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IHO Week 1 > Anemia- Krafts > Flashcards

Anemia- Krafts Flashcards

1
Q

Symptoms of Anemia

A 
Pale skin/mucous membranes
Jaundice
Tachycardia
Breathlessness 
Dizziness
Fatigue
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2
Q

Koilonychia

A

Spoon shaped nails

in IDA

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3
Q

3 ways to get anemic

A
  1. Lose blood
  2. Destroy too much blood (intracorpusular or extracorpuscular reasons)
  3. Make too little blood
    • too few building blocks
    • Too few erythroblasts (aplastic anemia)
    • Not enough room
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4
Q

3 Morphologic Groups of Anemia

A
  1. Weird Size
  2. Weird Shape
  3. Normal size and shape
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5
Q

Weird Size

A

Iron- deficiency anemia
Thalassemia
Megaloblastic anemia

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6
Q

Iron Deficiency Anemia

A
  • Most important cause–> GI bleeding
  • Microcytic, hypochromic anemia
  • increased anisocytosis (varying cell sizes) & poikilocytosis (abnormal shape)
  • Abnormal iron studies
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7
Q

Iron:
Absorption?
Circulation?

A

Absorbed in duodenum

Carried in circulation by transferrin

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8
Q

Iron:
Absorption?
Circulation?

A

Absorbed in duodenum

Carried in circulation by transferrin

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9
Q

Hemoglobin

A

4 globin chains (2 alpha, 2 beta)

4 heme molecules
-iron only binds O2 in ferrous (Fe2+) state

Fe3+/ferric state=methemoglobin

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10
Q

Ferritin vs hemosiderin?

A

Ferritin is quick iron storage

Hemosiderin is long term

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11
Q

Causes of iron deficiency

A

Decreased iron intake (bad diet/absorption)

Increased Iron loss( GI bleed, menses, hemorrhage)

Increased iron requirement (prego)

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12
Q

IDA in premenopausal women?

IDA in everyone else?

A

premen women–> MENORRHAGIA

everyone else–> GI BLOOD LOSS

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13
Q

Signs/symptoms of IDA:

A

Asymptomatic
Fatigue, dizziness
Signs: pale, spoon nails, smooth tonue
Pica

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14
Q

First sign of ID?

A

Poikilocytosis: see elliptocytes –cigar shaped cells

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15
Q

Blood smear in IDA?

A
  • hypochromic, microcytic anemia
  • anisocytosis
  • poikilocytosis
  • decreased reticulocytes
  • increased platelets
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16
Q

Bone marrow biopsy findings in IDA?

A
  • erythroid hypoplasia (not as many RBC as you would expect)
  • dyserythropoiesis (funny looking RBCs)
  • decreased iron stores
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17
Q

Labs in IDA? **

A
  • decreased serum iron
  • increased TIBD
  • decreased ferritin
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18
Q

Labs in IDA? **

A
  • decreased serum iron
  • increased Total iron binding capacity
  • decreased ferritin *** only ID will make this low
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19
Q

Do look at what lab test first for diagnosis of IDA?

A

Ferritin

DECREASED in IDA!

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20
Q

Tx of IDA?

A

Figure out why they are iron deficient

-give oral iron

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21
Q

Megaloblastic anemia

THINGS TO KNOW

A
  • Defective DNA synthesis
  • Nuclear/cytoplasmic asynchrony (nuc lags behind in maturity)
  • decreased B12/folate
  • Macocytic anemia with oval macrocytes and hypersegmented neutrophils
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22
Q

Megaloblastic anemia

Retarded DNA syn & unimpaired RNA syn —–>

A

BIG BIG Cells

Immature nucleus
Mature cytoplasm

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23
Q

B12 sources & absorption

A

Meat, dairy, cereal. (NOT veggies, dude!)

Need IF secreted by parietal cells to get absorbed in distal ileum

24
Q

Causes of B12 Deficiency

A 
diet
lack of IF (pernicious anemia)
pancreatic damage
Ileal damage
Tapeworm
25
Q

Megoloblastic symptoms?

A

Atrophic glossitis –beefy tongue, lack of papilli

26
Q

Long term B12 def

A

Subacute combined degeneration

-sensory & motor probs
Need B12 to convert homocysteine –> methionine

27
Q

Folate: sources & absorption

A

Green leafy veggies

-Absorbed in jejunum

28
Q

Causes of folate def

A

diet
alcohol abuse
jejunal damage
drugs

29
Q

What will you see in a blood smear with megalobastic anemia?

A
  • macrocytic anemia
  • oval macrocytes
  • Hypersegmented neutrophils (*only happens with this)
30
Q

What will you see in a blood smear with megaloblastic anemia?

Labs?

A
  • macrocytic anemia
  • oval macrocytes
  • Hypersegmented neutrophils (*only happens with this)

MCV >100

31
Q

What do you see in BM biopsy with megaloblastic anemia?

A
  • megaloblastic erythroblasts

- megaloblastic neutrophils

32
Q

Weird Shaped Anemias?

Hemolytic anemias!

A
  • HS
  • AIHA
  • Sickle cell anemia
  • G6PD deficiency
  • MAHA
33
Q

Weird Shaped Anemias?

Hemolytic anemias!

A
  • HS
  • AIHA
  • Sickle cell anemia
  • G6PD deficiency
  • MAHA
34
Q

Symptoms of acute hemolytic anemia

A

back, abdominal, limb pain
headache malaise, fever
jaundice, pallow, tachycardia

35
Q

Types of hemolytic Anemia

A
  1. Chronic (hereditary) -well compensated
  2. Acute (acquired)
  3. Inherited- defects in RBCs
  4. Acquired -infection or drug related
36
Q

Bottom line of hemolytic anemia, you’ll see signs of both:

A

increased RBC destruction ——–> Increased RBC production

37
Q

Signs of Increased RBC Destruction

A
  • increased serum bilirubin
  • increased LDH
  • Decreased haptoglobin
38
Q

Signs of Increased RBC PRODCUTION:

A
  • Reticulocytosis

- Nucleated RBCs in blood

39
Q

Signs of Increased RBC PRODCUTION:

A
  • Reticulocytosis

- Nucleated RBCs in blood

40
Q

Labs test in hemolytic anemia

A
  1. direct antiglobulin test (DAT)- look for Abs on RBC surface by using a anti-human globulin (+ = immune process)
  2. Osmotic fragility test: +=spherocytes present
41
Q

Morphology of hemolytic anemia

A
  • Normochromic, normocytic anemia
  • Spherocytes
  • Poikilocytes: targets, sickles, fragmented
42
Q

How to diagnose Hemolytic anemia

A

Look for signs of destruction & production

Determine cause with DAT (immune vs non immune)

43
Q

Tx of hemolytic anemia

A

Depends on cause
Acute: tx shock
Splenectomy if needed

44
Q

Hereditary Spherocytosis (HS)

A
  • Tons of spherocytes
  • Defect in RBC cytoskeleton (spectrin)
  • Splenectomy is curative
45
Q

Triad of Hereditary Spherocytosis

A
  1. anemia
  2. jaundice
  3. spenomegaly
46
Q

Pathogeneisis of HS:

A
  • abnormal RBC cytoskeleton
  • loss of surface area
  • spleen removes spheres (macrophages)
47
Q

HS Morphology

A
  • mild normochromic, normocytic anemia

- numerous spherocytes

48
Q

HS tx:

A

Splenectomy

49
Q

Autoimmune Hemolytic Anemia (AIHA)
Warm and cold types

THINGS TO KNOW

A
  • IgG bind to RBCs
  • destruction happens in spleen
  • Spherocytes
50
Q

Pathogenesis of WAHA

A

IgG coats RBCs —>Macs eat whole cell OR nibble and cell becomes spherocytes

Get Splenomegaly

51
Q

WAHA dx and tx

A

Dx: DAT (direct antiglobulin test)

Tx: steroids and maybe splenectomy

52
Q

WAHA dx and tx

A

Dx: DAT (direct antiglobulin test)

Tx: steroids and maybe splenectomy

53
Q

Cold AIHA

THINGS TO KNOW:

A

-IgM, complement bind at colder temp areas, hands ears feet. falls off in warm body parts

  • some intravasulcar hemolysis (b/c of complement)
  • mostly spleen
  • Agglutination: IgM forms petamers and clumps RBCs up (bridges RBCs)
54
Q

Clinical signs of Cold AIHA

A

chronic hemolysis aggravated by cold. Pallor, cyanosis in cold body parts

55
Q

Morphology of Cold AIHA

A

Red cell agglutinates (from IgM)

Rare spherocytes

56
Q

Cold AIHA dx and tx

A

Dx: DAT positive for complement (doesn’t pick up IgM)

tx: keep patient warm, treat underlying cause

IHO Week 1 (12 decks)

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