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09 Hematology > Anemia 2 > Flashcards

Anemia 2 Flashcards

(45 cards)

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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

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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

21
Q

drugs that cause aplastic anemia

Study These Flashcards
A 
benzene
chloraphenicol
chemo drugs
nsaids
anticonvulsants
22
Q

viruses that cause aplastic anemia

Study These Flashcards
A

hepatitis
hiv
parvovirus
ebv

23
Q

other acquired causes of aplastic anemia

Study These Flashcards
A

radiation
immune diseases
paroxysmal nocturnal hemoglobinuria
pregnancy

24
Q

inherited causes of aplastic anemia

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A

fanconi anemia
dyskeratosis congenita
schwachman-diamond syndrome

25
histology of aplastic anemia
devoid of hematopoietic elements | dominated by fat spaces
26
moderately severe aplastic anemia
hg <100 g/L reticulocyte < 40 x 10^9/L neutrophil <1.5 x 10^9/L platelet <50 x 10^9/L
27
severe aplastic anemia
hg < 90 g/L reticulocyte < 30 x 10^9/L neutrophil <0.5 x 10^9/L platelet <30 x 10^9/L
28
very severe aplastic anemia
hg <80 g/L reticulocyte <20 x 10^9/L neutrophil <0.2 x 10^9/L platelet <20 x 10^9/L
29
treatment of aplastic anemia
hematopoietic stem cell transplantation = BEST TREATMENT supportive treatment: - red cell or platelet transfusion - immunomodulatory agents (anti-thymocyte globulins, cyclosporine)
30
triad of paroxysmal nocturnal hemoglobinuria
pancytopenia intravascular hemolysis venous thrombosis
31
pathophysio of pnh
loss of phosphatidyl inositol glycan = loss of cd55 and cd59 = hemolysis
32
diagnosis of pnh
fluorescent aerolysin toxin (flaer) | ham's test or acidified serum lysis test
33
treatment of pnh
hematopoietic stem cell transplant (have pig = cd55 and cd59) eculizumab (prevents complement mediated hemolysis) low dose steroids supportive transfusions
34
features of hemolytic anemia
``` 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
classificaiton of hemolytic anemias
figure 9
36
inherited hemolytic anemias
``` hereditary spherocytosis (ankirin or spectrin deficiency, high mchc) hereditary elliptocytosis (membrane defect) ```
37
diagnosis of inherited hemolytic anemias
cbc morphology osmotic fragility test
38
treatment of inherited hemolytic anemias
supportive transfusion | splenectomy and gallbladder removal
39
___ is used in the hexose monophosphate shunt
glucose 6 phosphate dehydrogenase
40
purpose of hmp shunt
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
treatment of g6pd deficiency
avoidance of oxidative stressors (e.g. fava beans) | avoid certain drugs
42
drugs that risk critical hemolysis
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
patho in autoimmune hemolytic anemia
red cell is coated with autoantibody due to failure of immune tolerance or autoimmune mechanisms = destroyed by macrophages
44
diagnosis of aiha
coombs test = coagulation of red cells
45
treatment of aiha
immunosuppression - steroids -rituximab: anti cd20 antibody kills b cells that produce antibodies

09 Hematology (9 decks)

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