Anemia Flashcards
1
Q
Labs in IDA
A
dec serum iron
inc total iron-binding capacity
dec ferritin
2
Q
reduction below normal in hgb or RBC
A
anemia
3
Q
Symptoms of anemia
A
Pale skin, mucous membranes Jaundice (if hemolytic) Tachycardia Breathlessness Dizziness Fatigue
4
Q
atrophic glossitis
A
red swollen tongue w/ misshapen papillae
megaloblastic anemia
5
Q
koilonychia
A
spoon shaped nails
IDA
6
Q
jaundice
A
yellow tinge in sclera/skin d/t excess bile
hemolytic anemia
7
Q
3 ways to get anemia
A
Lose blood
Destroy too much blood
Make too little blood
8
Q
Reasons for destroying too much blood (vague)
A
Intracorpuscular vs extracorpuscular
9
Q
Reasons to make too little blood
A
Too few building blocks
Too few erythroblasts
Not enough room
10
Q
three morphological groups of anemia
A
weird size
weird shape
normal size and shape
11
Q
which anemias are “Weird size”
A
IDA
Thalassemia
Megaloblastic
12
Q
Most important cause IDA
A
GI bleeding
13
Q
Microcytic, hypochromic anemia
A
IDA
also thalassemia
14
Q
IDA is a ____cytic, _____chromic anemia
A
microcytic
hypochromic
15
Q
IDA has increased ____ and _____ (morphology), and _____ (lab)
A
anisocytosis and poikilocytosis
abnormal iron studies
16
Q
most of our iron is in
A
hgb
17
Q
Iron absorption
A
duodenum/proximal jejunum
binds to transferrin
18
Q
Iron circulation
A
transferrin carries iron
iron goes to red cell precursors, organs
19
Q
Structure of Hemoglobin
A
4 globin chains
4 heme molecules
globin - 2a and 2b chains
heme - iron molecule in protoporphyrin ring
20
Q
iron only binds O2 in what state
A
ferrous (fe2+)
21
Q
methemoglobin
A
ferric (fe3+)
22
Q
Iron metabolism (where does it go)
A
most goes to RBCs
rest goes to macrophages
23
Q
Iron storage
A
ferritin: quick in, quick out
hemosiderin: more stable
24
Q
Causes of iron deficiency (Vague)
A
decreased iron intake
increased iron loss
increased iron requirement
25
reasons for decreased iron intake
bad diet
| bad absorption
26
reasons for increased iron loss
GI bleed
menses
hemorrhage (slow)
27
reasons for increased iron requirement
pregnancy, fast growth
28
bottom line in IDA:
premenopausal women think ___
everyone else think ____
menorrhagia
| GI blood loss
29
IDA sxs
asymptomatic
or fatigue, dizziness
Pica
30
IDA signs
pale
spoon nails
smooth tongue
31
morphology IDA - blood
```
hypochromic, microcytic anemia
anisocytosis
poikilocytosis
dec reticulocytes
inc platelets
```
32
morphology IDA - bone marrow
erythroid hypoplasia
dyserythropoiesis
decreased iron stores
33
treatment IDA
find out why!
| oral iron
34
megaloblastic anemia - underlying cause
Defective DNA synthesis
Nuclear/cytoplasmic asynchrony
Dec B12/folate
35
Macrocytic anemia with oval macrocytes and hypersegmented neutrophils
megaloblastic anemia
36
Megaloblastic: _____cytic anemia with ____ _____cytes and _____ ________
Macrocytic anemia with oval macrocytes and hypersegmented neutrophils
37
What is slow/not slow in megaloblastic anemia that leads to big cells?
Slow DNA synthesis (not enough dTMP from dec. B12/folate)
| Normal RNA synthesis --> normal cytoplasm w/ immature nucleus
38
B12 sources
meat, dairy, cereal NOT VEGGIES
39
B12 absorption, transport
Binds to IF (from parietal cells)
Absorbed in distal ileum
Carried in blood by transcobalamin II
40
Causes of B12 deficiency
```
Diet (rare)
Lack of IF
Pancreatic damage
Ileal damage
Tapeworm
```
41
What else is B12 good for?
homocysteine --> methionine
42
homocysteinemia --->
atheroscelosis, thrombosis (from dec. B12)
43
dec methionine -->
myelin damage --> subacute combined degeneration
| from dec. B12
44
In a patient w/ macrocytosis, always check for
B12 deficiency (even if folate is low)
45
folate sources
lots
| green leafy veggies
46
folate absorption, transport
Absorbed in jejunum
Converted to methyl-FH4
Transported freely to liver, red cells
47
causes of folate deficiency
Diet (small reserve)
Alcohol abuse
Jejunal damage
Drugs
48
morphology of megaloblastic anemia - blood
Macrocytic anemia
Oval macrocytes
Hypersegmented neutrophils
49
morphology of megaloblastic anemia - bone marrow
Megaloblastic erythroblasts
| Megaloblastic neutrophils
50
How to test for Pernicious anemia
Schilling test
1. drink radiolabeled B12
2. Intramuscular injection of B12 (to saturate tissue stores with normal B12, so that if you absorb the radioactive B12, it won’t bind in the tissues, but will be passed into the urine.
3. Collect urine, see how much radiolabeled B12 there is in it.
4. If there’s no radioactive B12 in the urine (all passed in feces - not absorbed), try the test again, giving some IF along with the b12….
51
weird shape anemias are
```
Hereditary spherocytosis
Autoimmune hemolysing anemia
Sickle cell anemia
G6PD deficiency
MAHA
```
52
Types of hemolytic anemia (time)
Chronic - usually congenital
| Acute - usually acquired
53
symptoms chronic hemolytic anemia
well-compensated, sometimes w/ crises
54
sxs acute hemolytic anemia
Back, abdominal, limb pain
Headache, malaise, fever
Jaundice, pallor, tachycardia
55
types of hemolytic anemia (how to get them)
inherited
| Acquired
56
causes of inherited hemolytic anemia
Membrane defects
Enzyme deficiencies
Globin defects
57
causes of acquired hemolytic anemia
Autoimmune hemolytic anemia
Microangiopathic hemolytic anemia
Infection-related
Drug-related
58
Increased red cell destruction -->
| bottom line re: hemolytic anemia
increased red cell production
59
Signs of inc. RBC destruction
Inc. serum bilirubin
Inc. LDH
Dec. haptoglobin
Hemoglobinemia/-uria
60
Signs of inc. RBC production
Reticulocytosis
| Nucleated red cells in blood
61
Test to see if Hemolytic anemia is autoimmune
Direct antiglobulin test
62
Direct antiglobulin test
Looks for antibody/c’ on RBC surface
Positive result means immune process
take red cells + AHG = agglutination = +
means there are already abs on RBCs
63
Osmotic fragility test
Measures fragility of red cells
Positive result means spherocytes present
Doesn't give us a lot more information
64
morphology hemolytic anemia
```
Normochromic, normocytic anemia
Spherocytes
Other poikilocytes:
targets
sickles
fragmented red cells
```
65
How to diagnose hemolytic anemia
```
Look for signs of hemolysis (destruction, production)
Determine cause (DAT)
```
66
hereditary spherocytosis has what distinctive cells
spherocytes
67
what is the defect in hereditary spherocytosis
spectrin
68
what is the cure/tx for hereditary spherocytosis
splenectomy
69
triad of HS
anemia, jaundice, splenomegaly
70
age of onset, severity HS
variable
71
Do HS have crises?
Yes
| Often with parvovirus
72
pathogenesis HS
Abnormal RBC cytoskeleton
Loss of surface area
Spleen removes spheres
73
Morphology of HS
Mild normochromic, normocytic anemia
| Numerous spherocytes
74
Tx HS
splenectomy, or RBC transfusions PRN
75
Warm AIHA
| 3 main words/hallmarks
IgG
Spleen
Spherocytes
76
Warm AIHA - secondary
```
Leukemia/lymphoma
Other malignancies
Autoimmune disorders
Infections
Drugs
```
77
pathogenesis WAIHA
IgG coats red cells
Macrophages either:
wolf red cells down whole (cells disappear)
nibble at red cells (cells become spherocytes)
78
morphology WAIHA
spherocytosis
79
dx WAHA
DAT
80
tx WAHA
steroids
| splenectomy
81
cold AIHA
| 4 words/hallmarks
IgM, complement
Some intravascular hemolysis
Mostly spleen
Agglutination
82
where does hemolysis happen in warm AIHA
spleen
83
what kind of Ab for WAHA
IgG
84
what kinds of Ab for CAHA
IgM, complement
85
Secondary CAHA
Infections
| Lymphoproliferative diseases
86
Pathogenesis of CAHA
IgM, complement coat red cells
IgM falls off in warm body parts
IgM bridges red cells (agglutination)
Complement may lyse red cells (in blood) but usually just opsonizes them (and macrophages in spleen eat them)
87
where does hemolysis happen in CAHA
some in intravascular, mostly spleen
88
clinical picture of CAHA
Chronic hemolysis aggravated by cold
| Pallor, cyanosis in cold body parts
89
morphology CAHA
Red cell agglutinates
| Rare spherocytes
90
dx CAHA
DAT
91
Tx CAHA
keep pt warm
| treat underlying cause
92
what is wrong in hemoglobinopathies
qualitative hemoglobin abnormality
93
what is the most important hemoglobinopathy
sickle cell
94
what do sickle cells cost?
hemolysis, vaso-occlusion
95
best lab test for hemoglobinopathies
hgb electrophoresis
96
which direction does hgb run in electrophoresis
towards the anode (+ end)
97
what does sickle cell/sickle trait look like on electrophoresis
sickle cell anemia does not run as far
| sickle train has one that runs normal, one that runs short
98
underlying cause sickle cell
point mutation in b chain genes
substitution of valine for glutamate
aggregates and polymerizes on deoxygenation - red cell becomes sickle shaped - clog up vessels and are fragile
99
clinical findings/sxs in sickle cell anemia
chronic hemolysis
vaso-occlusive
increased infections (autosplenectomy)
foot ulcer
100
morphology of sickle cell anemia
sickle cells
| post-splenectomy blood picture = nucleated RBCs, targets, howell jolly bodies, pappenheimer bodies, incr. platelet count
101
howell jolly bodies
basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes. (blue)
102
pappenheimer bodies
abnormal granules of iron found inside red blood cells on routine blood stain
103
tx sickle cell
prevent triggers
vaccinate against encapsulated bugs (s. pneumo, H. influ)
blood transfusions
bone marrow transplantation
104
triggers sickle cell anemia
infection, fever, dehydration, hypoxemia
105
Thalassemia - can't make enough
alpha or beta chains
106
thalassemia disease severity
variable
107
Hypochromic, microcytic anemia with increased RBC and target cells
thalassemia
108
Thalassemia: _____hromic, _____cytic anemia with increased ____ and ____ cells
Hypochromic, microcytic anemia with increased RBC and target cells
109
hemoglobin chain development
Hgb F = a2g2
Hgb A2 = a2d2
Hgb A = a2b2
110
normal globin genes
4 a-chain genes
| 2 b-chain genes
111
globin genes in alpha thal
deletion of a-chain genes --> decreased amount a-chains
112
globin genes in beta thal
defective b-chain genes --> decrease amount b-chains
113
problem with the genes in b-thal
defective transcription, translation,
| or processing of mRNA of -chain gene
114
severity of defect - b-thal
B gene: normal gene
B+ gene: produces some B chains
B0 gene: produces no B chains
115
3 kinds of b-thal
b-thal minor (asymptomatic)
b-thal intermedia (less severe)
b-thal major (severe)
116
problem with genes in a-thal
a-chain genes are absent
117
4 kinds of a-thal
silent
a-thal train
HbH disease (only one a-gene)
Hydrops fetalis
118
what causes the anemia in a-thal
not enough a chains
| excess unpaired b, g, d chains (newborns make g4 = Hb barts, adults make b4 = HbH)
119
what causes anemia in b-thal
not enough b chains
| excess unpaired a chains
120
morphology of thalassemia
hypochromic, microcytic
minimal to marked anisocytosis and poikilocytosis
target cells, basophilic stippling
121
medullary expansion happens in
thalassemia
122
clinical findings a thal population
asians, blacks
123
population b-thal
mediterraneans, blacks, asians
124
what leads to cell lysis in G6PDD
dec G6PD --> inc. perosides --> cell lysis
| oxidant exposure
125
what kinds of cells do you see in G6PDD exclusively
Bite cells (removal of heinz bodies)
126
inheritance G6PDD
x-linked
127
what does G6PD do
G6P --> 6PG (PPP) also sending NADP to NADPH, replenishing NADPH for GSSG --> GSH = antioxidant
128
why do G6PDD cells die
```
They can’t reduce nasties
Nasties attack hemoglobin bonds
Heme breaks away from globin
Globin denatures, sticks to red cell membrane (“Heinz body”)
Spleen bites out Heinz bodies
```
129
Highest incidence of G6PD is in areas where
malaria is epidemic (endemic?)
130
triggers G6PDD
broad beans (fava), drugs (antibiotics, aspirin)
131
tx G6PDD
spontaneous resolution
132
morphology G6PDD
w/o exposure: no anemia
after exposure: acute hemolysis
bite cells, fragments
heinz bodies
133
microangiopathic hemolytic anemia - anemia caused by
physical trauma to red cells
134
causes of MAHA
artificial heart valve
| anything causing DIC, TTP, HUS
135
morphology MAHA
schistocytes
triangulocytes
136
anemias of normal size and shape
anemia of blood loss
chronic disease
kidney, liver disease
aplastic anemia
137
cause of anemia of blood loss
traumatic, acute blood loss
138
morphology in anemia of blood loss
at first - normal hgb
| after 2-3 days, see reticulocytes
139
chronic vs acute blood loss anemia
chronic --> IDA
| acute --> A of blood loss
140
what causes AOCD
infections, inflammation, malignancy
141
pathogenesis AOCD
iron metabolism - absorption is okay, but release is screwed up- cannot get iron into hgb because hepcidin is overproduced
shortened RBC survival, impaired marrow response to anemia
142
AOCD: ___ chromic, _____ cytic
normochromic normocytic
143
anemia severity in AOCD
usually mild (other CD more a problem)
144
abnormalities in red cell in AOCD
none
145
labs in AOCD vs IDA
```
AOCD:
dec serum iron
dec/normal TIBC
inc ferritin
inc marrow storage iron
```
```
IDA:
dec serum iron
inc. TIBC
dec ferritin
dec marrow storage iron
```
146
what does hepcidin do
Hepcidin inhibits iron transport by binding to the iron export channel ferroportin which is located on the basolateral surface of gut enterocytes and the plasma membrane of reticuloendothelial cells (macrophages).
Stuck in cells
147
labs AOCD
dec serum iron (stuck in cells)
dec/nl TIBC (can't transport but want to)
inc. ferritin (have to store it)
inc. marrow storage iron
148
anemia of renal disease: things you must know
end-stage renal failure
cause: lack of EPO
may see echinocytes
149
what do you see in anemia of renal disease
echinocytes (pointy)
150
cause of anemia of renal disease
EPO
151
anemia severity of anemia of renal disease
roughly correlates w/ degree of renal failure
152
mgt anemia of renal disease
if mild, none
| if severe, replace EPO
153
anemia of liver disease: things you must know
frequent in liver disease
multiple causes
"uncomplicated" cases are rare
may see acanthocytes (weird little offshoots), targets
154
why is anemia of liver disease rarely uncomplicated
get other kinds of anemia - ie inflammation, or slow bleed from esophageal varices, folate deficiency
155
causes of uncomplicated liver disease anemia
dec RBC survival and impaired marrow response
156
morphology uncomplicated liver disease anemia
mild anemia
usually normocytic - sometimes macrocytic
poikilocytosis (targets, acanthocytes)
157
morphology complicated liver disease anemia
megaloblastosis (from folate)
| microcytosis (from IDA)
158
aplastic anemia: things you must know
pancytopenia
empty marrow
most are idiopathic
159
causes of aplastic anemia
```
Idiopathic
Drugs
Viruses
Pregnancy
Fanconi anemia
```
160
clinical findings in aplastic anemia
Pallor, dizziness, fatigue (anemia)
Recurrent infection (leukopenia)
Bleeding, bruising (thrombocytopenia)
161
morphology of aplastic anemia
blood - empty
| bone marrow - empty
162
tx aplastic anemia
avoid exposure/trigger
give blood products
drugs: G-CSF, prednisone, ATG
bone marrow transplant as last resort
