Anemia (complete) Flashcards
1
Q
What is anemia
A
a reduction below normal in hemoglobin or red blood cell number
2
Q
What are the two components of a complete blood count (CBC)
A
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin concentration (MCHC)
3
Q
What does the Mean Corpuscular Volume (MCV) measure
A
the size of the Red blood cell
4
Q
What are the terms for a low, normal, and high MCV
A
low MCV = microcytic
normal MCV = Normocytic
high MCV = macrocytic
5
Q
what does it mean if a RBC is macrocytic
A
that the RBC is abnormally large
6
Q
what does it mean if a RBC is normocytic
A
that the RBC is the normal size
7
Q
what does it mean if a RBC is microcytic
A
that the RBC is abnormally small
8
Q
What does the Mean Corpuscular hemoglobin concentration (MCHC) measure
A
it measures the amount of hemoglobin in the RBC
9
Q
What are the terms for low, normal, and high MCHC
A
low MCHC = hypochromic
normal MCHC = normochromic
high MCHC = DOESN’T HAPPEN
10
Q
What does it mean if a RBC is hypochromic
A
that the RBC has an abnormally low hemoglobin concentration
11
Q
what does it mean if a RBC is normochromic
A
that the RBC has a normal hemoglobin concentration
12
Q
What are the three different types of abnormalities that a RBC can have
A
- Size varation
- Hemoglobin concentration
- Shape variation
13
Q
what is the term for variation in RBC shape
A
poikilocytosis
14
Q
What are the symptoms of anemia
A
- pale skin/mucus membranes
- jaundice (if hemolytic)
- breathlessness
- tachycardia
- dizziness
- fatigue
15
Q
What symptom of anemia is specific to hemolytic anemia
A
Jaundice
16
Q
What are the three main causes of anemia
A
- Blood loss
- Excessive RBC destruction
- Insufficient RBC production
17
Q
What are the two types of reasons for excessive RBC destruction
A
- extracorpuscular reasons
2. intracorpuscular reasons
18
Q
What are the three reasons for insufficient RBC production
A
- too little material
- too few erythroblasts
- not enough room
19
Q
What is the specific cause of anemia caused by blood loss
A
trauma resulting in acute blood loss
20
Q
anemia caused by acute blood loss due to trauma will result in an increase of what
A
reticulocytes
21
Q
what are reticulocytes
A
immature RBCs
22
Q
how long does it take a reticulocyte to develop into a mature RBC after it has left the bone marrow and entered the blood
A
about one day
23
Q
What is the normal percentage of RBCs in the blood that are reticulocytes
A
1%
24
Q
What are the two types of signs that we will see when a patient is suffering from anemia due to excessive destruction of RBCs
A
signs of the excessive destruction
signs of an increase in production of RBCs (due to anemia)
25
What are the three signs of destruction of RBC
1. increased bilirubin
2. increased LDH
3. reduced haptoglobin
26
What are the two signs of increased production of RBCs
1. increased reticulocytes
| 2. nucleated red cells in blood
27
what is the life span of RBCs
120 days
28
Where are RBC destroyed
the liver and the spleen (NOT KIDNEYS)
29
What are RBCs broken down into in the spleen and liver
1. Globin
| 2. Heme
30
after RBCs are broken down in the spleen and liver what is the globin used for
the globin is used in Amino Acid formation
31
after RBCs are broken down in the spleen and the liver what is the Heme turned into
1. bilirubin
| 2. Iron
32
the Heme group of RBCs are broken down into bilirubin and iron. Where is the iron used
liver
spleen
bone marrow
33
the Heme group of RBCs are broken down into bilirubin and iron. What happens to the bilirubin
it is taken to the liver where it is conjugated, then secreted with the bile.
34
Why is bilirubin conjugated in the liver?
because unconjugated bilirubin is toxic
35
How does bilirubin travel in the blood
with albumin as the bilirubin-albumin complex
36
how is unconjugated bilirubin harmful
it damages cell membranes
37
what allows unconjugated bilirubin to be harmful to cell membranes
it is fat soluble
38
What is the enzyme that takes unconjugated bilirubin and conjugates it so that it is no longer toxic
glucoronyl transferase
39
What are the possible routes that bilirubin can take after it is excreted from the liver with bile
1. it can be eliminated from the body with fecal matter
2. it can be converted into urobilinogen and excreted in fecal matter
3. it can be converted into urobilinogen and reabsorbed into the blood
4. it can be converted into urobilinogen and excreted in the urine
40
What happens to the uronilinogen that is reabsorbed into the blood
it is taken back to the liver where it is further metabolized, and then will be secreted with bile again and eliminated in either the urine or feces
41
What happens if we have excess bilirubin in the body
a patient with too much bilirubin will get jaundice
42
what is jaundice
a condition caused by excess bilirubin
43
what are the symptoms of jaundice
skin, nail beds, whites of the eye take on a yellow color
44
What causes the excess bilirubin that leads to jaundice
1. when there is too much destruction of RBCs
| 2. When bilirubin isn't being secreted normally
45
when does excessive destruction of RBCs lead to excessive bilirubin levels
when so many RBCs are being destroyed that bilirubin levels are increasing faster than the liver is able to conjugate it
46
What things can cause bilirubin to not be secreted normally
1. reduced hepatic uptake
2. decreased ability to conjugate
3. bile duct obstruction
47
What disorders can cause the reduced hepatic uptake that can lead to jaundice
cirrhosis and hepatitis
48
What disorders can cause the decreased ability of the liver to conjugate bilirubin, which leads to jaundice
cirrhosis, hepatitis, and enzyme deficiencies
49
what can cause the bile duct obstruction that can lead to jaundice
tumors or stones
50
To which types of cells is bilirubin very toxic
brain cells
51
What are the treatments of jaundice
1. treat the causes of the condition
2. blood transfusion
3. Sun
52
what two things do you look for when you are trying to determine if a patients jaundice was caused by intrahepatic obstruction or extrahepatic obstruction
you look for the color of the urine and the feces
53
What is the cause of extrahepatic obstructive jaundice
obstruction of the bile duct
54
what is the cause of intrahepatic obstructive jaundice
damaged hepatocytes
55
What kind of jaundice is indicated by light or clay colored feces and dark urine
extrahepatic obstructive jaundice
56
how does extrahepatic obstructive jaundice lead to light feces and dark urine
the bilirubin isn't able to be secreted with the bile and then excreted with the feces, so the feces is light. because the bilirubin can't leave through the bile duct it goes to the kidney and leaves in the urine causing the urine to be dark
57
what kind of jaundice is indicated by light feces and light urine
intrahepatic obstructive jaundice
58
how does intrahepatic obstructive jaundice lead to light feces and light urine
because the liver can't conjugate bilirubin, it can't be secreted from the liver with the bile, or to the kidneys. so it just stays in the body. The lack of bilirubin in the feces and urine lead both to being light
59
what kind of jaundice is indicated by dark feces and dark urine
hemolytic anemia (too many RBCs being destroyed for the liver to keep up)
60
how does hemolytic anemia lead to dark feces and dark urine
A LOT of bilirubin is created in hemolytic anemia and the liver converts as much of it as it can and it is excreted into the urine and feces so both are dark
61
What are the three extracorpuscular hemolytic anemias
1. Microangiopathic Hemolytic Anemia
2. Warm Autoimmune hemolytic anemia
3. Cold autoimmune hemolytic anemia
62
What are the characteristics of microangiopathic Hemolytic anemia
1. extracorpuscular
2. physical trauma to RBCs
3. Creates Schistocytes
63
Is microangiopathic hemolytic anemia extracorpuscular or intracorpuscular
extracorpuscular
64
how does microangiopathic hemolytic anemia affect RBCs
it causes physical trauma to RBCs (breaks them into pieces)
65
What are schistocytes
fragments of RBCs
66
in what type of hemolytic anemia do you see schistocytes
microangiopathic hemolytic anemia
67
What are the common causes of microangiopathic hemolytic anemia
1. artificial heart valve
2. malignancy
3. obstetric complications
4. sepsis
5. trauma
68
What are the characteristic of Warm autoimmune hemolytic anemia
1. Immunoglobin G (IgG) is active at high Temp
2. it occurs in the spleen
3. RBCs are turned into spherocytes
4. it is extracorpuscular
69
What does intracorpuscular vs. extracorpuscular anemia refer to
intracorpuscular anemia is anemia caused by factors inside the RBCs
extracorpuscular anemia is anemia caused by factors outside of the RBC
70
is warm autoimmune anemia intracorpuscular or extracorpuscular
extracorpuscular
71
what is the Immunoglobin that is active in warm autoimmune hemolytic anemia
Immunoglobin G
72
Where does warm autoimmune hemolytic anemia occur
in the spleen
73
What happens to the RBCs in warm autoimmune hemolytic anemia
they lose there normal shape and become spherocytes
74
What are the characteristics of Cold autoimmune hemolytic anemia
1. It is extracorpuscular
2. it is caused by Immunoglobin M (IgM) and C3b
3. It occurs inside the blood vessels
4. it causes agglutination of RBCs
75
is Cold Autoimmune hemolytic anemia extra or intracorpuscular
it is extra corpuscular
76
what two things cause Cold Autoimmune hemolytic anemia
IgM and C3b
77
Where does cold autoimmune hemolytic anemia occur
in the blood vessels
78
what does cold autoimmune hemolytic anemia cause to happen to the RBCs
they agglutinate (stick together)
79
What are the 4 types of intracorpuscular hemolytic anemia
1. Sickle Cell Anemia
2. Thalassemia
3. Hereditary Spherocytosis
4. G6PDH deficiency
80
What are the characteristics of sickle cell anemia
1. it is intracorpuscular
2. it causes RBCs to be misshaped, and fragile
3. it is caused by a single amino acid substitution (VAL for Glut Acid)
4. it is autosomal recessive
5. it is most common in Africans
6. causes an infarcted spleen
81
is sickle cell anemia intracorpuscular or extracorpuscular
intracorpuscular
82
what does sickle cell anemia cause to happen to RBCs
they become misshapen and fragile
83
What are some problems associated with the shape of RBCs in sickle cell anemia
1. they don't carry as much Hemoglobin
2. they are more fragile
3. they can become stuck in capillaries
84
what causes sickle cell anemia
a single amino acid substitution of VAL for Glut Acid
85
is sickle cell anemia a sex-linked or autosomal disorder
autosomal
86
is sickle cell anemia autosomal dominant or autosomal recessive
autosomal recessive
87
Which ethnicity is most likely to have sickle cell anemia
African
88
What happens to the spleen in sickle cell anemia
it becomes infarcted
89
what causes the spleen to become infarcted in sickle cell anemia
the sickle cell shaped RBCs get stuck in the capillaries leading into the spleen, so that nothing can enter the spleen and it becomes all small and shriveled up
90
which type of anemia causes an infarcted spleen
sickle cell anemia
91
What are the characteristics of thalassemia
1. it is intracorpuscular hemolytic anemia
2. it is caused by an inability to produce alpha and beta subunits of hemoglobin
3. it is a hypochromic anemia
4. it is a microcytic anemia
5. it leads to an increase in EPO and RBC synthesis
6. it can lead to "chipmunk" cheeks
92
Is thalassemia intra or extra corpuscular
intracorpuscular
93
what causes thalassemia
an inability to produce either the alpha or beta subunits of hemoglobin
94
in which ethnicity is an inability to produce the alpha subunit of hemoglobin (thalassemia) most common
South East Asian
95
in which ethnicity is an inability to produce the beta subunit of hemoglobin (thalassemia) most common
Mediterranian
96
What happens to the RBCs in thalassemia
they are hypochromic and microcytic
97
how does thalassemia lead to hypochromic and microcytic RBCs
less alpha and beta subunits of hemoglobin decreases the hemoglobin content of the RBCs = hypochromic.
less hemoglobin leads to smaller RBCs = microcytic
98
Why does thalassemia lead to increased EPO
because the malformed hemoglobin can't carry enough oxygen, so the body increases RBC synthesis by secreting EPO
99
Why does thalassemia cause "chipmunk" cheeks
because the body is trying to make a lot of new RBCs so the jaw expands from excessive production of RBCs
100
What are the characteristics of hereditary spherocytosis
1. intracorpuscular
2. RBCs are turned into spherocytes
3. it is caused by a spectrin defect
4. it can be cured by a splenectomy
5. it can lead to splenomegaly
101
Is hereditary spherocytosis intra or extracorpuscular
intracorpuscular
102
What happens to the RBCs in hereditary spherocytosis
the RBCs become spherocytes
103
what are spherocytes
RBCs that are in the shape of a ball as opposed to a biconcave disk
104
what causes hereditary spherocytosis
a spectrin defect
105
how can hereditary spherocytosis be cured
with a splenectomy
106
What is splenomegaly
enlargement of the spleen
107
what type of anemia results in splenomegaly
hereditary spherocytosis
108
how does hereditary spherocytosis lead to splenomegaly
the spherocytes in the spleen form polymers and are unable to leave the spleen and cause it to be blocked, so more RBCs enter the spleen but can't leave so the spleen becomes enlarged
109
What are howell-jolly bodies
they are nuclear remnants left inside of blood cells
110
what do howell-jolly bodies indicate
they are evidence of markedly decreased splenic function
111
What are the characteristics of G6PDH deficienct anemia
1. it is intracorpuscular
2. leads to increased ROS which kill RBCs
3. causes the development and removal of heinz cells
4. Forms bite cells
5. Triggered by fava beans and drugs
112
Is G6PDD deficient anemia intra or extracorpuscular
it is intracorpuscular
113
How does G6PDH deficiency lead to anemia
deficient G6PDH leads to an loss of glutathione. Low glutathione means that Reactive oxygen species (ROS) can't be neutralized. Increasing levels of ROS begin to lyse RBCs
114
What are heinz bodies
When globin in the RBCs denatures and sticks to the RBC membrane
115
in which type of anemia do we see heinz bodies
G6PDH deficient anemia
116
in which type of anemia do we see bite cells
G6PDH deficient anemia
117
what causes bite cells to form
G6PDH definiency causes heinz bodies to form, thenthoe heinz bodies are removed leaving a cell that looks like it has had a bite out of it
118
What things can trigger G6PDH deficiency
Fava beans and drugs
119
What are the three reasons that can cause insufficient RBC production
1. too little material
2. too few erythroblasts
3. not enough room
120
What are the three conditions that lead to too little material that can cause insufficient RBC production
1. Iron deficiency
2. Chronic Disease
3. Megaloblastic
121
What is the condition that leads to anemia due to having too few erythroblasts
Aplastic anemia
122
what is the condition that leads to anemia due to not having enough room in the bone to produce sufficient RBCs
Myelophthisic anemia
123
What are the characteristics of Iron-deficient Anemia
1. Causes Microcytic RBCs
2. Causes Hypochromic RBCs
3. Shows in indented finger nails and a glossy, smooth tongue
4. Many Causes for low iron
124
What does iron-deficiency cause to happen to the RBCs
They become microcytic and hypochromic
| they become small and have less amounts of hemoglobin
125
if you see a patient with a smooth glossy tongue, and indented finger nails, what anemia is it likely that they have
Iron-deficient anemia
126
What are the six main causes for low Iron that can lead to iron-deficient anemia.
1. Decreased Iron uptake
- poor diet
- poor absorption
2. Increased Iron loss
- GI bleeding
- Meses
- Hemorrage
3. Increased Iron Requirement
- Pregnancy
127
What are the characteristics of Anemia caused by chronic disease
1. caused by disrupted iron metabolism due to increased hepcidin in the liver
2. has normochromic RBCs
3. has normocytic RBCs
128
How does Chronic disease lead to Anemia
Chronic disease causes an increase in hepcidin in the liver. High hepcidin levels pull iron out of the blood and hold it so it isn't used in RBC production, leading to less RBCs overall
129
what does Chronic disease cause to happen to RBCs
they are both normocytic, and normochromic. but There are just a lot less RBCs overall
130
What are the characteristics of Megaloblastic Anemia
1. Caused by reduced B12/Folate in the body
2. causes normochromic RBCs
3. causes Macrocytic anemia
4. Due to inadequate absorption through insufficient Intrinsic Factor
5. Pernicious anemia is a type of megaloblastic anemia
6. Schilling test
7. Hypersegmented neutrophils
131
What are the RBCs like in megaloblastic anemia/pernicious anemia
they are normochromic and macrocytic
| normal hemoglobin, but extra large
132
How does lack of Folate/B12 lead to megaloblastic anemia (specifically normochromic and macrocytic RBCs)
Folate uses B12 to "cut" cells in half that have duplicated their cellular components. So when either B12 or Folate aren't present then these cells that are twice the size with twice the components aren't able to divide. So the RBCs are large with the right amount of hemoglobin for their size
133
How does intrinsic factor (the lack of it) lead to megaloblastic/pernicious anemia
Intrinsic factor is responsible for absorbing B12. so when it is lacking, so is B12, so folate can't divide RBCs
134
What happens to neutrophils in megaloblastic/pernicious anemia
they become hypersegmented
135
Nutritional B12 deficiency is rare, but a lack of intrinsic factor can lead to malabsorption of B12. What causes lack of intrinsic factor
1. Autoimmune disease of stomach
2. GI surgery (gastric bypass)
3. Chronic gastritis
136
What is the treament for people who suffer from megaloblastic/pernicious anemia due to lack of intrinsic factor
B12 injections
137
What does the Schilling test look for
it is a test to see if a patient has pernicious anemia
138
what are the steps of the schilling test
1. Feed patient labeled B12
2. Inject regular B12 (to saturate the liver so it doesn't store any)
3. Check for labeled B12 in urine
- if 10% of B12 is labeled in urine = Normal
- if less that 10% of B12 is labeled in urine = Abnormal
if first round is abnormal
4. Feed patient labeled B12 and intrinsic factor
5. Check urine
- if B12 levels are normal = Pernicious anemia
- if B12 levels are still reduced = GI pathology (not pernicious anemia)
139
What are the characteristics of Aplastic anemia
1. Hypoplastic (empty) bone marrow
2. pancytopenia (decreased blood cells)
3. normochromic RBCs
4. normocytic RBCs
5. Causing increased bleeding and decreased immune function
6.
140
What causes aplastic anemia
destruction of bone marrow and Blood stem cells
141
What is pancytopenia that is seen in aplastic anemia
a decrease in all cellular components of blood (RBC, WBC, Platelets)
142
if aplastic anemia has normochromic and normocytic RBCs. How does it cause anemia
a significant decrease in total number of RBCs
143
What does pancytopenia (thus aplastic anemia) cause
increased bleeding (low platelets) and decreased immune function (low WBCs)
144
What are the characteristics of Myelophthisic anemia
1. caused by infiltration of bone marrow by a tumor or fibrosis
2. possible pancytopenia
3. normochromic RBC
4. normocytic RBC
5. Tear shaped RBCs
145
How does infiltration of bone marrow by tumors or fibrosis cause myelophthisic anema
the tumor or fibrosis takes up the bone marrow space that would normally be used to produce Blood cells
146
What two types of anemia can cause pancytopenia
Myelophthisic anemia
| aplastic anemia
147
What type of anemia can cause tear shaped RBCs
myelophthisic anemia
148
Other than the fact the myelophthisic anemia can cause tear shaped RBCs, what are the RBCs like
they are normochromic and normocytic
149
which types of anemia have RBCs that are normocytic
1. anemia caused by chronic disease
2. aplastic anemia
3. myelophthisic anemia
4. anemia due to blood loss
150
Which types of anemia have RBCs that are microcytic
1. thalassemia
| 2. Iron deficient anemia
151
which types of anemia have RBCs that are macrocytic
1. Megaloblastic/pernicious anemia
152
Which types of anemia have RBCs that are hypochromic
1. Thalassemia
| 2. Iron deficient Anemia
153
which types of anemia have RBCs that are normochromic
1. Chronic disease induced anemia
2. Megaloblastic anemia
3. aplastic anemia
4. myelophthisic anemia
154
what are the types of anemia we discussed
1. Microangiopathic hemolytic anemia
2. Hot autoimmune hemolytic anemia
3. cold autoimmune hemolytic anemia
4. Sickle cell anemia
5. Thalassemia
6. hereditary spherocytosis
7. G6PDH deficiency
8. Iron deficient anemia
9. anemia of chronic disease
10. Megaloblastic (pernicious) anemia
11. Aplastic anemia
12. Myelophtisic anemia
155
what are the causes of aplastic anemia
1. idiopathic
2. drugs
3. viruses
4. pregnancy
5. fanconi anemia
