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Flashcards in Anemia Deck (89)
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0
Q

Anemia is a disorder characterized by a reduction in the amount of hemoglobin present in blood and a decrease in RBC count. The blood hemoglobin concentration is believed to be a better marker of the total cell mass than than which other test?

A

hematocrit

1
Q

Diagnostic evaluation of anima starts with ______

A

Hemoglobin

2
Q

Classification of Anemia Based on what 2 things?

A

RBC size and RDW

3
Q

With a cell size of Microcytosis (MCV <80) which condition would show a normal RDW? An increased RDW?

A

Normal: Thalassemia minor
Increased: Iron deficiency anemia and G6PD deficiency

4
Q

With a cell size of Nomocytosis which condition would show a normal RDW? An increased RDW?

A

Normal: Acute bleeding
Increased: Early or partially treated iron or vitamin deficiency and sickle cell disease

5
Q

With a cell size of Macrocytosis (MCV >100) which condition would show a normal RDW? An increased RDW?

A

Normal: Aplastic anemia, myelodysplastic syndrome
Increased: Vitamin B12 or folate deficiency, alcohol, liver disease

6
Q

Whenever anemia is suspected or discovered with a CBC, order a ______ __________ to check for cell abnormalities.

A

peripheral smear

7
Q

Basophilic stippling representing aggregated ribosomes can be seen in which 3 conditions?

A
  • thalassemia syndromes
  • iron deficiency
  • lead poisoning
8
Q

Howell-Jolly bodies are nuclear remnants seen in which 3 conditions?

A
  • asplenia
  • pernicious anemia
  • severe iron deficiency
9
Q

Cabot’s ring bodies are nuclear remnants seen in which 3 conditions?

A
  • lead toxicity
  • pernicious anemia
  • hemolytic anemias
10
Q

Heinz’s bodies are from denatured aggregated hemoglobin and can be seen in which 3 conditions?

A
  • thalassemia
  • asplenia
  • chronic liver disease
11
Q

Which 2 tests detect Spherocytes? What do they indicate?

A
  1. Coombs DAT: indicates immune mediated hemolytic anemia (AIHA) 2. Osmotic fragility increased: indicates spherocytosis (HS)
12
Q

When looking for Fragments, which test would be best, and what does it assess?

A

Disseminated Intravascular Coagulation (DIC) screen to assess: intravascular thrombus

13
Q

With Sickle cells and target cells, which screen is used?

A

Hemoglobin electrophoresis

14
Q

When screening for Nucleated RBC which exams would be used?

A
  1. Hemoglobin electrophoresis (HGBE)

2. Bone marrow examination

15
Q

Microcytic hypochromic anemia is caused by which 3 main things and which 4 minor things:

A

Main:

  1. Iron deficiency anemia (IDA)
  2. Thalassemia
  3. Sideroblastic anemia

Minor:

  1. Anemia of chronic disease (some cases)
  2. Pyridoxine Responsive anemia
  3. Chronic blood loss
  4. Lead poisoning
16
Q

Lack of iron or inability to use iron for heme production for Iron deficiency is a result of which 3 situations?

A
  1. Chronic Blood loss
  2. Dietary lack during high demand
  3. Poor absorption of food iron
17
Q

Lack of iron or inability to use iron for heme production for poor iron mobilization from body stores results in what?

A

inflammatory states

18
Q

Lack of iron or inability to use iron for heme production for Sideroblastic anemia is due to what?

A

Failure of iron incorporation into protoporphyrin ring leads to RBC iron precipitation called Basophilic stippling and causes polychromasia

19
Q

Defective globin chain synthesis involves which 2 conditions?

A
  1.   Alpha-thalassemia

2.   Beta-thalassemia

20
Q

What is the most common microcytic hypochromic anemia?

A

Iron deficiency anemia

21
Q

In the GI tract, iron is chiefly absorbed from the _________

A

Duodenum

22
Q

Dietary Iron absorption is facilitated by what?

A

gastric acid secretion

23
Q

What has come to be recognized as the “gold” standard operation for treatment of morbid obesity? Exclusion of nearly all of the stomach & the entire duodenum predisposes these patients to develop vitamin/mineral deficiencies.

A

RYGB: Roux-en-Y Gastric Bypass

24
Q

Average western diet includes what daily intake of iron?  What is the % of absorption?

A
  • 10-30 mg daily

- Absorption is 5-10% of intake

25
Q

Total body iron is about ___ grams

A

4

26
Q

Total iron absorption is approximately 1 or 2 mg a day, balanced by about the same daily loss, mostly through what 2 means?

A
  • skin desquamation

- in the stool

27
Q

Many common foods interfere with iron absorption, what are 3 examples?

A
  • phytates in cereal & grains
  • vegetables (very high in soy)
  • casein in milk
28
Q

___% of body total is incorporated into hemoglobin

___% of body total is stored as ferritin

A

70%

30%

29
Q

What transports absorbed iron from intestine to bone marrow?

A

Transferrin

30
Q

When assessing for IDA use iron indices, use which 4 laboratory parameters to make an accurate diagnosis?

A
  1. serum iron level
  2. total iron-binding capacity
  3. percentage transferrin saturation
  4. serum ferritin level
31
Q

With IDA laboratory tests, which test is the measurment of the iron bound to transferrin?

A

Serum Iron

32
Q

Severe stress decreases serum iron values by ___%

A

65

33
Q

Which 6 conditions will increased serum iron values?

A
  1. Hemosiderosis or hemochromatosis
  2. Iron poisoning
  3. Hemolytic anemia
  4. Massive blood transfusions
  5. Liver dz
  6. Lead toxicity
34
Q

Which 5 conditions will decreased serum iron values?

A
  1.   Dietary deficiency
  2. Chronic blood loss
  3.   Malabsorption
  4.   Pregnancy – late
  5. Neoplasia
35
Q

What are 4 interfering factors with iron measurements?

A
  1. Recent blood transfusions
  2. Recent ingestion of high iron meal or supplements
  3. Hemolytic diseases
  4. Drugs
38
Q

What is the measurement of all proteins available for binding mobile iron?

A

Total iron binding capacity: TIBC

39
Q

Which 4 conditions will have increased TIBC or transferrin?

A
  1. Estrogen therapy
  2. Pregnancy – late
  3. Polycythemia vera
  4. Iron def. Anemia
40
Q

Which 6 conditions will have decreased TIBC or transferrin?

A
  1.   Malnutrition
  2. Hypoproteinemia
  3. Inflammatory diseases
  4. Cirrhosis
  5. Hemolytic, pernicious
  6. Sickle cell anemias
41
Q

Most iron in circulation is bound to what? TIBC is an indirect measurement of this.

A

transferrin

42
Q

Ferritin not included in TIBC, why?

A

only binds stored iron

45
Q

What is the major iron-storage protein? Where is it primarily found?

A

Ferritin; in the liver

46
Q

T/F: Ferritin is a good indicator of available iron stores in the body.

A

True

47
Q

Ferritin is normally present in serum in concentrations directly related to iron storage. 1 ng/ml serum ferritin corresponds to about ___ mg of stored iron. Levels below 11 in women and 24 in men mg/dl = diagnostic for which condition?

A

8; IDA

48
Q

Ferritin levels rise persistently in which 2 populations?

A

males and post-menopausal females

49
Q

T/F: Severe protein depletion can decrease ferritin levels.

A

True

50
Q

T/F: Normal levels of ferritin will exclude iron deficiency

A

FALSE!!! Normal levels does NOT exclude iron deficiency

51
Q

Ferritin is factitiously __________ in patients with chronic disease states

A

elevated

52
Q

Ferritin acts as acute phase reactant protein. It ___________ 1-2 days after onset of acute illness, peaking at __-__ days

A

increases; 3-5

53
Q

What are 5 interfering factors for lab testing ferritin?

A
  1. Recent blood transfusion, high iron intake
  2. Hemolytic dz
  3. Excess iron storage dz
  4. Menstruation
  5.   Recent administration of radionuclide if test is performed via RIA
54
Q

What are 6 causes for increased ferritin levels?

A
  1. Hemochromatosis, hemosiderosis
  2. Megaloblastic anemia
  3. Hemolytic anemia
  4. Alcoholism
  5. Inflammatory dz
  6. Advanced cancers
55
Q

What are 3 causes of decreased ferritin levels?

A
  1. Iron deficiency anemia
    2 Severe protein deficiency
  2. Hemodialysis
56
Q

What are the three stages of iron deficiency?

A
  1. iron depletion (reduced stores)
  2. early iron deficiency anemia (depleted stores, normal MCV, and red cell morphology)
  3. advanced iron deficiency anemia
57
Q

In IDA, PLT count may be ________ secondary to BM stimulation. Reticulocyte count will be _________.

A

increased; decreased

58
Q

In IDA, PB smear will show __________ __________ RBC

A

microcytic hypochromic

59
Q

Free erythrocyte protoporphyrin (FEP) a precursor to HgB is _________ in IDA but _________ in thalassemia.

A

increased; normal

60
Q

According to the Mentzer Index: Ratio of MCV/RBC:

Ratio 13 indicates ______

A

Thalassemia; IDA

61
Q

What is an inherited disorder of globin chain synthesis and can affect either alpha or beta chain production?  Homozygous is which form? Heterozygous?

A

Microcytic hypochromic anemias thalassemia
Homozygous: major
Heterozygous: minor

62
Q

B-Thal Major smear exhibits which 4 types of cells?

A
  1. microcytic hypochromic cells
  2. basophillic stippling
  3. target cells
  4. NRBC’s
63
Q

Which microcytic hypochromic anemia has the following conditions?
•  Serum iron increased
•  TIBC decreased or normal
•  % saturation increased
•  Ferritin increased or normal
•  Reticulocyte count increased
•  Serum LDH may be increased with active hemolysis

A

Thalassemia

64
Q

What is a carrier for FREE plasma HGB- levels tend to be reduced due to hemolysis?

A

Haptoglobin

65
Q

Hp levels ___________ with increased RETIC and decreased RBC/Hbg/Hct –> points to which condition?

A

DECREASED; hemolytic anemia

66
Q

What is happening when Hp levels DECREASE without signs of hemolytic anemia?

A

Liver is not making enough Hp

67
Q

What is happening when Hp levels are normal with increased RETIC?

A

RBC destruction in the spleen/liver with no free Hgb released and no Hp consumed.

68
Q

What is happening when Hp levels are normal with NORMAL RETIC?

A

Anemia present is not due to RBC breakdown as no Hp is being consumed

69
Q

Thalassemia related Anemia Lab Evaluation Summary:

  1. RBC size & Hgb content:
  2. Abnormal shape RBCs:
  3. Reticulocyte production response:
  4. Clinical indicators:
A
  1. microcytic
  2. “thalassemia picture” if severe, normal if mild
  3. increased
  4. Congenital hx of anemia
70
Q

Tests to DDx from IDA:

  1. Thalassemia has ______ to ______ serum ferritin
  2. TIBC ______ to _____
  3. Serum iron ______ to _______
  4. Hemoglobin eletrophoresis in ____________
A
  1. normal to high
  2. normal to low
  3. normal to high
  4. Thalassemia
71
Q

What is required for synthesis of δ-ALA for heme production?

A

B6

72
Q

Which microcytic hypochromic anemia deficiency is an acquired form more common and associated most frequently with isoniazid therapy for TB, hereditary form very rare?

A

pyridoxine (vitamin B6) deficiency

73
Q

Which condition has the following characteristics?

  • Acquired or Hereditary (often due to B6 deficiency)
  • Ineffective RBC formation (two RBC populations, one normochromic & one hypochromic)
  • Diagnosed by BM biopsy, find “Rings” of Fe in RBC
A

Sideroblastic Anemia

74
Q

Which condition has a defect in heme synthesis which leads to anemia when Pb levels are very high? Also, a significant lead intoxication will occur before micro-hypo anemia. Basophilic Stippling in RBCs & Retic Low

A

Lead Poisoning

75
Q

The following are which types of -cytic/-chromic anemia?

  • Acute blood loss
  • Anemia of Chronic Disease (ACD)
  • Hemolytic Anemia from any cause
  • Hereditary spherocytosis
  • Aplastic Anemia
  • G6PD deficiency
A

Normocytic normochromic anemias

76
Q

Which type of anemia has the following characteristics?
•  Mild normo-normo (sometimes micro-hypo) anemia that persists more than 1-2 months.
•  Characterized by low serum iron despite high iron stores (ferritin)
•  Iron is being sequestered by the body so as to not damage the tissue during inflammatory processes.
•  Mediated by cytokines and regulated by hepcidin
•  Affects many aspects of RBC synthesis and lifespan

A

Anemia of chronic disease

77
Q

What is the master regulator of iron homeostasis?

A

Hepsidin

78
Q

Which type of anemia has the following characteristics?
•  Cellular depletion with fatty replacement of marrow
•  Pancytopenia - decreased production of all cell lines
•  Increased serum iron - because there aren’t enough RBCs to store the iron
•  Patients given marrow transplants, but have to match HLA (human leukocyte locus A), usually with a family member

A

Aplastic anemia

79
Q

T/F: The etiology of aplastic anemia is almost always by environmental, or chemical factors, is idiopathic but linked to benzene, radiation, infections, and Chloramphenicol.

A

True

80
Q

Lab features of aplastic anemia include which 3 things?

A
  1. normocytic normochromic anemia
  2. decreased platelets
  3. increased risk of infection
81
Q

Lab tests for aplastic anemia include which 3 things?

A
  1. reticulocyte count of zero
  2. normocytic normochromic anemia
  3. elevated serum iron
82
Q

Aplastic anemia patients need to be kept alive by what means? What is their prognosis?

A

transfusions of WBCs and platelets

die within 4-5 years of onset

83
Q

In Hemolytic Anemia: due to G6PD deficiency, decreased ATP production leads to which 2 detriments of the RBC?

A
  1. decreased membrane flexibility

2. increased oxidative damage

84
Q

Which anemic condition has the following characteristics?
•  Sex-linked genetic disorder, X chromosome
•  More common in Kurdish Jews & Af.-American
•  Selective advantage to malaria
•  Females can manifest if defect on both XX

A

Hemolytic Anemia: due to G6PD deficiency

85
Q

What is the most definitive test method for hemolytic anemia due to G6PD deficiency?

A

Assay of G6PD enzyme

86
Q

Susceptible persons with Hemolytic Anemia: due to G6PD deficiency exhibit hemolysis under which 3 conditions?

A
  1. oxidative stress – usually drugs: antimalarials, sulfa, nitrofurantoins, aspirin
  2. certain foods - fava beans
  3. high dose intravenous vitamin C
87
Q

Spherocytosis has both hereditary and acquired forms. ___% or more RBC are affected if hereditary.

A

70%

88
Q

Spherocytosis has an elevated retic (>9%) count in ____% of patients.

A

90%

89
Q

The following are indicative of labs for which condition?

  • Normal to decreased MCV
  • Decreased Hgb
  • Normal to increased MCH
  • Increased MCHC
  • Hemolytic anemia pattern
A

Spherocytosis

90
Q

Osmotic fragility test indicates the ability of the RBC to do what, and depends upon surface/volume ratio or shape?

A

take up water without bursting

91
Q

When conducting the Osmotic fragility test:

RBCs in hypertonic solutions, cells ______; in hypotonic solutions, cells ________

A

shrink; swell

92
Q

Full/thick cells like spherocytes have a/an _________ fragility; thin cells like target cells have a/an _______ fragility

A

increased; decreased