ANEMIA Flashcards by Queen KCMB

is defined as a decrease in erythrocytes and hemoglobin, resulting in decreased oxygen delivery to the tissues Impoverished condition of the blood caused by reduction in RBC, Hgb or both. It is considered to be present if the Hgb conc. of the Hct is below the lower limit of the__% reference interval for the individual’s age, sex and geographic location.
• Can be classified morphologically using RBC indices (______) or etiology/cause
• Anemia is suspected when the hemoglobin level is <___ g/dL in men or <___ g/dL in women

Anemia

MCV, MCH, MCHC

12
11

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total production of RBCs production of RBCs that reach the measured using M:E ratio, fecal circulation of peripheral blood measured by urobilinogen and plasma iron; the RBC turnover utilization of iron, entire lifespan done

Total Erythropoiesis

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production of RBCs that reach the measured using M:E ratio, fecal circulation of peripheral blood measured by urobilinogen and plasma iron; the RBC turnover utilization of iron, entire lifespan done reticulocyte count and RBC lifespan

Effective Erythropoiesis

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CAUSE OF ANEMIA
1. Decrease RBC___
2. Increase RBC___

production

destruction

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GENERAL SIGNS AND SYMPTOMS
LFDFVPH

Low Hgb conc, & blood volume
Fatigue
Dyspnea on exertion
Faintness
Vertigo
Palpitation
Headache

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COMMON SIGNS AND SYMPTOMS
PRLSSS

Pallor
Rapid bounding pulse
Low blood pressure
Slight fever
Some dependent edema
Systolic murmurs

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MACROCYTIC NORMOCHROMIC

MCV is greater than __ fl. MCHC is normal
• MCHC is more accurate than MCH

•96

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MACRO/ NORMO

A. MEGALOBLASTIC ANEMIA
• Erythroblast in bone marrow shows abnormality and delayed maturation
Causes:
1. Vitamin B12 deficiency –___\ anemia
2. Folic acid deficiency – ____ anemia
3. Abnormalities of Vit B12 or folate metabolism
4. Inherited disorders of DNA synthesis
5. Drug-induced disorders of DNA synthesis

pernicious

nutritional megaloblastic

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WHAT LAB FINDINGS

Red cells are macrocytic - MCV is greater than 95 fl. and often as high as 120-140 fl.
2. Macrocytes are typically oval shape.
3. Reticulocytes count is low in relation to the degree of anemia.
4. Total white cell count and platelet counts may be moderately reduced, especially in severely anemic patients.

MEGALOBLASTIC ANEMIA

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PERIPHERAL SMEAR WHAT ANEMIA

Show normal red blood cells in morphology despite the drop of Hgb, Het and RBC count.
2. Increased bone marrow activity (increased of Reticulocyte count), w/o increased red cell or hgb breakdown.
• •
After menstruation, retics might increase. Normal: 0-1/field

MEGALOBLASTIC ANEMIA

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Macrocytosis – many big RBCs
• Bone marrow shows normoblastic
Causes:
1. Accelerated erythropoiesis
2. Increased membrane surface area
3. Obscure causes (hypoplastic & aplastic anemias)
4. Alcohol
5. Liver disease
6. Cytotoxic drugs (e.g.: metronidazole – drug for amebiasis)

NON MEGALOBLASTIC ANEMIA

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MCV is less than 80 fl MCHC less than 30%
Causes:
1. Iron deficiency
2. Disorder of globin synthesis as in thalassemia
3. Disorders or porphyrin & heme synthesis as in sideroblastic anemia
4. Other disorders of iron metabolism

MICROCYTIC HYPOCHROMIC ANEMIA

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Aniso- and poikilocytosis
• The red blood cells are microcytic since many are smaller
than the nucleus of the lymphocyte
• The erythrocytes are hypochromic with an increased
central pallor
• Elliptocytic and pencil-shaped forms are present.

MICROCYTIC HYPOCHROMIC

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• MCV is
Causes:
1. Recent blood loss
2. Overexpansion of plasma volume as in pregnancy
3. Hemolytic diseases
4. Hypoplastic bone marrow (aplastic anemia)
5. Infiltrated bone marrow (leukemia)
6. Endocrine abnormality
7. Chronic disorders
8. Renal disorders TIBC
9. Liver diseases

NORMOCYTIC NORMOCHROMIC

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INC RETICS

Very acutely, with hypovolemia, may have normal
blood counts, will become anemic with volume
replenishment

ACUTE BLOOD LOSS

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INC RETICS

Increased reticulocyte production cannot keep pace
with loss of RBCs peripherally.
• Response to specific therapy in nutritional anemias

HEMOLYTIC ANEMIA

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LAB FINDING WHAT ANEMIA
1. Plasma volume and red cell volume - reduced in proportionate amount.
2. Hct is normal.
3. Platelet count is reduced.
4. Plasma fibrinogen level is reduced.
5. Neutrophilic leukocytosis is present.
6. Normocytes and normochromic cells are present.

NORMOCYTIC NORMOCHROMIC

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WHAT ARE THE ANEMIA UNDER DEC RBC PRODUCTION AND INC RBC DESTRUCTION

MACROCYTIC NORMOCHROMIC
-MEGALOBLASTIC ANEMIA
- NON MEGALOBLASTIC ANEMIA

MICROCYTIC HYPOCHROMIC

NORMOCYTIC NORMOCHROMIC

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CAUSES

Anemia due to Impaired Red Cell Production
Anemia due to blood loss – Post Hemorrhagic Anemia 3. Anemia due to Accelerated Red Cell Destruction – Hemolytic Anemia

IMPAIRED OR DEFECTIVE PRODUCTION ANEMIAS

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WHAT ARE UNDER IMPAIRED OR DEFECTIVE PRODUCTION ANEMIAS

IDA
ACD
SIDERIBLASTIC ANEMIA
THALASSEMIA
LEAD POISONING
PORPHYRIAS
MEGALOBLASTIC ANEMIAS
APLASTIC ANEMIA
MYELOPHTHISIC (Bone marrow replacement) ANEMIA

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Most common form of anemia • Microcytic/hypochromic anemia

Serum iron, ferritin, hemoglobin/hematocrit, RBC indices, retics count - LOW

RDW and TIBC - HIGH

IDA

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Inability to use available normal RBCs
• Impaired release of storage iron associated with increased
HEPCIDIN levels
• Normocytic/normochromic anemia, or slightly
microcytic/hypochromic anemia
• Associated with persistent infections, chronic
inflammatory disorders

ESR, FERRITIN ___
SERUN IRON and TIBC ____

ANEMIA OF CHRONIC DISEASE

INC
DEC

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Caused by blocks on the protoporphyrin pathway resulting in defective hemoglobin synthesis and iron overload
• Excess iron accumulates in the mitochondrial region of immature erythrocytes (ringed sideroblasts)
• Two RBC populations (dimorphic) are seen • Microcytic/hypochromic anemia

FERRITIN AND SERUM IRON ___
TIBC ____

SIDEROBLASTIC ANEMIA
DEC

INC

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• an inherited blood disorder that causes your body to have less hemoglobin than normal

Study These Flashcards

THALASSEMIA

Multiple blocks in the protoporphyrin pathway Normocytic/normochromic anemia with characteristic course basophilic stippling

LEAD POISONING

Group of inherited disorders characterized by a block in the protoporphyrin pathway Heme precursors before the block accumulate in the tissues, and large amounts are excreted in urine/feces Photosensitivity, abdominal pain, CNS disorders Hematologic findings are insignificant

PORPHYRIAS

Defective DNA synthesis causes abnormal nuclear maturation; RNA synthesis is normal, so the cytoplasm is not affected Nucleus matures slower than the cytoplasm (asynchronism) Caused by either Vitamin B12 deficiency or folic acid deficiency Macrocytic/normochromic anemia

MEGALOBLASTIC ANEMIAS

Bone marrow failure Decrease in hemoglobin/hematocrit and reticulocytes Normocytic/Normochromic anemia

APLASTIC ANEMIA

Hypoproliferative anemia caused by replacement of bone marrow hematopoietic cells by malignant cells or fibrotic tissue Normocytic/normochromic anemia

I. MYELOPHTHISIC (BONE MARROW REPLACEMENT) ANEMIA

ANEMIA DUE TO BLOOD LOSS - POST HEMORRHAGIC ANEMIA

ACUTE AND CHRONIC

if blood is lost over a short period of time in amount sufficient to cause anemia. LAB decrease of hgb, hct and RBC count increase of bone marrow activity, without increase red cell or hgb breakdown. PERIPHERAL BLOOD SMEAR • shows normal red cells • elevated reticulocyte count

ACUTE POSTHEMORRHAGIC ANEMIA

if blood is lost in small amount over an extended period of time, both the clinical and hematologic features that characterize acute posthemorrhagic anemia are lacking LAB FINDINGS WBC count is normal or slightly decreased platelet count is increased PERIPHERAL BLOOD SMEAR reticulocyte count may be normal or slightly increased • red blood cells at first normochromic and normocytic and gradually the newly formed red cells become microcytic and hypochromic

CHRONIC POST HEMORRHAGIC ANEMIA

Sudden loss of blood resulting from trauma or other severe forms of injury • Normocytic/normochromic anemia

ACUTE BLOOD LOSS

Gradual, long-term loss of blood • Normocytic/normochromic anemia (initially) • Microcytic/hypochromic (caused by gradual loss of iron)

CHRONIC BLOOD LOSS

ANEMIA DUE TO ACCELERATED DESTRUCTION OF RBC Hemolytic anemia - may be due to: A.____, hemolytic anemias - defect of red cell itself, usually hereditary & grouped as membrane, metabolic or hemoglobin defects. B.___ hemolytic anemias - a factor outside the red cell & acting upon it. Almost always acquired.

Intrinsic Extrinsic

INTRINSIC HEMOLYTIC ANEMIAS: HEMOLYTIC ANEMIA DUE TO MEMBRANE DISORDERS HEREDITARY SPHEPSAR

1. HEREDITARY SPHEROCYTOSIS (CONGENITAL HEMOLYTIC JAUNDICE OR ANEMIA) 2. PAROXYSMAL NOCTURNAL HEMOGLOBINURIA/MACHIAFAVA-MICHELI SYNDROME 3. HEREDITARY ELLIPTOCYTOSIS/OVALOCYTOSIS 4. HEREDITARY PYROPOIKILOCYTOSIS 5. HEREDITARY STOMATOCYTOSIS (HYDROCYTOSIS) 6. HEREDITARY ACANTHOCYTOSIS (ABETALIPOPROTEINEMIA) 7. RHNULL DISEASE

inherited as a non-sex-linked dominant trait • most common in North Europeans • spherocytes die prematurely • SPLENOMEGALY LABORATORY FINDINGS OF HEREDITARY SPHEROCYTOSIS: • Osmotic Fragility Test is increased. • Reticulocytes are usually 5-20% • Direct Coomb’s (antiglobulin test is negative). • MCV is normal; MCHC is often increased. • WBC, platelet counts are normal except during periods of hemolysis. • Total bilirubin is elevated. PERIPHERAL SMEARS: • blood film shows microspherocytes

HEREDITARY SPHEROCYTOSIS (CONGENITAL HEMOLYTIC JAUNDICE OR ANEMIA)

chronic intravascular hemolysis • nocturnal hemoglobinuria occurs during sleep or after awakening • pH of plasma is low due to red cells • ACIDOSIS LAB FINDINGS positive sucrose hemolysis test or Ham’s acidified serum test or sugar water test. • WBC count and platelet count are often low. • Hemosiderinuria is a feature. PERIPHERAL SMEARS Reticulocyte count is elevated. • Normocytic –normochromic anemia is present.

PAROXYSMAL NOCTURNAL HEMOGLOBINURIA/MACHIAFAVA-MICHELI SYNDROME

associated w/ severe hemolytic anemia in infants defect involves the impaired association of spectrin dimers resulting in free, unconnected dimers. • Dominant inheritance LAB FINDINGS Osmotic fragility test is increased. • Autohemolysis of red cells is present PERIPHERAL BLOOD SMEAR non-hypochromic elliptoytes are abundant on blood films. • Reticulocytes and NRBC are normal in shape.

HEREDITARY ELLIPTOCYTOSIS/OVALOCYTOSIS

rare, moderately severe congenital hemolytic anemia • inherited as recessive autosomal traits • occurs in blacks PERIPHERAL SMEARS: • microcytosis, striking micropoikilocytosis & fragmentation

HEREDITARY PYROPOIKILOCYTOSIS

rare congenital anemia • inherited as recessive autosomal trait caused by inc. Na & dec. K due to increased permeability of membrane • 10-30% red cells appear as mouth like LAB FINDINGS Osmotic Fragility Test is increased. • Reticulocyte may be normal or elevated. PBS 10-30% red cells appear as mouth like linear pallor instead of the normal central round pale area. • 10-50% of red cells appear as a stomatocytes

HEREDITARY STOMATOCYTOSIS (HYDROCYTOSIS)

caused by absence of beta-lipoprotein • associated w/ plasma lipid abnormalities • low total lipid, cholesterol & phospholipids • autohemolysis occurs • Reticulocyte count ranges from normal to increased • Presence of mild anemia • EDTA: usual anticoagulant used

HEREDITARY ACANTHOCYTOSIS (ABETALIPOPROTEINEMIA)

inherited due to gene suppression or presence of silent Rh gene (Xo) membrane abnormalities due to absence of all Rh-Hr antigens on the red cells. LAB FINDINGS High Reticulocyte count • autohemolysis & Osmotic Fragility are increased PBS mild,chronic normocytic normochromic hemolytic anemia smear shows stomatocytes & spherocytes

RHNULL DISEASE

inherited represents an imbalance in the membrane phospholipids in the red cells anemia may increase due to infection or under condition of stress. PERIPHERAL SMEARS: • causes mild anemia w/ morphologically normal • Cells

HIGH PHOSPHATIDYLCHOLINE HEMOLYTIC ANEMIA

HEMOLYTIC ANEMIA DUE TO METABOLIC DISORDERS

9. G6PD DEFICIENCY 10. PYRUVATE KINASE DEFICIENCY 11. PYRIMIDINE-5-NUCLEOTIDASE (PN) DEFICIENCY 12. GLUCOSE PHOSPHATE ISOMERASE DEFICIENCY 13. TRIOSEPHOSPHATE ISOMERASE, HEXOKINASE AND DIPHOSPHOGLYCERATE MUTASE DEFICIENCY 14. GLUTATHIONE SYNTHASE, GLUTATHIONE PEROXIDASE AND GLUTATHIONE REDUCTASE DEFICIENCIES

inherited sex-linked • complex heterogeneous disorder w/c is ubiquitous • most common defect seen in enzyme deficient hemolytic anemia • Type A, Type B & Favism o Type A: seen in___; clinically mild hemolytic condition o Type B: seen in_____ ; more susceptible to sever oxidant hemolysis than type A o Type B worse than Type A o___\\: most delicate & life threatening that occurs 1 hour after eating fava beans LABORATORY TESTS: • Methyl violet or crystal violet stains • Dye Reduction test • Ascorbate Cyanide test • Fluorescent Spot test • Quantitative Assay of G6PD

G6PD blacks Mediterraneans Favism

the most common red cell enzyme deficiency involving the Embden-Meyerhof glycolytic pathway • inherited disorder, • PK converted to phosphophenolpyruvate to pyruvate in the EMP w/ the production of ATP • rbc loses its flexibility due to decrease ATP • mild to moderately hemolytic anemia w/ splenomegaly PBS no notable red cell abnormalities until after splenomegaly • ecchinocytes • irregularly contracted red cells • crenated red cells may be prominent LAB FINDINGS Reticulocyte count is elevated • Fluorescent test – positive • Quantitative assay of PK

PYRUVATE KINASE DEFICIENY

inherited • caused by an abnormality in nucleotide metabolism • acquired occurs in lead poisoning & responsible for the • • • Anemia of chronic inflammation Iron deficiency anemia Unexplained anemia • Vitamin b12 deficiency • Sideroblastic anemia • Thalassemia basophilic stippling LAB Reticulocytosis is observed Positive in the demonstration of decreased Nucleosidase activities PBS There are marked basophilic stipplings in red cells

PYRIMIDINE-5-NUCLEOTIDASE (PN) DEFICIENCY

this causes an abnormality in anaerobic glycolysis causes a moderately severe anemia LAB Reticulocyte count may be significantly increased PBS red cells show anisocytosis and Poikilocytosis

GLUCOSE PHOSPHATE ISOMERASE DEFICIENCY

are other enzyme deficiencies that involve anaerobic glycolysis.

TRIOSEPHOSPHATE ISOMERASE, HEXOKINASE AND DIPHOSPHOGLYCERATE MUTASE DEFICIENCY 14

also show hemolytic anemia - these enzymes are required in the HMP like G-6-PD, hemolysis increase due to oxidant drug exposure or infection.

GLUTATHIONE SYNTHASE, GLUTATHIONE PEROXIDASE AND GLUTATHIONE REDUCTASE DEFICIENCIES

EXTRINSIC HEMOLYTIC ANEMIA CAUSES

Causes: 1. Chemical agents – drugs and chemicals 2. Physical agents – heat, trauma 3. Vegetable and animal poisons 4. Infectious agents – malarial parasite, bacteria 5. Presence of autoantibodies, isoantibodies or drug-related antibodies causes

Hemoglobin less than 13g/dl in males and less than 12g/dl in females FACTORS CONTRIBUTING Decreased bone marrow function • Decline in physical activity • Nutritional deficiencies • Cardiovascular disease • Chronic inflammatory disorders HYPOPROLIFERATION Secondary to iron deficiency • Vitamin b12 or folate deficiency • Renal failure • Hypothyroidism • Chronic inflammation • Endocrine disease MOST COMMON AMONG ELDERLY Anemia of chronic inflammation Iron deficiency anemia Unexplained anemia INEFFECTIVE ERTHROPOIESIS Vitamin b12 deficiency • Sideroblastic anemia • Thalassemia

ANEMIA AND THE ELDERLY

Lab evaluation: CBC, retic count, peripheral blood film review, chemistry panel, iron studies, vit b12 and folate levels, free erythrocyte porphyrin o Hypoproliferative anemia o Most common form of anemia in the hospitalized geriatric population Impaired erythropoietin-dependent erythrocytosis – involved in the pathogenesis of this diseas

ANEMIA AND THE ELDERLY

Affects both erythrocytes and metabolic pathways of iron- dependent tissue enzymes Results from conditions leading to chronic gastrointestinal blood loss, including long term use of nonsteroidal inflammatory medications, gastritis, peptic ulcer disease, gastropharyngeal reflux disease and angiodysplasia

IRON DEFIENCY ANEMIA

Sideroblastic anemia – impaired heme synthesis and abnormal globin synthesis Megaloblastic anemia – defective DNA synthesis; results in ineffective erythropoiesis (deficiency of vitamin B12 and folate)

INEFFECTIVE ERYHTROPOIESIS

Megaloblastic anemia in 5 -10% of elderly Attributed to inadequate intestinal absorption of found bound vitamin B12 and pernicious anemia • Loss of gastric acid – bacterial growth: Helicobacter pylori

VITAMIN B12 deficiency

Develops from inadequate dietary intake • Alcoholic elderly are more prone because alcohol interferes with folate absorption

FOLATE DEFICIENCY

Shortened RBC survival time • Drug induced haemolytic anemia – high doses of antibiotics, non steroidal inflammatory drugs, quinidine, phenacetin, etc. • Also results from collagen vascular disease, infections, chronic lymphocytic leukemia • Major types: o Caused by immunologic mechanisms o Due to intrinsic effects o Resulting from extrinsic factors

HEMOLYTIC ANEMIA

ANEMIA Flashcards

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