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Haematology > Iron, B12, folate deficiency > Flashcards

Iron, B12, folate deficiency Flashcards

1
Q

What are the general symptoms of anaemia?

A

Fatigue, dizziness, headache, SoB, palpitations, angina, pallor, intermittent claudication, tachycardia, flow murmur, congestive cardiac failure

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2
Q

What are symptoms of anaemia that are more specific for iron deficiency?

A

Glossitis, koilonychia, angular stomatitis, alopecia, picca (e.g. ice)

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3
Q

What are the broad causes for iron deficiency anaemia?

A

Reduced intake, reduced absorption, blood loss, increased iron requirement

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4
Q

What abnormality is suspicious in a man or post menopausal woman?

A

Iron deficiency anaemia, suspicious of chronic GI bleed

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5
Q

At what level will symptoms be present in iron deficiency anaemia?

A

<8g/dL

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6
Q

What are the investigation findings in iron deficiency anaemia?

A 
Microcytic, hypochromic anaemia
Reduced serum iron and ferritin
Increased serum transferrin and TIBC
Reduced plasma transferrin saturation
Absence of iron stores on bone marrow smear
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7
Q

How should iron deficiency be treated?

A

Treat underlying
Ferrous sulphate for 4-6 months
Parenteral Fe if absorption is the issue

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8
Q

What are the side effects of iron treatment?

A

Diarrhoea, constipation, dark faeces

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9
Q

Who does anaemia of chronic disease commonly affect?

A

Elderly and hospital inpatients

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10
Q

What is the pathogenesis of anaemia of chronic disease?

A

Activated macrophages are erythropagocytic and secrete cytokines e.g. TNF
Activation of macrophages leads to decreased erythropoiesis and RBC lifespan

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11
Q

What are the FBC findings for anaemia of chronic disease?

A

Can be normocytic, microcytic

Normochromic, hypochromic in a third

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12
Q

How can you differentiate Fe deficiency and anaemia of chronic disease?

A

If MCV is very low (<70) Fe is more likely
Fe: low serum Fe, low ferritin, high/normal transferrin, high expression transferrin receptors
Chronic disease: low serum Fe, high/normal ferritin, low/normal transferrin, low/normal transferrin receptor expression

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13
Q

Apart from Fe deficiency and anaemia of chronic disease what are other causes of microcytic anaemia?

A

Sideroblastic anaemia
Thalassaemia
Lead poisoning

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14
Q

What is sideroblastic anaemia?

A

Refractory anaemia, increased bone marrow iron

Presence of ringed sideroblasts, which are red-cell precursors containing iron granules surrounding the nucleus

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15
Q

Why does lead poisoning cause anaemia? What are the other symptoms?

A

Inhibits haem and globin synthesis

Abdominal pain and neuropathies

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16
Q

What is B12 composed of?

A

Cobalamin bound to methyl or adenosyl group

17
Q

How is B12 transported and absorbed?

A

Intrinsic factor secreted by gastric parietal cells binds to B12 to prevent HCl degradation
Absorption occurs in the terminal ileum
Transported by plasma protein transcobalamin II

18
Q

Where is B12 stored? How long does it take to become deficient?

A

In the liver

Approx 2 years

19
Q

What are the causes of B12 deficiency?

A

Diet (e.g. vegan), low IF (pernicious, gastrectomy, congenital), malabsorption (Crohn’s), blind loop/diverticulae of small bowel (breed bacteria that uses vitamin B12)

20
Q

What is pernicious anaemia also known as?

A

Autoimmune chronic atrophic gastritis

21
Q

What causes pernicious anaemia?

A

Auto antibodies against gastric parietal cells in serum and gastric juice

22
Q

What clinical feature accompanies pernicious anaemia as a result of destruction of parietal cells?

A

Achlorhydria (parietal cells secrete H+)

23
Q

What other conditions is pernicious anaemia associated with?

A

AI thyroid, increased risk gastric carcinoma

24
Q

What are the signs and symptoms of pernicious anaemia?

A

Lemon-yellow skin, glossitis, GI disturbances, psychiatric disturbance
Neuro: peripheral neuropathy, subacute degeneration of the cord

25
Q

What is the treatment of pernicious anaemia?

A

Correct B12 with IM B12 injections every 3 months

26
Q

Where is folate absorbed?

A

Duodenum, jejunum

27
Q

What are the causes of folate deficiency?

A

Reduced intake (poor diet), increased loss (dialysis), drugs (EtOH, trimethoprim, methotrexate, anticonvulsants), increased cell turnover (pregnancy, prematurity, malignancy, haemolytic anaemia)

28
Q

How do you differentiate between B12 and folate deficiency?

A

Measure serum folate

Haematology (4 decks)

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