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Haematology > Iron, B12 + folate > Flashcards

Iron, B12 + folate Flashcards

1
Q

Fe deficiency management

A

confirm iron deficiency anaemia
determine cause
treat anaemia
treat underlying

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2
Q

What type of anaemia is Fe deficiency anaemia?

A

microcytic hypochromic
target cells present

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3
Q

What type of anaemia is B12 deficiency anaemia?

A

macrocytic
(megaloblastic)

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4
Q

What type of anaemia is folate deficiency anaemia?

A

macrocytic
(megaloblastic)

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5
Q

Iron deficiency causes

A

Inadequate diet
Increased requirements (pregnancy, growth)
Malabsorption
Blood loss (menstrual, GI, urinary, lung)

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6
Q

When should you do GI investigations in iron deficiency anaemia?

A

all men
all post-menopausal women
symptomatic women (eg. blood in stools)
women >45
FH colon cancer

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7
Q

GI causes of iron deficiency anaemia

A

hookworm infections
oesophago-gastric cancer
coeliac disease
crohn’s disease
gastritis
peptic ulceration
oesophagitis
gastrectomy
NSAID enteritis
meckel’s diverticulum
colon cancer
large polyps
colitis
angiodysplasia
diverticular bleeding
haemorrhoids

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8
Q

Describe iron replacement therapy

A

(continue for 3 months post Hb stabilisation)
oral ferrous sulphate
ferrous gluconate
sodium ironedetate
ferric maltol
avoid slow release preparations

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9
Q

Describe folic acid

A

synthesised by bacteria
green veg, offal
biologically active as polyglutamates
small store
requires B12 for biological activity

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10
Q

Describe vitamin B12

A

synthesised by microorganisms
stable to cooking
large store
essential to folate metabolism

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11
Q

Describe B12 + folate deficiency

A

affects all cells
rapidly dividing cells most vulnerable (bone marrow precursors, gut epithelium)

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12
Q

B12 deficiency symptoms

A

neuropathy
optic atrophy
fatigue
headaches
pallor
(can lead to neural tube defects, stroke and dementia)

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13
Q

Fe deficiency symptoms

A

fatigue
weakness
fast/irregular heartbeat
chest pain
dizziness
restless legs syndrome
failure to thrive in infants
growth retardation in children
pallor
shortness of breath
brittle nails
cold hands + feet

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14
Q

Folate deficiency symptoms

A

paraesthesia
mouth ulcers
tiredness

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15
Q

Investigation + management of megaloblastic anaemia

A

confirm haematological diagnosis:
- blood film
- B12 + folate levels
- consider other macrocytosis causes
- bone marrow

provide replacement therapy
determine underlying cause

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16
Q

Macrocytic anaemia megaloblastic causes

A

B12 deficiency
Folate deficiency
Combined deficiency
Abnormal folate metabolism (methotrexate)
Abnormal DNA synthesis (orotic aciduria, azathioprine, zidovudine)
Myelodysplasia

17
Q

Macrocytic anaemia non-megaloblastic causes

A

(not problem with cell division)
Just macrocytosis
Pregnancy
Liver disease
Alcoholism
Reticulocytosis
Hypothyroidism
Drugs
Marrow infiltration
Sideroblastic anaemia
Cold agglutinins

18
Q

Describe B12 replacement

A

Parenteral hydroxycobalamin
3 monthly replacement
prophylaxis after total gastrectomy or ileal resection
oral replacement if absorption intact (eg. vegans)

19
Q

Describe folate replacement

A

oral folic acid (4 months or continuously)
prophylaxis in pregnancy + preconception (reduce risk of neural tube defects)
prophylaxis for patients with haemolysis or on methotrexate

20
Q

In combined B12 and folate deficiency, which should be replaced first?

A

B12 then folate
initial folate may exacerbate neuropathy

21
Q

Folate deficiency causes

A

Diet (anorexia, children, elderly, alcoholics)

Increased utilisation:
- physiological = pregnancy, growth
- pathological = haemolysis, cancers, inflammation

Malabsorption (diffuse small bowel diseases)

Urinary loss (haemodialysis)

Drugs (phenytoin, primidone, sulfasalazine, methotrexate)

22
Q

B12 deficiency causes

A

Diet (vegan)

Gastric disease (Autoimmune gastritis, major gastrectomy)

Ileal disease (resection, inflammation)

Infections (small bowel bacterial overgrowth, Fish tapeworm)

Pancreatic disease

Transcobalamin-2 deficiency

B12 destruction (nitrous oxide)

23
Q

B12 deficiency investigations

A

dietary history
autoantibodies (anti-parietal cell, anti-intrinsic factor)
B12 absorption tests
small bowel FT + biopsy
gastric biopsy
gastric + pancreatic function tests

24
Q

Folate deficiency investigation

A

dietary history
autoantibodies (anti-gliadin, anti-endomysial)
duodenal biopsy
consider systemic diseases

25
Q

Vitamin B12 function

A

development, myelination, function of CNS
RBC formation, DNA synthesis

26
Q

Folate function

A

RBC formation
cell growth + function
works with B6 + B12 to control elevated blood homocysteine

27
Q

Dietary sources of folate

A

liver
yeast extract
green leafy vegetables
legumes (beans, lentils)
orange juice
fortified cereals

28
Q

Dietary sources of vitamin B12

A

Products of animal origin:
- meat (especially liver)
- poultry
- fish
- milk + dairy products
- eggs

fortified breakfast cereals
fermented foods (eg. sauerkraut)

29
Q

Vulnerable groups for nutritional anaemias

A

Infants + young children (iron)
Vegans (iron + B12)
Pregnant women (iron + folate)
Elderly (iron, folate + B12)
Low income
Ethnic minorities

30
Q

Signs of iron deficiency in infants

A

poor weight gain
frequent infections
developmental delay
behavioural disorders

31
Q

Why is anaemia more common in the elderly?

A

impaired absorption (particularly B12)
dental problems (restricted food choice)
poor quality meals in institutions
lower socioeconomic status
less mobile (restricted shopping)
mental problems (dementia, depression)
lower physical activity requires lower energy intake (less chance of taking in adequate nutrients)

32
Q

Why can serum folate levels be unreliable?

A

a single meal containing folate can rapidly elevate serum folate levels
must do further tests if folate levels are borderline

33
Q

Ferrous sulphate side effects

A

metallic taste
constipation
black, tarry stools

34
Q

Anaemia of chronic disease features

A

Normochromic, normocytic or mildly hypochromic
mild + non-progressive anaemia
serum iron and TIBC reduced
serum ferritin normal/platelets
Transferrin saturation low

Haematology (16 decks)

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