Anaemia Treatments IN EXAM Flashcards Preview

Haematology > Anaemia Treatments IN EXAM > Flashcards

Flashcards in Anaemia Treatments IN EXAM Deck (37)
Loading flashcards...
1
Q

what makes an anaemia microcytic and hypochromic

A

low MCV and low MCH (low Hb, what gives it low colour)

2
Q

what causes microcytic anaemias

A

problems with Hb synthesis = iron deficiency or haemoglobinopathies (alpha/ beta thalassaemia)

3
Q

why do you get anaemia in iron deficiency

A

cant form heam (porphyrin ring and Fe2+)

4
Q

why are cells microcytic in iron deficiency anaemia

A

In the bone marrow the erythroblasts start as large nucleated cells, the nucleus is responsible for production for haemoglobin. The signal for enucleation is when cell reaches critical point of Hb. With each cell division the cell gets smaller, if the cell isn’t making much Hb it will continue divide and so there are more divisions than normal and therefore the cells are microcytic.

5
Q

what does ferittin measure

A

stored iron

6
Q

where is iron stored

A

macrophages, liver, spleen, bone marrow

7
Q

can iron be raised in iron deficiency

A

yes- if acute inflammatory process there will be high ferittin as it is an acute phase protein

8
Q

name 3 iron supplements

A

ferrous sulphate
ferrous fumarate
ferrous gluconate

9
Q

what is the therapy of choice for iron deficiency anaemia

A

ferrous sulphate 200mg TDS

10
Q

what are side effects of ferrous sulphate

A

(not uncommon for people to not tolerate them)

  • constipation
  • diarrhoea
  • epigastric pain
  • faecal impaction
  • GI irritation
  • nausea
11
Q

what are the alternative options if someone is struggling to tolerate iron supplements

A
take the pill with food 
reduce dose to BP or QD
encourage dietary iron intake 
avoid tea (tannis impair absorption of iron) 
vitamin C enhances iron absorption 

ferrous gluconate 300mg

if cant tolerate at all can give S/c or IM iron

12
Q

what are sources of iron in diet

A

red meat
green veg
breakfast cereals fortified

13
Q

what should you worry about in older people/ non menstruating female with iron deficiency anaemia

A

right sided colon (caecal) cancers- can cause occult blood loss

14
Q

what Ix for non menstruating females/ males with iron deficiency anaemia

A

colonoscopy, up GI endoscopy

15
Q

why do children develop anaemia more easily than adults

A

as have increased need for iron and so can develop deficiency more easily

16
Q

what is the commonest reason for not improving on iron replacement therapy

A

non compliance

17
Q

how much should Hb conc rise on iron therapy

A

2g/100ml over 3-4 weeks

18
Q

what tests can assess response to iron therapy

A
reticulocyte count (marker of bone marrow activity) 
ferritin levels
19
Q

when is blood transfusion indicated for iron deficiency anaemia

A

Hb <70g/l

20
Q

why are people usually well in chornic anaemia

A

Haemoglobin will change to become more efficient at delivery to the tissues. The oxygen dissociation curve will shift to the right to increase oxygen tissue delivery to the tissues (increase in 2,3-BPG)

21
Q

what Tx if iron deficiency unresponsive to Tx

A

Im iron injection
dietary advice
find cause

22
Q

what are B12 and folate required for

A

cell mitosis

23
Q

is there b12 in seafood

A

yes

24
Q

where is B12 absorbed

A

terminal ileum

25
Q

what does B12 bind to

A

intrinsic factor which is secreted by gastric parietal cells which binds to B12 and facilitates transport across terminal ileum

26
Q

what are common causes of B12 deficiency

A

crohns (terminal ileum)
diet
metformin (affects absorption)
pernicious anaemia

27
Q

what antibodies will be present in pernicious anaemia

A

anti IF (intrinsic factor) (these are specific)

gastric pariental cell antibodies not specific but are sensitive so these used less

Antibodies can either bind to gastric parietal cells and prevent secretion of IF or they can bind to IF and prevent it binding to B12

28
Q

what is pernicious anaemia associated with

A

hypothyroidism, vitiligo, addisons disease

29
Q

what is the treatment for pernicious anaemia

A

IM vit B12 injections lifelong (1mg 3x a week for 2 weeks, then 1mg every 2-3 months)

alternatives= massive oral doses of B12

30
Q

what is the pathology of pernicious anaemia

A
  • Autoantibodies to the gastric parietal cells of the stomach result in reduced intrinsic factor release and therefore no absorption of vitamin B12 can occur in the terminal ileum of the small bowel
  • This results in macrocytic anaemia due to inadequate nuclear maturation of the red cell precursors in the bone marrow and a subsequent apoptosis of dysfunctional red cell precursors
  • With the injections of vit B12; normal red cell production can occur resolving the anaemia
31
Q

what is the treatment for macrocytic anaemia in an alcoholic with folate deficiency

A

5mg folic acid for 3-4 months (or lifelong if think high risk)
would also give B12 injections as important for myelin shealth development

(if you were to just give folate on its own you would switch on haematopoesis and use up B12 quickly causing irreversible neuro disorders)

blood count in 4 weeks to check levels

32
Q

what can a combined deficiency of folate and B12 cause

A

irreversible sub acute combined degeneration of the cord

33
Q

how can alcohol affect rbcs

A

cause macrocytosis

34
Q

how can liver disease cause anaemia

A

causes MACROcytic anaemia due to abnormal lipid metabolism = dysfunctional red cell membrane
(important to remember in alcoholics) (also consider NAFLD)

35
Q

what will you see on blood film of someone with macrocytic anaemia

A

target cells

36
Q

why is folate low in alcoholics

A

poor diet

damage to liver

37
Q

why can you get high B12 in alcoholics

A

as is released when liver is damaged