anemia Flashcards
(33 cards)
what are the 3 groups of anemia?
- weird size
- weird shape
- Normal size and shape
what does anisocytosis mean?
Abnormal size
What doe piokilocytosis mean?
abnormal shape
What are the 3 groups of weird size anemias?
- IDA
- Thalassemia
- Megaloblastic anemia
what are the things you need to know of IDA?
- most important cause is GI bleed
- Microcytic, Hypochromic anemia
- Increased anisocytosis and piokilocytosis
- Decreased reticulocytes and increased platelets
- abnormal iron studies
Where is iron absorbed in the gut?
Duodenum and proximal jejunum
- after it crossed enterocytes it binds to transferrin in the blood
- about 33% of transferrin molecules are bound to iron
What is the purpose of transferrin?
-chaperone protein that transporter iron in the blood and liver it to the liver and BM Macs for storage
What is hemoglobin made up of?
Hgb= 4 heme+ 4 globin -heme= fe+protoporphyrin
What is methemoglobin and what is its purpose?
heme cousin
- but finds Fe3+ (ferric) rather than Fe2+
What are 2 forms of iron storage?
Ferritin- quick in quick out
- long protein with multiple holding sites of Fe
Hemosiderin- more stable (harder to get in and out of RBC precursors and Macs)
What are the causes of IDA?
- Decreased iron intake (Bad diet or absorption)
- Increased iron loss (GI bleed, menses and slow bleeding over time)
- Increased Iron requirement (pregnancy or huge growth spurs)
What should you think when it comes to IDA dx?
Premenopausal women–> Menorrhagia
Everyone else–> Gi blood loss and rule our GI carcinoma in elderly
What are some symptoms of IDA?
- Weak, fatigue, and dyspnea
- pale conjunctiva and skin
- HA and lightheadedness
- angina with preexisting CAD
- you can be asymptomatic
- Pica- craving dirt, ice or windex
What is a common blood smear finding with IDA?
- ovalocytes
- increased zone of central pallor
what are the BM findings in IDA?
- erythroid hypoplasia
- dyserythropoiesis
- decreased iron stores
What are the common labs in IDA?
- Low ferritin
- increased TIBC
- Lowe serum iron
- Low % saturation
How does one treat IDA?
Find out the cause!!!!
give oral iron (ferrous sulfate)
What do you need to know about Megoloblastic anemia?
- Defective DNA synthesis
- Nuclear/cytoplasmic asynchrony
- decreased B12 or folate or both
- macrocytic anemia with oval macs and hypersegmented neuts (>5)
What is the source of B12 and where do you absorb it?
comes from animal derived proteins
- Binds to IF from parietal cells and gets absorbed in the ileum
- onces in blood stream B12 binds to transcobalamin 2
- takes years to present
what are the cause of B12 deficient anemia?
- Diet– rare (ton stored in liver
- lack of IF (pernicious anemia destroyes pareital cells which make IF
- Pancreatic damage (lack of proteases to break R-binder of of B12 in the duodenum
- Illeal damage
- Tapeworm (raw fish)
What are signs and sx’s of B12 anemia?
- Atrophic glossitis (swelling of tongue called beefy tongue and papillae disappear)
- Macrocytosis RBC and hypersegmented neuts
- Subacute combined degeneration of spinal cord
- Increased methylmalonic acid
- increased serum homocysteine
- decreased serum vit b12
What can increased homocysteine cause?
atherosclerosis and thrombosis
What can decreased methionine cause?
Subacute combined degeneration
- both sensory and motor loss (DC/ML and lateral corticospinal tract respectively)
What are the sources of folate and where is it absorbed?
Lots of sources but mainly from green vegetables and fruits
- absorbed in jejunum and converted to methyl-FH4
- transported freely to liver and red cells
