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09 Hematology > Anemia 2 > Flashcards

Anemia 2 Flashcards

1
Q

causes for megaloblastic anemia

A

cobalamin (b12) or folate (b9) deficiency

important in purine synthesis -> dna synthesis

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2
Q

sources of cobalamin and folate

A

folic acid: uncooked green leafy vegetables

cobalamin: meat

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3
Q

causes of decreased intake of folate

A 
poor nutrition
old age, poverty, alcoholism
hemodialysis
premature infants
spinal cord injury
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4
Q

causes of impaired absorption of folate

A

tropical and non-tropical sprue

other diseases of small intestine

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5
Q

causes of increased requirement for folate

A

pregnancy
chronic hemolytic anemia
exfoliative dermatitis

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6
Q

causes of impaired absorption of cobalamin

A

gastric

  • pernicious anemia
  • gastrectomy (intrinsic factor)
  • zollinger ellison syndrome

intestinal causes

  • ileal resection/disease
  • blind loop syndrome
  • fish tapeworm (d. latum)
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7
Q

causes of decreased intake of cobalamin

A

strict veganism

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8
Q

drugs that cause megaloblastic anemia

A

dihydrofolate reductase inhibitors in chemo
antimetabolites in chemo
inhibitors of deoxynucleotide synthesis
anticonvulsants
oral contraceptives
long term exposure to weak folate antagonists

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9
Q

smear findings in megaloblastic anemia

A

large red cells
large precursor cells in the marrow
neutrophils with hypersegmentation (only 3-5 segments)

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10
Q

treatment for megaloblastic anemia

A 
oral or parenteral (for gastrectomy) cobalamin
folate supplementation (green leafy vegetables, meat)
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11
Q

third most common cause of hypoproliferative anemia

A

anemia of inflammation or chronic disease

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12
Q

type of anemia in inflammation or chronic disease

A

normocytic normochromic anemia
normal to high (reactant) ferritin
low serum iron!!

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13
Q

pathophysio of anemia of inflammation or chronic disease

A

monocytes and t-cells are activated -> secrete ifn-y, tnf-a, interleukins -> inhibit release of epo + inhibit proliferation in marrow + increase hepatic synthesis of hepcidin -> iron is not released from stores and cannot absorb iron from gi tract -> low serum iron

augmented hemophagocytosis = eat more red cells

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14
Q

other effects of cytokine release

A 
il1 = dec epo production
tnf = suppresses epo response

== INCREASE LIVER SYNTHESIS OF HEPCIDIN

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15
Q

treatment of anemia of inflammation or chronic disease

A

treat underlying disease

epo or exogenous epo

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16
Q

characteristics of iron deficiency

A 
mild to severe anemia
microcytic hypochromic
low serum iron
low serum ferritin
high tibc
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17
Q

characteristics of inflammation anemia

A 
mild
normocytic, normochromic
low serum iron!!
normal to high serum ferritin
normal to low tibc
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18
Q

characteristics of renal disease

A

mild to severe anemia
normocytic normochromic
no epo production

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19
Q

presentation of aplastic anemia

A

hypoproliferative anemia = pancytopenia

decreased proliferation of ALL cell lines, not just rbcs
immune mediated t-cell destruction

20
Q

common cause of aplastic anemia

A

idiopathic

21
Q

drugs that cause aplastic anemia

A 
benzene
chloraphenicol
chemo drugs
nsaids
anticonvulsants
22
Q

viruses that cause aplastic anemia

A

hepatitis
hiv
parvovirus
ebv

23
Q

other acquired causes of aplastic anemia

A

radiation
immune diseases
paroxysmal nocturnal hemoglobinuria
pregnancy

24
Q

inherited causes of aplastic anemia

A

fanconi anemia
dyskeratosis congenita
schwachman-diamond syndrome

25
Q

histology of aplastic anemia

A

devoid of hematopoietic elements

dominated by fat spaces

26
Q

moderately severe aplastic anemia

A

hg <100 g/L
reticulocyte < 40 x 10^9/L
neutrophil <1.5 x 10^9/L
platelet <50 x 10^9/L

27
Q

severe aplastic anemia

A

hg < 90 g/L
reticulocyte < 30 x 10^9/L
neutrophil <0.5 x 10^9/L
platelet <30 x 10^9/L

28
Q

very severe aplastic anemia

A

hg <80 g/L
reticulocyte <20 x 10^9/L
neutrophil <0.2 x 10^9/L
platelet <20 x 10^9/L

29
Q

treatment of aplastic anemia

A

hematopoietic stem cell transplantation = BEST TREATMENT

supportive treatment:

  • red cell or platelet transfusion
  • immunomodulatory agents (anti-thymocyte globulins, cyclosporine)
30
Q

triad of paroxysmal nocturnal hemoglobinuria

A

pancytopenia
intravascular hemolysis
venous thrombosis

31
Q

pathophysio of pnh

A

loss of phosphatidyl inositol glycan = loss of cd55 and cd59 = hemolysis

32
Q

diagnosis of pnh

A

fluorescent aerolysin toxin (flaer)

ham’s test or acidified serum lysis test

33
Q

treatment of pnh

A

hematopoietic stem cell transplant (have pig = cd55 and cd59)
eculizumab (prevents complement mediated hemolysis)
low dose steroids
supportive transfusions

34
Q

features of hemolytic anemia

A 
jaundice, pallor
splenomegaly
frontal bossing (congenital)
low hemoglobin
increased mcv and mch
increased unconjugated bilirubin
increased lactate dehydrogenase (high cell turnover)
reduced to absent haptoglobin
35
Q

classificaiton of hemolytic anemias

A

figure 9

36
Q

inherited hemolytic anemias

A 
hereditary spherocytosis (ankirin or spectrin deficiency, high mchc)
hereditary elliptocytosis (membrane defect)
37
Q

diagnosis of inherited hemolytic anemias

A

cbc
morphology
osmotic fragility test

38
Q

treatment of inherited hemolytic anemias

A

supportive transfusion

splenectomy and gallbladder removal

39
Q

___ is used in the hexose monophosphate shunt

A

glucose 6 phosphate dehydrogenase

40
Q

purpose of hmp shunt

A

production of 5 carbon sugars in dna synthesis (deoxyribose and ribose)
only pathway to produce nadph

nadph is used in glutathione production to neutralize free radicals

41
Q

treatment of g6pd deficiency

A

avoidance of oxidative stressors (e.g. fava beans)

avoid certain drugs

42
Q

drugs that risk critical hemolysis

A

antimalarials

  • primarquine, dapsone, chlorproguanil
  • chloroquine

sulfonamides/suphones
- sulfamethoxazole, dapsone

antibiotics

  • cotri
  • nadilixic acid
  • nitrofurantoin
  • niridazole

antipyretics/analgesics

  • acetanilide
  • phenazopyridine

others: naphthalene, methylene blue, rasburicase

43
Q

patho in autoimmune hemolytic anemia

A

red cell is coated with autoantibody due to failure of immune tolerance or autoimmune mechanisms = destroyed by macrophages

44
Q

diagnosis of aiha

A

coombs test = coagulation of red cells

45
Q

treatment of aiha

A

immunosuppression
- steroids
-rituximab: anti cd20 antibody
kills b cells that produce antibodies

09 Hematology (9 decks)

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