Anemia

Question 1

Define Anemia

Answer 1

Insufficient red cell mass to adequately deliver oxygen to peripheral tissues

Question 2

Anemia - influence of gender, age, etc demands

Answer 2

Females lower
High at birth, drops, then increase
pregnancy/menstration decrease HCT/HGB

Question 3

Define Reticulocytes

Answer 3

Presence of mRNA in RBC first say in systemic circulations. Larger and darker - immature

Question 4

Count and Absolute count RET

Answer 4

percent of RBC; a definite number of RBC

Question 5

Reticulocyte index

Answer 5

way to measure RBC production by correcting RET count for concentration and stress reticulocytosis (1.5 - mild, 2.0 mod, 2.5 severe)
RI < 1 = anemia = decrease production of RBC
RI > 2 = loss of RBC, destruction/bleeding

Question 6

MCV 80-100 =?

Answer 6

normocytic anemia

Question 7

MCV >100

MCV < 80

Answer 7

macro and microcytic anemia

Question 8

RET is normal –> consider which factors?

Answer 8

hemolysis or hemorrhagic causes

Question 9

Iron more soluble at ____ pH

Answer 9

low

Question 10

Distribution of Fe in hemoglobin, muscle, intracellular

Answer 10

65, 6, 25

Question 11

Intracellular Fe storage by ____ and ____

Answer 11

ferritin and hemosiderin

Question 12

Fe absorbed in __

Answer 12

duodenum

Question 13

Iron transportation steps from duodenum across BL membrane

Answer 13

Fe3+ –> DCYTB to Fe2+ –> Enter cell DMT1 –> Fe stored in ferritin –> transported BL membrane –> ferrous exit via ferroportin –> Hephaestin oxidize to Fe3+ to plasma apotransferrin

Question 14

Iron transportant from plasma to endocytosis

Answer 14

Fe3+ in plasma –> transferrin –> transferrin receptor on normoblast –> invagination –> endosome –> pH drops –> Fe released –> leaves DMT1 –> Fe in ferritin –> Transferrin/TR to cell surface

Question 15

Transferrin is a _____ _______

Answer 15

plasma transporter

Question 16

Ferritin is a _______ ______

Answer 16

intracellular Fe storage

Question 17

Iron deficiency - stages 1, 2, 3 described as?

Answer 17

1: iron stores decreased (ferritin lvl)
2: iron deficient erythropoiesis - decrease in serium ion, increase iron binding capacity - decrease in percent sat
(Iron loading of normoblast impaired, no change in RBC)
3: Transferrin increase, serum iron low, sat low - microcytic/hypochromic; Red cell protoporhyrin increase

Question 18

Causes of iron deficiency

Answer 18

Excessive losses - bleed, Failure to accumulate Fe, inability to gain Fe during growth

Question 19

hepcidin - define and fcn

Answer 19

25 amino acid peptide - regulates iron absorption
binds to ferroportin + degradation = loss of Fe export out of epithelial cell –> response from (increased accumulation of Fe/infection/inflammation)

Question 20

Koilonychia - define

Answer 20

bowing of nail

Question 21

Achlorhydria - define

Answer 21

low production of gastric acids

Question 22

Decreased RBC causes (by categories)

Answer 22

iron deficiency
chronic infection/inflammation
malignant disease
renal insufficiency
endocrine disorder
lead intoxication
Mal nutrition

Question 23

Hemoglobin synthesis

Answer 23

Heme + globin

Question 24

Heme synthesis

Answer 24

Protoporphyrin synthesis + Fe

Question 25

Lead effect on Hgb

Answer 25

Pb prevents synthesis of protoporphyrin + enzyme that ligates iron to proto

Question 26

Chronic disease: TNF --> effect

Answer 26

Decrease iron, decrease EPO

Question 27

Chronic disease INF-B --> effect

Answer 27

Inhibits erythropoiesis

Question 28

TNF/INF B defect occurs during _____ and _____?

Answer 28

malignancies (neoplasm) and sepsis

Question 29

Chronic infection/inflammation affect which 2 factors

Answer 29

IL1 / INF Y

Question 30

IL1 effect on RBC

Answer 30

Decrease iron and EPO

Question 31

INF Y on RBC

Answer 31

inhibits proliferation of erythroid precursors

Question 32

Lead intoxication signs/symptoms

Answer 32

moderate anemia, decreased ret, microcytosis, basophilic stippling, increase zinc protoporphyrin

Question 33

Renal insufficiency signs/symptooms

Answer 33

Kidney<40% - normochromic, EPO deficiency | Treatment - give EPO

Question 34

Macrocytic anemia causes

Answer 34

Folate and B12 deficiency

Question 35

Folate absorbed in the _____

Answer 35

Jejunum

Question 36

B12 absorbed in the

Answer 36

Terminal ilieum

Question 37

B12 and folate --> macrocytic - why?

Answer 37

Folic acid --> methyltetrahdrofolate --> B12 --> Homocysteine = methionine (pass on methyl group) THF substrate for purine/pryimidine sythesis (DNA synthesis) Deficienc = stops in S --> destruction

Question 38

B12 deficiency is caused by

Answer 38

``` Mostly malabsorption (pernicious anemia - autoimmune destruction of IF producing gastric parietal cells) Food - mostly with vegans ```

Question 39

Folate deficiency caused by

Answer 39

Diet

Question 40

B12/Folate deficiency blood/smear test:

Answer 40

Increase erythoid to myeloid ratio - hyperplasia Megaloblastic anemia Macrocytosis RET decrease Macro-ovalocytes/hyperseg neutro, poikilocytes Neutropenia, thrombocytopenia, increase bilirubin, LDH (intramedullary destruction)

Question 41

B 12 and folate lab differences

Answer 41

B12 - neurological problems + MMA (methylmalonic acid)

Question 42

Onset rate of B12 and folate deficiency

Answer 42

B12 - months/year; folate - weeks

Question 43

B12 deficiency AKA ________ deficiency

Answer 43

cobalamin

Question 44

Treatment for B12 deficiency

Answer 44

IM/SQ B12 QD, QW --> HCT normal = maintance for life

Question 45

Folic deficiency

Answer 45

1 mg/day orally/parenterally (IV,SQ, IM)

Question 46

normochromic/normocytic anemia associated with

Answer 46

vitamin,mineral, protein/calorie malnutrition

Question 47

define hemolysis

Answer 47

decreased in red cell survival/increase turnover

Question 48

Intravascular hemolysis

Answer 48

destroyed in circulation

Question 49

Extravascular hemolysis

Answer 49

by RE system, enterohepatic cirrculation or excreted by kidney to urine

Question 50

Test for anemias

Answer 50

CBC, periphery smeas, RET/RI, bilirubin increase = hemolysis

Question 51

RBC membrane/cytoskeleton and hereditary spherocytosis

Answer 51

Spectrin, ankyrin, band3.1

Question 52

osmotic fragility test

Answer 52

Place cells in solution with different cocentration. At higher water concentration - cells will swell and lyse; spherocytes will lyse more easily

Question 53

Hereditary spherocytosis treatment

Answer 53

splenectomy

Question 54

G6PD deficiency and hemolysis anemia

Answer 54

G6PD gets rid of ROS by restoring GSSH --> GSH

Question 55

direct antiglobulin test DAT

Answer 55

IgG or C3d/C4d on RBC by adding coombs reagent --> agglutiniation

Question 56

Coombs reagents have Ab for ___, ___, ___

Answer 56

IgG, C3d, C4d

Question 57

IAT - indirect antiglobulin test

Answer 57

ABility to patient serum to bind IgG/complement - test normal RBC

Question 58

Autoimmune hemolytic anemia - define and DAT

Answer 58

antibody to red cell antigen - induces lyse/phagocytosis | DAT +

Question 59

Warm auto immune hemolytic anemia

Answer 59

Positive DAT, max at 37 - without antigen specificy | IgG binds RBC --> splenic macrophage -> antibody mediated pahgocytosis

Question 60

Cold autoimmune hemolytic anemia

Answer 60

positive DAT - max at 5, antigen specific for i or I | antibodies of IgG/IgM - binds in periphery -> activate complement --> in body punch holes

Question 61

C3 induced phagocytosis via complement receptor --> intra/extra vascular hemolysis

Answer 61

extra

Question 62

Splenectomy: risk + benefit

Answer 62

Risk: Clearance of intravascular microbe - increas spesis mortality, developmenet of adaptive humoral response, origin of IgM agglutinins Benefit - less hemolysis of red cell

Question 63

splenectomy - contraindicated and post op care

Answer 63

kids under 5 Give vaccine against H influ. S. Pneumonia, meingococcus Give prophylactic antibotics 9penicillin) during childhood - prevents infection