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Hematology > Microcytic, Hypochromic Anemias > Flashcards

Microcytic, Hypochromic Anemias Flashcards

1
Q

Anemia Definition

What is it correlated with?

A

deficiency of oxygen delivery to the tissues / healthy red blood cells

Low RBC Count
Low hematocrit
Low Hemoglobin

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2
Q

Anemia is classified by:

A

Physiology
- symptoms, bone marrow response

Morphology
- visual interpretation of peripheral smear
- RBC indices: MCV, MCHC, MCH

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3
Q

Microcytic, hypochromic anemias definition

A

group of red cell disorders that involve a defect in hemoglobin synthesis and can produce RBCs that are:

Microcytic: < 6 um
(often MCV <80fL

Hypochromic = CAP >3 um
(often MCHC <32%)

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4
Q

Deficiency of iron

A

IDA - iron deficiency anemia

  • Majority
  • Most common anemia
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5
Q

Abnormal utilization of iron

A
  • Anemia of chronic disease
  • Sideroblastic Anemia
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6
Q

Abnormal heme synthesis

A

Poryphyrias

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7
Q

Abnormal globin chain synthesis

A

Thalassemia

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8
Q

Iron (Fe)

A

Iron is essential for life
- makes hemoglobin
- essential mineral our body needs

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9
Q

Iron can be classified in two categories

A

Heme iron

Non heme iron

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10
Q

Heme iron

A

complexed into a porphyrin ring to form heme ring of hemoglobin

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11
Q

non-heme iron

A
  • Any iron outside of hemoglobin
  • **Transfer and storage compounds **
  • RBC inclusions
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12
Q

Examples of non-heme iron; transfer and storage compounds

A

Transferrin

Ferritin

Hemosiderin

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13
Q

Transferrin

A

CARRIER protein

  • carrier protein for serum iron
  • composed of beta globulin
  • made in the liver
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14
Q

Ferritin

A

STORAGE

  • Water soluble
  • Storage pools of bone marrow and liver
  • Easily mobilized
  • Serum Ferritin - proportional to iron stores in liver and BM
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15
Q

Hemosiderin (harder to access)

A

STORAGE

  • Water insoluble
  • lysosomal membranes of macrophages (where they are stored)
  • Precipitated aggregates of ferritin
  • Long term-storage (last resort)
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16
Q

Ferritin vs Hemosiderin

A

Hemosiderin has an extra phosphate

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17
Q

Non heme iron in RBC

A

inclusions terminology
- Wright stained - pappenheimer bodies
- Prussian blue (iron stain) - siderotic granules

Cell terminology
- nulceated RBC - Sideroblasts
- Non-nucleated RBC - siderocytes

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18
Q

wright stained RBC

A

pappenheimer bodies

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19
Q

Prussian blue (iron stain)

A

Siderotic granules

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20
Q

Nucleated RBC

A

sideroblasts

21
Q

non-Nucleated RBC

A

Siderocytes

22
Q

Iron absorption pathway

A

Iron in diet (Fe3+ and Fe2+)

Stomach (acidic pH)

Reduced to Fe2+

Intestines

Absorbed (Duodenum/Jejunum)

Blood (converted back to Fe3+)

Binds to Transferrin (carrier protein)

BM & Liver for storage (Ferritin)

23
Q

Iron is absorbed in

A

Duodenum/Jejunum which components of the small intestine

24
Q

Iron Sources

A

Meats (muscles)
Organ meats
Wheat Germ
Brewer’s yeast
Certain legumes
Milk/formula
Green veggies

25
Q

Green veggies (vitamin C and fructose)

A

enhance iron absorption

26
Q

Iron Minimal Daily Requirement (MDR)

A

Iron - loss of 1% of RBCs/day that must be replenished

Most (95% in adults) iron comes from recycling senescent (old) RBCs. – Remaining approx. 5% needs to come from diet

Additional Loss of iron: Normal conditions
- sweating, stool. menstruation

27
Q

Serum Iron (Analysis)

A

Transferrin - bound Iron

Normal Range: 50-150 ug/dL

28
Q

TIBC - Total Iron Binding Capacity (analysis)

A

Availability of iron binding sites on Transferrin

Normal Range: 250-450 ug/dL

29
Q

Transferrin % Saturation

A

Amount of iron bound in plasma/serum

Normal Range: 20-50%

30
Q

Serum Ferritin

A

Proportional to amount of iron stored (Liver and BM - Acute phase reactant)

Normal Range Male: 20-250 ug/dL

Normal Range Female: 10-120 ug/dL

31
Q

IDA - Most common anemia

A

State in which body iron stores are depleted

32
Q

IDA causes

A

Blood loss (most common cause in western world)
- Menstruation in females
- GI bleed in Males

Dietary insufficiency
- Increased need - pregnancy /infants
- lack in diet (3rd world)

Absorption issue
- Malabsorption - lack of gastric acids (gastrectomy, gastic bypass), or problem at absorption site (IBS, Celiac Disease)

Many more

33
Q

IDA stage 1

A

Iron Depletion
- Iron stores in the bone marrow are depleted (low ferritin)

  • our body compensated by increasing mucosal absorption of iron and producing more transferrin (increased TIBC)
  • CBC and RBC morphology = normal
  • Completely asymptomatic
34
Q

IDA stage 2

A

Iron Deficient Erythropoiesis
- Plasma iron level drops (low serum iron)

  • CBC (Hgb and Hct) low – more microcytic and hypochromic
  • RBC Morphology = slightly presentation of microcytic hypochromia
35
Q

IDA stage 3

A

Iron Deficiency Anemia
- RBCs are severely deficient in iron
- Hemoglobin formation is delayed

  • CBC (Hgb and Hct) marked Low
    - less O2 delivery to cells
    - EPO levels increase
    - Overt symptoms
  • RBC morphology = microcytic, hypochromic RBCs
    - possible to see reticulocytes, target cells and elliptocytes
36
Q

IDA clinical features

Typical symptoms

A

Typical Symptoms:

  • Fatigue/Lethargy
  • Pallor
  • Vertigo
  • Dyspnea
  • Cold Intolerance
37
Q

IDA clinical features

Miscellaneous Symptoms

A

Pica
- Pagophagia
- Geophagia

Koilonychia

38
Q

Pica

A

abnormal cravings

39
Q

Pagophagia

A

craving for ice

40
Q

Geophagia

A

Craving for dirt, clay

41
Q

Koilonychia

A

spoon nails

42
Q
A

Microcytic, Hypochromic RBC

43
Q

IDA Lab Findings - Peripheral Smear

A

Microcytic, Hypochromic RBCs
(large central pallor)

Mild to moderate anisopokilocytosis (variation in size/shape)

Additional Possibilities:
- slight reticulocytosis (polychromasia) - accelerated erythropoiesis

  • target cells

-Elliptocytes

44
Q

IDA Lab Findings - Iron Studies

A

Low serum ferritin (FOUND IN ALL IDA STAGES)

High TIBC

Low Serum Iron

Low % Transferrin Saturation

45
Q

LOW serum ferritin

A

FOUND IN ALL IDA STAGES

46
Q

IDA lab findings - Bone Marrow

A

Usually not indicated for testing

Mild to moderate erythroid hyperplasia. low M:E

Poorly hemoglobinized pre-cursors with scanty cytoplasm

Hemosiderin absent

47
Q
A

IDA bone marrow

48
Q

IDA treatment

A

Iron supplements
- oral tables or drops (infants/children)
- infusions (absorption issue)

Severe cases ( significantly low hemoglobin)
- transfusion

Hematology (36 decks)

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