Investigating Nutritional Anaemias - University of Portsmouth

Investigating nutritional anaemias Gavin Knight Learning Objectives Upon completion of this session you should be able to: 1) Define the term haematinics 2) Understand when haematinic measurements may be requested 3) Recognise that haematinic measurements are useful although they can l...

Investigating nutritional anaemias Gavin Knight Learning Objectives Upon completion of this session you should be able to: 1) Define the term haematinics 2) Understand when haematinic measurements may be requested 3) Recognise that haematinic measurements are useful although they can lack the necessary sensitivity and specificity to provide a definitive diagnosis What are haematinics? Haematinics are nutrients required by the haemopoietic tissue to produce blood cells Typically include: Iron Iron associated measurements including: Ferritin Transferrin Transferrin saturation Cobalamin (B12) Folate (B9) Other B vitamins – B2, B3, B6 Vitamin A Vitamin C > reducing power in gut Fe 3+ > Fe2+ Vitamin E Copper > Hephaestin and ceruloplasmin Cobalt  Determining Haematinics Each haematinic measurement has its limitations so additional tests are requested to identify nutritional anaemias Haematinics are important markers of anaemia and, when administered, can: promote a reticulocyte response increase the concentration of haemoglobin resolve selected cytopenias correct/partially correct clinically relevant symptoms FBC & blood cell morphology should be considered prior to testing Summary Many nutrients can be involved in the development of nutritional anaemias Most common involve iron, vitamins B12 (cobalamin) and folate Typically expected to be associated with microcytic or macrocytic blood picture although this is not always the case Depending on the organisation of the laboratory, haematinic measurements may be performed by haematology or biochemistry laboratories