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mohd keystone exam 2 > #26 - RBC disorders > Flashcards

#26 - RBC disorders Flashcards

1
Q

What reticulocyte index indicates insufficient marrow response?

A

less than 2.0

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2
Q

Which results in a bigger increase in reticulocytes: blood loss or hemolysis?

A

hemolysis.

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3
Q

acquired hyperproliferatve anemia diseases - 4

A
  • autoimmune hemolytic anemia
  • TTP-HUS
  • DIC
  • Malaria
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4
Q

inherited hyperproliferative anemia diseases - 3

A
  • spherocytosis
  • sickle cell
  • thalassemia
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5
Q

microcytic anemias- 3

A
  • iron deficiency
  • thalassemic disorders/ hemoglobinopathies
  • anemia of chronic disease (also normocytic)
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6
Q

normocytic anemias - 4

A
  • acute blood loss
  • iron deficiency (early)
  • anemia of inflammation/ chronic disease. (also microcytic
  • bone marrow suppression
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7
Q

macrocytic anemias - 4

A
  • alcohol abuse
  • folate, B12 deficiency
  • hemolytic anemia
  • bone marrow disorders such as MDS (myelodysplastic syndromes)
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8
Q

diagnostic testing for iron deficiency anemia

A
  • iron saturation will go down

- ferritin will go down (ferritin correlates with blood iron levels)

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9
Q

How can inflammation interfere with an anemia diagnosis?

A

Ferritin rises as an acute phase reactant in inflammation. This can mask the low level expected in iron deficiency. Iron saturation can also be borderline. Ferritin should drop though!!

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10
Q

If a person has iron deficiency without anemia, what will labs look like?

A

hemoglobin and serum iron will be normal, but ferritin will be low!

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11
Q

Vit B12 deficiency anemia - associations

A
  • vegans
  • autoimmune history
  • neurologic symptoms
  • gait ataxia
  • sensory loss/parasthesia
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12
Q

Folate deficiency anemia - associations

A

-malnourished
-alcoholic
NOT associated with autoimmune tendency
*NO neurologic signs**

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13
Q

You see a patient which you think has B12 or folate deficiency anemia but you aren’t sure. What do you do?

A

test for methylmalonate and homocysteine can confirm either diagnosis.

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14
Q

When should methylmalonate and homocysteine testing be done

A

When you see a patient which you think has B12 or folate deficiency anemia but you aren’t sure.

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15
Q

T/F - Anemia of chronic disease is always inflammatory

A

True. Thought to be cytokines interfering with action of EPO

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16
Q

Labs for anemia of chronic disease

A
  • low iron
  • low TIBC
  • low reticulocyte count.
  • normal RBC morphology.
  • iron deficiency may also be present.
  • may see kidney damage (decreased EPO)
17
Q

What is the most common cause of anemia in the Western world?

A

iron deficiency

18
Q

3 key features of iron deficiency anemia

A
  • hypochromia (pale RBCs)

- microcytosis (MCV

19
Q

anisocytosis

A

RBCs of different sizes. present in iron deficiency anemia.

20
Q

Therapy for B12 deficiency

A

lifelong cobalamin therapy (monthly B12 injections)

21
Q

Therapy for folate deficiency

A

folate + cobalamin

22
Q

Schistocytes on smear - likely diagnosis?

A

TTP

23
Q

Spherocytes on smear - likely diagnosis?

A

-autoimmune condition

24
Q

bite cells on peripheral blood smear

A

-G6PD deficiency

25
Q

Case: Patient with dark urine, jaundice. What is the next step/likely diagnosis?

A

Get a smear - likely to be hemolytic anemia.

bleeding = free hemoglobin damages kidney, jaundice = indirect bilirubin

26
Q

malaria = what type of anemia

A

hemolytic

27
Q

TTP - HUS = what type of anemia

A

Hemolytic

28
Q 
Case: 
young woman
-fatigue for several years
-family history of anemia
-MCV 60 
-targetoid cells on smear. Diagnosis?
A

Thalassemia

29
Q

labs in thalassemia

A

abnormal -hemoglobin electrophoresis

-microcytic anemia

30
Q

Associated symptoms - thalassemia

A

skeletal changes/ abnormalities

  • hepatomegaly
  • splenomegaly
  • iron overload.
31
Q

Treatment of thelassemias

A

**chronic blood transfusions!!!!: 2 units every 2-5 weeks to keep target Hb of 9-10 . Usually started in first decade of life.

Bone marrow transplant is curative, but not always done.

32
Q

sickle cell substitution

A

valine in place of glutamic acid on B globin gene - chromosome 11

33
Q

sickle cell disease =

A

recessive inherited, chronic hemolytic anemia

34
Q

Manifestations of sickle cell

A
  • RBCs only survive 10-25 days
  • hemolystic anemia
  • multiorgan involvement.
  • chest syndrome, pulmonary fibrosis
  • vascular occlusion, organ ischiemia, vasoconstriction
35
Q

Treatment for sickle cell

A

mainly supportive

  • hydration and analgesia for painful crisis.
  • RBC transfusions sometimes indicated
36
Q

hallmark of sickle cell disease

A

painful crisis

mohd keystone exam 2 (14 decks)

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