5-15 JOHNS Anemia

Question 1

What is the definition of anemia?

Answer 1

Reduction in one or more of the major RBC measurements:
Hemoglobin conc (normal is like 12 g/dL)
Hematocrit (a conc of sorts)
RBC count

Question 2

If a person is bleeding and is anemic as a result, what will his Hgb be?

Answer 2

NORMAL b/c Hgb is a CONC. Students and residents forget this fact.

Question 3

If Hb is HIGH (16,17,18), what are the TWO possibilities?

Answer 3

• dehydration (less vol => ↑conc)

- more Hb (increased mass => ↑conc)

Question 4

What are the two ways anemia can happen?

Answer 4

Either you’re NOT MAKING ENOUGH RBCs, or

You’re LOOSING RBCs

Question 5

What is the key test to determine whether someone is producing enough RBCs?

Answer 5

RETICULOCYTE COUNT (recall they are RBC precursor)

Question 6

Why does this make sense?

Answer 6

If person is LOOSING blood reticulocytes jump out into periphery to help make more
If person CAN’T MAKE blood, you WON’T see reticulocytes on blood smear

Question 7

What is a high reticulocyte count?

Answer 7

> 3%

Question 8

What is the morphological approach to differentiating anemias?

Answer 8

Classifying RBCs based on size

Question 9

How do we determine size of RBCs?

Answer 9

MCV (mean corpuscular volume)

Question 10

What are the different sizes of RBCs?

Answer 10

> 100 macrocytic
80-100 normocytic
<80 microcytic

Question 11

If the patient has a macrocytic anemia, what conditions should you consider?

Answer 11

B12 deficiency

Folate deficiency

Question 12

If the patient has microcytic anemia, what conditions should you consider?

Answer 12

Iron deficiency
Thalassemia
AoCD

Question 13

If the patient has normocytic anemia, what conditions should you consider?

Answer 13

AoCD
Bone marrow problems…
THIS ONE IS THE TRICKIEST

Question 14

Which of the macrocytic anemia conditions can be associated w/ neurological problems?

Answer 14

B12 deficiency

Question 15

What is pernicious anemia?

Answer 15

This is a condition that leads to a B12 deficiency anemia.
Self Ab’s against parietal cells in stomach -> ↓intrinsic factor
↓intrinsic factor -> ↓B12 absorption in terminal ileum -> macrocytic anemia

Question 16

What can lead to folate deficiency?

Answer 16

Dietary deficiency
EtOH
Pregnancy

Question 17

What is Thalassemia?

Answer 17

A genetic defect in Hgb synthesis

↓synthesis in 1 of the 2 chains (α or β)  ↓Hb production

Question 18

In what group are Thalassemias most often found?

Answer 18

African, Asian, and Mediterranean

Question 19

What is the range of severity?

Answer 19

Asymptomatic to fatal and anything in between

Question 20

What must a patient have in order to have AoCD?

Answer 20

A chronic disease!!!!!!

Question 21

What are the lab values that would indicate AoCD?

Answer 21

↓serum Fe
↑Ferritin
Low to Normal Tf saturation
↓TIBC (Transferrin)

Question 22

WTF is a sideroblastic anemia?

Answer 22

Group of anemias defined by ringed sideroblasts in bone marrow