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Anemia Flashcards

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1
Q

Anemia=

A

Is a decrease in the RBC count, hemoglobin and or hematocrit values resulting therefore in a lower ability of the blood to carry oxygen to body tissue
*its a sign of a disease process rather than a disease itself

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2
Q

RBCs=

A

Are flexible biconcave disk, with a very thin membrane which allows gases such as oxygen and co2 to diffuse easily across it

  • mature erythrocytes have no nucleus
  • immature erythrocytes are called reticulocytes
  • life span is 120 days
  • RBCs production process named: Erythropoiesis
  • the most important hormone for erythropoiesis is ERYTHROPOIETIN (produced in the kidney )
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3
Q

Erythropoietin produced by the kidneys in response to :

A

Hypoxemia

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4
Q

Mean corpuscular volume (MCV):

A

-measure of the RBC average size
-allows classification of anemia (normocytic, micro/macrosytic)
-normal range= 80-90fl
MCV=10x HCT(%)/ RBC count

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5
Q

Mean corpuscular hemoglobin concentration (MCHC):

A

Measure the concentration of Hb in a given volume of packed RBCs
Normal range 32-36 g/dL
MCHC=Hb/HCT

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6
Q

Mean corpuscular hemoglobin:

A

Mean cell hemoglobin
Average mass of hemoglobin per RBC
MCH= Hb/RBC
Normal range 27-31 pg/cell

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7
Q

WHO grading of anemia:

A

Grade 1: (mild anemia) 10g/dL
Grade 2/ (moderate anemia) 7-10 g/dL
Grade 3:(severe anemia) below 7g/dL

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8
Q

Classification of anemia on the basis of cause :

A

1) hypo-proliferative : inadequate production (iron def., b12/folate def., aplastic anemia, anemia of chronic dis., marrow infiltration)
2) hemorrhagic: blood loss
3) hemolytic anemia: increased rbc destruction( immune/non-immune, thalassemia, rbc membrane/ metabolism disorder..)

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9
Q

Classification of anemia on the basis of morphology:

A

1)microcytic anemia (hypochromic) : MCV & MCH ⬇️ ex. Iron def. / thalassemia
2)normocytic anemia (normochronic):
MCV& MCH normal, ex. Blood loss , hemolytic , chr. Disease
3)macrocytic : MCV& MCH raised , ex. Megaliblastic anemias , hypothyrodism, liver disease and alcoholism , drug toxicity ( phenytoin)

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10
Q

Pathophys. Of anemia:

A

⬇️ in RBCs, Hb or Hct level
⬇️ O2 carrying capacity
Hypoxia and hypoxia induced effects on organ function
Signs and sympts of anemia

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11
Q

Signs of anemia :

A

1) pallor of the skin and of the mucos membranes
2) brittle nails
3) koilonychia (spoon shaped nails )
4) papillary atrophy of the tongue
5) angular stomatitis
6) brittle hair
7) dysphagia and glossitis
8) splenomegaly

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12
Q

Diagnosis of anemia:

A

1) physical examination and medical history ( signs and symptoms of anemia)
2) laboratory tests :
▪️CBC
▪️stool hemoglobin test
▪️peripheral blood smear
▪️iron level
▪️transferrin level
▪️ferritin
▪️vitamin B12
▪️bilirubin
▪️hemoglobin
▪️reticulocyte count
▪️liver / renal function tests
▪️ bone marrow biopsy

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13
Q

Normal values :

A 
Hemoglobin: M(13.5-27.5)/ F(11.5-15.5)
Hematocrit: M(40-53%)/ F(36-48%)
RBCs: M(4.5-6.5)/ F( 3.9-5.6)
MCH: 27-34 pg
MCV: 80-95 fL
MCHC: 30-35 g/dL
Reticulocyte count : 50-150 x10*9/L
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14
Q

Iron deficiency anemia =

A

-Iron is essential for multiple metabolic processes including O2 transport, DNA synthesis and electron transport
-Iron deficiency anemia is caused by insufficient intake and absorption of iron and or iron loss from bleeding which can originate from a range of sources ( intestinal/ uterine or urinary tract )
🔸 each hemoglobin molecule is made up of 4 heme groups surrounding a globin group, and each heme is containing an Fe atom ( iron atom is attached to a ring-like porphyrin
🔸each heme group binds 1 o2 molecule -> hemoglobin binds 4 o2 molecules

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15
Q

Causes of iron deficiency anemia:

A

A) low dietary intake
B)increased demands
C) Malabsorption
* most common cause in developed countries is COLON CANCER , also long standing PEPTIC ULCER and bleeds
* most important cause of iron deficiency anemia in developing world children is PARASITIC WORMS

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16
Q

Total body iron mass=

A
  1. 5g women
  2. 5 men
    - 80% functional body iron
    - 20% iron storage ( hemosiderrin + ferritin)
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17
Q

Iron absorbed in the :

Study These Flashcards
A

Duodenum
* low ph of gastric acid in the proximal duodenum allows ferric reductase enzyme to convert insoluble ferric (Fe+3) to absorbable ferrous (Fe+2)

18
Q

Iron is transported by:
Hepcidin from the liver:
Ferroprtin:

Study These Flashcards
A

Transfirrin
Prevents absorbtion of iron
Regulated by hepicidin

19
Q

Hemosiderin:
Ferritin:

Study These Flashcards
A

Is an aggregate of hundreds and thousands of ferritin particles plus amorphous proteins and lipids
-is the major iron storage protein in the body

20
Q

Sympts of iron def. Anemia :

Study These Flashcards
A 
🔸shortness of breath 
🔸feeling week or tired all of the time 
🔸 cold hands and feet
🔸pallor 
🔸 increased susceptibility of infection
🔸PICA- compunction of eating non food stuff 
🔸 pagiphagia - craving ice
21
Q

Associated condition to IDA:

Study These Flashcards
A

▪️plummer - vinson syndrome
▪️achlorhydria
▪️glossitis and angular cheilitis

22
Q

Lab findings in IDA:

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A
  • microcytic , hypochromic anemia
  • ⬇️ serum ferritin
  • ⬇️ serum iron
  • ⬆️ serum transferrin
  • ⬆️ EPO levels
  • ⬆️platelet count
  • ⬇️ Hb levels <11g/dL
  • ⬆️RWD
23
Q

Treatment of IDA :

Study These Flashcards
A

✅oral iron therapy
✅if there is no improvement, the problem might be with absorption ( iv iron therapy) or there might be continued blood loss
***always treat the underlying cause

24
Q

Medication classification:

Study These Flashcards
A

🔸monocomponent tab:
Iron polyisomaltozate, iron gluconate , iron sulfate , iron fumarate, iron chloride
🔸contained ascorbic acid: sorbent durules, pheroplex
🔸contained folic acid : maltofer , foul , gyno-tradyferon

25
Differential diagnosis of IDA:
1) sideroblastic anemia - excess of iron , and defect in heme synthesis of rbcs mitochondria 2) anemia of chronic disease -increase in hepicidin
26
Megaloblastic anemia:
Hemoglobin production is normal 🔸defect in nuclear replication and division 🔸affects all marrow elements 🔸oval macrocyte , hypersigmented neutrophils
27
MBA has 2 major causes :
1) lack of VitB12 or cyanocoblamin | 2) folate deficiency
28
Other findings of MBA:
``` Pancytopenia reticulocytopenia LDH⬆️ Serum iron is normal/ ⬆️ Serum B12 or folate⬇️ ```
29
2 different entities of MBA:
▪️pernicious anemia- ⬇️RBCs occurs when the body cannot properly absorb VitB12 from GIT ▪️folate deficiency anemia -⬇️ RBcs due to lack of folate or lower than normal amount of folic acid in blood
30
Causes of MBA:
- lack of intrinsic factor in stomach - alcohol abuse - poor dietary intake - VitaminB12- free diet - intestinal dysfunction - certain medications such as PHENYTOIN
31
Signs and sympts of MBA:
-Megaloblastic anemia , pancytopenia -Paresthesias, peripheral neuropathy, combined system disease -irritability, personality change , mild memory impairment, dementia, depression, psychosis -possible ⬆️ risk of MI and stroke 🔸muscle weakness, paresthesia, atrophic glossitis, headache , pallor and weight loss
32
Lab findings of MBA:
1) Hb⬇️ 2) Hct⬇️ 3) RBCs ⬇️/normal 4) MCV⬆️ 5) MCH⬆️ 6) MCHC normal 7) reticulocytopenia 8) total WBCs- normal/ ⬇️ 9) platelet count- normal/⬇️ 10) pancytopenia , if severe
33
Pernicious anemia:
Autoimmune destruction of parietal cells - Abs versus parietal cells -> intrinsic factor def. And achlorhydria - accompanied by⬆️ incidence of gastric cancer - often associated with other immune diseases
34
Schilling test :
-oral radioactive B12 is given - then an Iv injection of non radioactive B12 is performed in order to staurate B12 binding proteins and to flush out Co-B12 -the urine collected for 24 hrs -Normal person will excrete >10% of the oral dose If <10% repeat test with addition oral IF -if now normal the diagnosis is pernicious anemia -if still abnormal , the lesion must be located in the terminal ileum
35
Treatment of MBA:
✅if necessary, transfuse with care ( when hemoglobin l<7 g/dL) ✅folic acid tablets ✅slowly developing anemia, usually well compensated
36
Hemolytic anemia =
- hemolysis is the destruction or removal of RBCs from the circulation before their normal lifespan of 120 days - are defined as an increase in destruction of RBCs - because of the compensation from the bone marrow so the anemia appears when destruction of RBCs is more important than compensatory mechanisms
37
Polychromasia:
- abnormally high number of immature cells in the bloodstream as a result of being prematurely released * hemolysis-> erythroid hyperplasia-> immature RBcs goes to circulation-> reticulocytosisand polychromasia
38
Causes of hemolytic anemia:
1) hereditary is due to intrinsic RBCs defect 2) acquired- are due to environmental changes 3) intravascular hemolysis- When the destruction of RBCs takes place in the blood vessels and hemoglobin is released ‏ - is associated with physical trauma , like an artificial heart valve.
39
Hereditary causes of Hemolytic anemia :
1) RBCs membrane defect 2) RBCs cell enzyme deficiency 3) disorders of Hb synthesis
40
Signs and symptoms of hemolytic anemia :
1) pallor 2) FLUCTUATING JAUNDICE 3) urine - no bilirubin but presence of urobilinogen 4) gallstones are common 5) SPLENOMEGALY
41
Lab diagnosis of HA:
1) Reticulocytosis 2) bone marrow biopsy, erythroid hyperplasia 3) ⬆️serum bilirubin levels 4) ⬆️ the urinary urobilinogen, stercobilinogen ⬆️ 5) ⬇️ plasma haptoglobin 6)⬆️LDH 7)positive coomb’s test 8) Hb⬇️, MCV is normal/ slightly ⬆️, MCHC ⬆️, RDW ⬆️ 9) peripheral blood smear - poikilocytosis and polychromatiphilia

Internal Medicine (4 decks)

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