Anemia 2 Flashcards by Wendy Pitts

Normochromic/Normocytic Anemias (NNA) causes:

w/ ↑ retic count?

w/ normal retic count?

w/ ↑ retic count:
post hemorrhage or recent (not chronic) hemolysis

w/ normal retic count:

+ normal bone marrow = ACD, hypothyroidism, liver dx

+ abnormal bone marrow = myelofibrosis, leukemia, myeloma, metastases, renal failure

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Megaloblastic (macrocytic) Anemias caused by?

B12 and/or folate deficiency

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B12 and/or folate deficiency result in?

defective DNA synth =

disordered RBC maturation ->
cytoplasmic RNA accumulation ->
large RBCs

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Difference in Peripheral Smear and Bone Marrow results for B12 and folate deficiency?

none, they appear identical

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What happens if tx B12 deficiency as a Folate deficiency?

Folate replacement alone will correct blood picture, HOWEVER,
must replace B12 also or will results in neuro damage (degen of spinal cord)

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Cobalamin (B12) absorption?

Daily requirement?

Binds to IF in stomach ->
released from IF and absorbed in ileum

Cobalamin (B12) daily requirement = 1 - 2 µg

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Pernicious Anemia is?

Results in?

Autoimmune disorder causing autoantibodies against gastric parietal cells ->
results in IF deficiency

B12 malabsorption

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Other causes of B12 malabsorption? (4)

gastrectomy
iliac dx
bacteria
parasites

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Pernicious Anemia clinical findings?

anemia sxs
glossitis
jaundice
splenomegaly

neuro findings:
↓ vibratory and position sense
ataxia
paresthesia
confusion

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Pernicious Anemia typical Lab Results:

MCV

Peripheral Smear

B12

other findings

MCV = ↑ (macro)

Peripheral Smear =
hypersegmented neutrophilis,
Anisocytosis,
Poikilocytosis,
macro-ovalocytes (large, oval RBCs)

B12 = ↓

other findings =
+ Schilling test,
IF antibodies,
↑ methylmalonic acid AND homocystiene levels

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Pernicious Anemia tx?

parenteral B12:
daily x 7d ->
weekly x 4w ->
monthly x life

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Folic Acid daily requirement?

Half-life?

200 µg/day (400 - 800 for preggos)

3 wk half-life

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Folic Acid deficiency for how long causes anemia?

4-5 months

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Causes of Folate Deficiency?

alcoholism
end term of pregnancy
anticonvulsant therapy
malabsorption
hemolytic anemias

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Folate Deficiency clinical findings?

typical anemia

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Folate Deficiency typical Lab Findings?

folate = ↓

methylmalonic acid = normal
homocysteine = ↑

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Folate Deficiency tx?

tx underlying cause
folate replacement ( 1 mg PO QD or 5 mg if malabsorb)

r/o co-existing B12 deficiency

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Hemolytic Anemia is?

early destruction of RBCs

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↑ bone marrow production can compensate for early RBC destruction down to how may days?

20 days
(can sustain 2 - 5 times normal RBC production)

RBCs destroyed in less then 20 days, bone marrow can’t compensate

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Hemolytic Anemia clinical findings?

typical anemia
jaundice
gallstones (U) bilirubin
↑ risk of salmonella or pneumococcus infections

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Hemolysis classifed how? (3)

1) duration (acute/chronic)
2) acquired or inherited
3) main site of lysis

Intravascular vs Extravascular hemolysis?

intra - destruction of RBC in blood stream

extra - destruction of RBC in reticuloendothelial system, (U) spleen

Hemolysis typical Lab Results:

Retic count

Peripheral smear

other findings

Retic count = ↑

Peripheral Smear =
immature RBC,
nucleated RBC,
fragments RBC (schistocytes)

↑ uncong bilirubin
↑ LDH
↑ plasma Hgb

Haptoglobin is?

serum levels of haptoglobin in Hemolysis?

mucoprotein from liver ->
binds Hgb from lysed RBC ->
bound haptoglobin catabolized ->
free haptoglobin ↓

Serum Haptoglobin = ↓ in INTRAvascular hemolysis

Intravascular Hemolysis caused by? (3)

Fragmentation syndromes: -macro or microangiopathic Red cell enzyme defects: -G6PD deficiency Paroxysmal nocturnal Hgburia

Extravascular Hemolysis caused by? (5)

``` Hereditary Spherocytosis Sickle Cell Autoimmune Hemolytic Anemia Incompatible blood transfusion Drug-induced ```

Hereditary Spherocytosis is? Results in?

auto-dominant disorder dense RBCs w/ smaller surface area (normal MCV), RBCs w/ globular appearance and no central pallor, RBCs trapped in splenic sinusoids

Hereditary Spherocytosis clinical findings?

(U) asymp mild jaundice/scleral icterus, splenomegaly

Hereditary Spherocytosis may cause what 2º anemia?

megaloblastic anemia due to inadequate folate: | hemolysis causes need for ↑ folate

Hereditary Spherocytosis test?

Osmotic fragility test: Defect in RBC membrane results in ↑ RBC destruction when exposed to hypotonic solution

Hereditary Spherocytosis tx?

splenectomy: RBC lifespan returns to normal, ends risk of bilirubin gallstones pneumo vaccine to combat splenectomy's ↑ risk of infections

Sickle Cell Anemia (SCA) is?

auto-recessive Hgb structure disorder, | RBCs misshaped when deoxygenated

Sickle Cell homozygous vs heterozygous forms?

``` homo = disease (Hb SS) hetero = trait/carrier (Hb S + Hb A) ```

SCA epidemiology?

ºBlacks | M=F

SCA signs/sxs?

start 4-6 mo (fetal Hgb ∆ to adult Hgb), delayed development, ↑ infections

SCA signs/sxs precipitated by? (4)

dehydration hypoxia high altitude intense exercise

SCA chronic hemolysis results in? (2)

``` aplastic crisis (sudden ↑ in Hgb), bilirubin gallstones ```

SCA vaso-occlusive ischemic tissue injury results in? (5)

``` pain crisis, osteonecrosis of femoral/humeral heads, MI, splenic infarc, leg ulcers ```

SCA typical Lab Results: Hgb color/size Retic count Peripheral smear other

Hgb = 5 - 11 g/dl color/size = normo/normo Retic count = ↑ ``` Peripheral smear = sickled RBCs, nucleated RBCs, target cells, Howell-Jolly bodies, thrombocytosis ``` other: Hgb electrophoresis = Hb S

Howell-Jolly Bodies are?

nuclear remnants U removed by spleen (black dots)

SCA tx? (4)

RBC transfusion, pain management, hydroxyurea (chemo) to ↓ bone marrow fxn Ѧ pain crisis, bone marrow transplant

Autoimmune Hemolytic Anemia (AIHA) caused by?

antibodies to RBC -> fixes complement -> causes body to destroy cell

RBC w/ antigen/antibody complex destroyed how?

phagocytized by macrophages -> form spherocytes -> spleen destroys

Hemolysis tx?

tx cause, corticosteroids, splenectomy, folic acid

Most antibodies to RBC directed against?

ABO/Rh antigens

Coomb's test detects what?

patient antibodies coating transfused RBCs

Aplastic Anemia is?

acquired bone marrow stem cell abnormality: | total or selective (RBC, WBC, platelets)

Aplastic Anemia etiology?

> 50% idiopathic 20% drug/chemical 10% viral (P) ionizing radiation

Aplastic Anemia clinical findings?

weakness, infections, bleeding Pancytopenia (hallmark): anemia, leukopenia, thrombocytopenia bone marrow = absent precursors

Aplastic Anemia tx?

``` tx cause, r/o DDx, blood component replacement, bone marrow transplant, immunosuppressant ```