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Path - Intro to Haematology + Anaemia (ii) (Fe deficient anaemia (Clinical…
Path - Intro to Haematology + Anaemia (ii)
Fe deficient anaemia
causes
blood loss
duodenal/gastric ulcer
CR cancer
any patient over 40 with fe deficient tanemia needs upper + lower GIT endoscopy
menorrhagia (heavy menstrual bleeding)
caecum bleeding presents late
wide so no obstruction
no bright red blood
increased requirements
childhood
pregnancy
dietary malabsorption
Coeliac
Crohn's
intestinal resection
Clinical features
mucosal pallor
angular cheilitis/stomatitis (inflammed corners of mouth)
atrophic glossitis
brittle nails
eating ice
koilonychia (spoon nails)
hypochromic (pale RBCs)
low Hb, ferritin (blood cell protein that contains Fe), MCV + Fe saturation
normal reticulocytes
hyperplasia of marrow
Tx
oral Fe
in severe cases Fe infusions or blood transfusions (! infection + rejection)
Folate
absorbed in duodenum + upper jejunum
causes of deficiency
MTX
pregnancy
diet
malabsorption - crohns, sprue (coeliac or tropical)
alcoholism
lactation
haemolytic anaemia
malignancy
anticonvulsants (phenytoin - impairs absorption)
Tx: oral folic acid
B12 (aka cobalamin)
in milk, eggs, meat
combines with intrinsic factor secreted by gastric parietal cells, + complex is absorbed in terminal ileum
hence absorption not affected by coeliac
causes of deficiency
diet
lack of intrinsic factor
pernicious anaemia (immune destruction of gastric parietal cells)
atrophic gastritis
chronic inflamm causes parietal cells to be replaced by intestinal/fibrous cells
also achlorhydria
partial gastrectomy
crohns
terminal ileum resection
blind loop bacteria
part of SI bypassed by food - bacterial overgrowth, + these bacteria compete for B12
B12 deficient anaemia
low Hb + B12
high MCV + bilirubin
peripheral neuropathy, subacute combined degeneration of cord, optic atrophy, psychiatric disorders, atrophic glossitis, neurological changes (due to failure to make S-adenosyl methionine which is necessary for myelin production)