g gluten induced enteropathy
Excess utilisation e.g pregnancy, cancer
Drugs e.g anticonvulsants
