Anemia I

Question 1

what vitamins are required for RBC production?

Answer 1

iron, folate, vit B12

Question 2

what conditions will lead to decreased hgb affinity for oxygen?

Answer 2

decreased pH
increased DPG
increased temp
(think exercising!)

Question 3

MCH

Answer 3

mean corpuscular hemoglobin - measure of mass of hemoglobin per RBC. low = hypochromic

Question 4

MCHC

Answer 4

conc of hemoglobin in a given volume of packed RBCs

Question 5

diseases w/ low MCHC

Answer 5

iron deficiency

thalessemia

Question 6

diseases w/ high MCHC

Answer 6

hereditary spherocytosis, hemolytic anemias

Question 7

MCV

Answer 7

volume of the average RBC

Question 8

RDW

Answer 8

measure of degree of variation in RBC size

Question 9

aniscytosis

Answer 9

high RDW

Question 10

polychromasia

Answer 10

indicates shift of marrow reticulocytes into the periphery

Question 11

normal reticulocyte count

Answer 11

0.5% to 2.0% of total RBCS

absolute usually 25K to 75K

Question 12

reticulocyte production index (RPI)

Answer 12

RPI = reticulocyte % x (Hct/normal Hct) / maturation factor

> 2 = adequate response; <2 inadequate response

Question 13

if you have anemia and another cell line down, what should you do?

Answer 13

bone marrow biopsy!

Question 14

with acute blood loss, what will happen to Hgb/Hct?

Answer 14

they may lag (normal at first despite lots of blood loss) - will decrease later as compensatory fluid moves from extravascular to intravascular space

Question 15

causes of microcytic anemia (5)

Answer 15

1. iron deficiency anemia
2. lack of iron release from macrophages
3. failure of heme synthesis
4. failure of globin synthesis
5. lead intoxication (inhibits heme and globin synthesis)

Question 16

hepcidin

Answer 16

peptide that regulates absorption of iron at the duodenum

Question 17

transferrin and ferritin

Answer 17

transferritin: transporter for circulating iron
ferritin: intracellular storage protein for iron - can be elevated by inflammation

Question 18

plummer-vinson syndrome

Answer 18

dysphageia
esophageal web
atrophic glossitis

due to IDA

Question 19

koilonychia

Answer 19

spoon nails assoc w/ IDA

Question 20

iron deficiency in a patient over 50 raise red flags for ______

Answer 20

colon cancer (until proven otherwise)

Question 21

tx of iron deficiency

Answer 21

ferrous sulfate (oral or IV)
address cause

Question 22

normal hemoglobin composition in adults

Answer 22

Hgb A1: alpha2-beta2 - 95-98%
Hgb A2: alpha2-delta2 - 2-3%
HgbF: alpha2gamma2 - 0.8-2.0%

Question 23

beta-thalessemia Hgb levels

Answer 23

beta–thal trait (B/B0): increased Hgb F (1-5%) and increased Hgb A2 (4-7%)
beta-thad major (B0/B0): very increased Hgb F (95+%), Hgb A2 (0-5%)

Question 24

beta-thal blood smear findings

Answer 24

target cells

microcytosis, hypochromia

Question 25

geographic distribution of beta-thal and alpha-thalal

Answer 25

beta: mediterranean and SE Asia alpha: SE asia, africa, india

Question 26

alpha thalessemia

Answer 26

gene deletion causes impaired production of alpha globin - 1-2 genes = alpha trait --> low MCV, but no tx req - 3 genes = beta chains form Hemoglobin H tetramers which are toxic to RBCs. Pts have anemia w/ hemolysis, sometimes need splenectomy. - 4 genes = formation of gamma aggregates --> hydrops fetalis

Question 27

sideroblastic anemia

Answer 27

anemia due to a problem with protoporphyrin synthesis --> microcytic anemia - erythroblasts accumulate iron in the mitochondria but can't produce adequate heme

Question 28

sideroblastic anemia blood smear

Answer 28

ringed sideroblasts | basophilic stippling

Question 29

congenital causes of sideroblastic anemia

Answer 29

``` ALAS mutation (rate-limiting step in porphyrin synthesis) other steps less common ```

Question 30

acquired causes of sideroblastic anemia

Answer 30

primary: myelodysplasia w/ ringed sideroblasts secondary: - nutritional (B6 or copper deficiency) - drugs: isoniazid, other alkalating agents - alcoholism - toxins: lead poisoning, zinc

Question 31

labs in sideroblastic anemia

Answer 31

iron high high ferritin normal TIBC high transferrin

Question 32

lead poisoning

Answer 32

inhibits heme and globin synthesis interferes w/ RNA breakdown --> basophilic stippling (sideroblast) labs: increased Fe, ringed sideroblasts in marrow, dx: lead level in blood or urine

Question 33

lead poisoning sx

Answer 33

abdominal pain neurologial symptoms: neuropathy, headaches, disorientation, insomnia irritability, psychosis

Question 34

anemia of chronic disease/inflammation

Answer 34

iron trapped in macrophages --> microcytic anemia