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MBD > Nutritional Anaemia > Flashcards

Nutritional Anaemia Flashcards

1
Q

What is anaemia (according to WHO)?

A

Condition in which the number of RBCs (and their oxygen carrying capacity) is insufficient to meet the body’s physiologic needs

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2
Q

What is haemoglobin?

A
  • Iron containing oxygen transport metalloprotein
  • Found within RBCs.
  • Reduction in Hb = anaemia
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3
Q

What are the elements found in blood?

A
  • Red blood cells
  • Platelets
  • White blood cells
    • Monocyte
    • Lymphocytes
    • Eosinophil
    • Basophil
    • Neutrophil
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4
Q

What are the relative Hb levels and what do you need to look at when interpreting blood results?

A
  • Age and biological gender
  • Adolescents reach adult level of Hb
  • Women who are not pregnant have lower amounts than men.
  • Pregnant women naturally have decreased Hb due to increased circulating volume etc
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5
Q

What should a normal blood film look like?

A
  • A normal blood film will have round RBC with an area of central pallor.
  • The central pallor has to be relatively small and the ring should be 1/3 of the diameter.
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6
Q

What does maturation of RBCs need?

A
  • Vitamin B12 and folic acid
  • DNA synthesis
  • Iron
  • Haemoglobin
  • Vitamins
  • Erythropoeitin
  • Healthy bone marrow environment
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7
Q

What are the mechanisms of action of anaemia?

A
  • Failure of haemoglobin production
  • Ineffective erythropoeisis
  • Decreased survival
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8
Q

What does a failure of haemoglobin production cause?

A
  • Hypoproliferation and reticulocytopenia
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9
Q

What is reticulocytopenia?

A
  • Not enough premature RBCs
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10
Q

What causes ineffective erythropoiesis?

A
  • Enough ingredients but wrong instructions
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11
Q

What causes decreased survival of RBCs?

A
  • Blood loss
  • Haemolysis
  • Reticulocytosis
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12
Q

What does MCV stand for?

A
  • Mean cell volume
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13
Q

What does MCV mean (not stand for)?

A
  • Average size of RBCs
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14
Q

What does microcytic mean?

A
  • Small MCV
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15
Q

What does normocytic mean?

A
  • Normal MCV
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16
Q

What does macrocytic mean?

A
  • Large MCV
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17
Q

Which anaemias are microcytic?

A
  • Iron deficiency
  • Thalassaemia
  • Chronic disease anaemia
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18
Q

Which anaemias are normocytic?

A
  • Anaemia chronic disease
  • Aplastic
  • Chronic renal failure
  • Bone marrow infiltration
  • Sickle cell disease
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19
Q

Which anaemias are macrocytic?

A
  • B12 deficiency
  • Folate deficiency
  • Myelodysplasia
  • Alcohol induced
  • Drug induced
  • Liver disease
  • Myxoedema
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20
Q

What does reticulocyte count help us with?

A

Lets us know if bone marrow is working

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21
Q

What does knowing MCV help with?

A

gives clues on what blood tests to do to predict possible conditions

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22
Q

Which is the most abundant trace element in the body?

A

Iron - essential for oxygen transport

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23
Q

What is your daily requirement for iron?

A
  • Depends on gender and physiological needs
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24
Q

How much iron is absorbed from the duodenum every day?

A

1-2mg/day

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25
Q

What is plasma transferrin?

A

Iron transport protein

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26
Q

Where does most of the iron in the body sit?

A
  • In RBCs, bone marrow and spleen
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27
Q

How do you loose iron naturally?

A
  • Sloughed mucosal cells in the duodenum

or

  • menstruation
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28
Q

Where does iron regulation happen?

A

Absorption stage

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29
Q

What do reticuloendothelial macrophages do?

A

They:

  • ingest senescent red cells
  • catabolise haemoglobin to scavenge iron
  • load the iron onto transferrin for reuse
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30
Q

What is the structure of Hb and how does this enable it to bind to oxygen?

A

Hb has 4 haem groups, 4 globin chains able to bind 4 O2

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31
Q

What are the stable form(s) of iron?

A

Ferric (3+)
Ferrous (2+)

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32
Q

What mechanism is iron absoption regulated by?

A

Negative feedback of GI mucosal cells and hepcidin

33
Q

What is hepcidin?

A

Iron regulatory protein

34
Q

How does hepcidin work?

A

Causes the internalisation and degredation of ferroportin, which decreases iron transfer into the blood plasma from the duodenum

35
Q

What does iron do in plasma?

A
  • Attaches to transferrin and then transported to bone marrow
  • Binds to transferrin receptors on RBC precursors
36
Q

What will iron deficiency do to ferritin/transferrin?

A
  • Reduced ferritin stores
  • increased transferrin
37
Q

What does ferritin do?

A

Primary storage protein and providing reserve, water soluble

38
Q

What does the transferrin saturation show you?

A

Ratio of serum iron and total iron binding capacity - revealing % age of transferrin binding sites that have been occuptied by iron

39
Q

What is transferrin produced by?

A

Liver

40
Q

What is transferrin production inversely proportional to?

A

Iron stores

41
Q

What is total iron binding capacity?

A
  • Measurement of the capacity of transferrin to bind iron
  • Indirect measurement of iron
42
Q

Why is the ferritin test so unreliable?

A
  • Ferritin is also involved in immune response, so infection may artificially increase ferritin
43
Q

With infection, how can you diagnose low ferritin?

A
  • Increased transferrin
44
Q

What are the causes of iron deficiency?

A
  • Poor diet
  • Malabsorption
  • Increased physiological needs
  • Loosing too much blood
45
Q

What can cause you to loose too much blood?

A
  • Menstruation
  • GIT loss
  • Parasites
46
Q

How can you investigate iron deficiency?

A
  • Full Blood Count (FBC)
  • iron studies
  • blood film
47
Q

What are the symptoms of iron deficiency anaemia?

A
  • Fatigue
  • lethargy
  • Dizziness
  • Pale mucus membrane
  • Bounding pulse
48
Q

What are the lab signs of B12 and folate deficiency?

A
  • Low Hb
  • high MCV with a normal MCHC
49
Q

What does megoblastic mean?

A
  • Low reticulocyte count
50
Q

What causes megaloblastic macrocytic anaemia?

A
  • Vitamin B12/folic acid deficiency
  • Drug related
51
Q

What causes nonmegaloblastic macrocytic anaemia?

A
  • Alcoholism
  • Hypothyroidism
  • Liver disease
  • Myelodysplastic syndromes
  • Reticulocytosis
52
Q

What is a source of vit B12?

A
  • Animal and dairy produce
53
Q

What is a source of folate?

A
  • Vegetables and liver
54
Q

What is the adult daily requirement of vit B12?

A
  • 1-2 mcg
55
Q

What is the adult daily requirement of folate?

A
  • 100-150mcg
56
Q

Where is vit B12 absorbed?

A
  • Ileum via intrinsic factor
57
Q

Where is folate absorbed?

A
  • Duodenum and jejunum
58
Q

What are vit B12 and folate important for?

A
  • RBC maturation
  • DNA synthesis
  • Thymidine triphosphate synthesis
59
Q

What are megaloblastic cells characterised by on the peripheral smear?

A
  • Macrovalocytes and hypersegmented neutrophils
60
Q

What are the causes of folate deficiency?

A
  • Increased demand
  • decreased intake
  • decreased absorption
61
Q

What can cause increased folate demand?

A
  • Pregnancy/breastfeeding
  • Infancy and growth spurts
  • Haemolysis and rapid cell turnover
  • Disseminated cancer
  • Urinary losses
62
Q

What can cause decreased intake of folate?

A
  • Poor diet
  • Elderly
  • Chronic alcohol intake
63
Q

What can cause decreased folate absorption?

A
  • Medication
  • Coeliac
  • Jejunal resection
  • Tropical sprue
64
Q

What is vitamin B12 important for?

A
  • Cofactor for methylation in DNA and cell metabolism
65
Q

Where is vitamin B12 sourced from?

A
  • Fish, meat and dairy
66
Q

What does vitamin B12 require the presence of to be absorbed into the terminal epithelium?

A
  • Intrinsic factor
67
Q

Where is intrinsic factor made?

A
  • Parietal stomach cells
68
Q

What molecules transport vitamin B12 to tissues?

A
  • Transcobalmin II and I
69
Q

What causes impaired vit B12 absorption?

A
  • Pernicious anaemia
  • Gastrectomy or ileal resection
  • Zollinger-ellison syndrome
  • Parasites
70
Q

What causes decreased vit B12 intake?

A
  • Malnutrition
  • Vegan diet
71
Q

What are some congenital causes of vitamin B12 deficiency?

A
  • Intrinsic factor receptor deficiency
  • Cobalamin mutation CG1 gene
72
Q

What causes the increased vit B12 requirements?

A
  • Haemolysis
  • HIV
  • Pregnancy
  • Growth spurts
73
Q

What medication causes vitamin B12 deficiency?

A
  • Alcohol
  • NO
  • PPI, H2 antagonists
  • Metformin
74
Q

What is pernicious anaemia?

A
  • Autoimmune disorder
75
Q

What does pernicious anaemia cause?

A
  • Lack of vit B12 absorption or intrinsic factor
76
Q

Where is pernicious anaemia most prevelant?

A
  • Low income areas
77
Q

What does a LDH (lactate dehydrogenase) test show?

A

Breakdown of RBCs. In bone marrow, RBCs are so abnormal they don’t survive.

78
Q

What are the clinical consequences of pernicious anaemia?

A
  • Brain: cognition, depression, psychosis
  • Neurology: sensory changes, spasticity, ataxia
  • Infertility
  • Cardiac cardiomyopathy
  • Tongue: glossitis, taste impairment
  • Blood: pancytopenia

MBD (23 decks)

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