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Flashcards in Anemia 2 Deck (75):
1

What level of Hb defines anemia in adults (men, women, pregnant women)?

Men

2

What is the most common cause of B12 deficiency? Folate?

***

3

How long does it take for B12 deficiency to present? Folate?

***

4

What is the treatment for B12 deficiency? Folate?

***

5

What is the chemical released by the kidneys that stimulate bone marrow production of RBCs?

EPO

6

What are the three measures that define anemia?

Low Hb
Low Hct
Low RBC

7

High hb = ?

Polycythemia

8

HIgh HCT = ?

Polycythemia

9

High RBC count = ?

Thalassemia

10

What is the equation for the absolute reticulocyte count?

(RBC count)*(% reticulocytes) /100

11

Under what number can reticulocytosis be excluded (for the reticulocyte count)?

12

What are the three ways in which we classifty anemias?

Onset (acute vs chronic)
Pathophysiology
Morphology

13

What are the two different categories of pathophysology for anemia?

Hyporoliferative
Proliferative

14

What is the usual cause of macrocytic anemia?

Defect in the maturation of RBCs

15

Normocytic anemia is usually caused by what?

Decreased production or increased destruction

16

Micro or macrocytic anemia: iron deficiency?

Micro

17

Micro or macrocytic anemia: anemia of chronic disease

micro

18

Micro or macrocytic anemia: thalessemias?

Micro

19

Micro or macrocytic anemia: siderblastic anemia?

Micro

20

Micro or macrocytic anemia: B12 deficiency

Macro

21

Micro or macrocytic anemia: folic acid deficiency

Macro

22

Micro or macrocytic anemia: drug related?

macro

23

Micro or macrocytic anemia: hypothyroidism

Normo

24

Micro or macrocytic anemia: liver disease

Normo

25

Micro or macrocytic anemia: alcoholism

normo

26

Micro or macrocytic anemia: myelodysplastic syndrome

Normo

27

What are the three general causes of intrinsic hemolytic anemia?

Membrane defects
Enzymatic defects
Hemoglobinopathies

28

What are the three general causes of extrinsic hemolytic anemias?

Autoimmune
Splenomegaly
Infections

29

What is the PMN findings for megaloblastic anemias?

Hypersegmented neutrophils

30

What are the sources for B12? Folate?

B12 = meat
Folate = green leafy vegetables

31

Where is B12 absorbed? Folate?

B12 = ileuem
Folate = proximal jejunum

32

What are the daily requirements for B12?

1-3 mcg

33

What are the daily requirements of folate?

50-100 mcg

34

How long does it take to become folate deficient? B12?

Folate = 3-4 months
B12 = 3-4 years

35

Which has a more rapid onset: B12 deficiency d/t malabsorption or dietary deficieny

Malabsorption

36

What are the two reactions that B12 is necessary in?

Methionine synthesis
Conversion of methylmalonic acid to succinyl-CoA

37

What intestinal disease is known to lead to B12 deficiency?

Crohn's

38

What are the two drugs that can lead to B12 deficiency?

Metformin
PPIs

39

B12 deficiency that presents a few weeks after birth = ?

Congential transcobalamin deficiency

40

B12 deficiency that presents at birth?

Congenital methylmalonic acidemia

41

Why are parethesias common in B12 deficiencies?

Demyelination

42

True or false: babinski's sign may be present with B12 deficiency

True

43

What happens to the reticulocyte count with B12 deficiencies?

Lower

44

What are the histological characteristics of PMNs in b12 deficiencies?

Hypersegmented (may lobes)

45

What is the treatment for B12 deficiency?

B12 1000mcg IM/SQ weekly, then monthly

46

What mineral must be monitored carefully during the treatment for B12 deficiency?

K (hypokalemia)

47

How long does it take Hb levels to return to normal following treatment with B12?

2 months

48

What causes the paresthesias with B12 deficiency?

Demyelination of the dorsal colums/ML pathways

49

Pts who have undergone what surgical procedure require B12 supplementation?

Gastrectomy

50

What is the most common cause of pernicous anemia?

Autoimmune attack against parietal cells

51

What are the tests for pernicous anemia now-a-days?

Parietal cell / IF antibody test

52

What would you expect gastric serum levels to be in a patient with pernicious anemia? Serum pepsinogen levels?

Gastrin high
Pepsinogen low

53

What would a biopsy of a stomch of a pt with pernicious anemia show?

Death of parietal cells, repalced with mucus cells

54

Borderline B12 levels is accompanied by what lab values in a pt with subclinical B12 deficiency?

Elevated Homocysteine /methylmalonic acid levels

55

What is the most common cause of folate deficiency anemia?

Inadequate dietary intake

56

Folate deficiency signs/symptoms are the same as B12, except for what?

B12 has neurological symptoms, while Folate does not

57

What are the signifiant lab findings with folate deficiency?

Low Hb
Low serum RBC/folate level

58

What is the methylmalonic acid level in pts with folate deficiency?

Normal

59

What is the treatment for folate deficiency?

1-5 mg/day oral folate

60

How long does it take for folate to reach normal levels?

8 weeks

61

What are the homocysteine levels in folate deficiency?

High

62

What are the two autoimmune causes of aplastic anemia?

idiopathic
SLE

63

What is the congenital cause of aplastic anemia?

Defected in telomere length maintenance

64

What are the toxins that can cause aplastic anemia? (3)

Benzene
Toluene
Insecticides

65

What is the virus that can cause aplastic anemia in the post-viral state?

Hepatitis

66

What treatment can cause aplastic anemia?

Chemotherapy

67

What are the CBC findings with aplastic anemia?

Panytopenia

68

What are the signs/symptoms of aplastic anemia? (4)

Immune suppression
Fatigue
Petechiae
HSM

69

True or false: LA / bone pain can be symptoms of aplastic anemia

False-- think osteosarcoma if these are present

70

True or false: reticulocytoenia is always present with aplastic anemia

True

71

What is the test that you should always order for patients with aplastic anemia?

Bone marrow biopsy

72

What is the treatment for mild aplastic anemia? Severe?

Symptomatic treatment for mild

Bone marrow transplant for severe

73

What are the methylmalonic acid levels in B12 deficiency? Folate deficiency?

b12 = high
Foalte = low

74

What are the serum folate levels in folate deficiency? B12/

B12 = normal
Folate = low

75

What are the CBC findings for aplastic anemia?

Pancytopenia