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Flashcards in Anemia II Deck (51):
1

Normochromic, Normocytic anemia with increased reticulocyte count 

  • prior or recent hemorrhage
  • recent hemolysis 

2

Normochromic, Normocytic anemia with normal reticulocyte count and normal bone marrow

  • anemia of chronic disease
  • hypothyroidism
  • liver disease 

3

What are the two causes of megaloblastic anemia 

  • B12 deficiency 
  • folate deficiency 

4

falsely elevated MCV due to 

  • large number of reticulocytes (larger RBC)
  • RBC clumping mimicking larger RBC 

5

Cause of megaloblastic anemias 

defective DNA synthesis results in disordered RBC maturation resulting in larger RBCs

6

Where does B12 come from 

diet

  • daily requirement is 1-2ug

7

How is B12 absorbed 

  • B12 (cobalamin) is bound to intrinsic factor in the somach
  • colbalamin is released from the Cobalamin-IF complex in the ileum where it is absorbed 

8

what cells produce intrinsic factor 

gastric parietal cells

9

What is pernicious anemia 

  • autoimmune
  • autoantibodies against the gastric parietal cells impair IF secretion 
  • deficiency of intrinsic factor which causes B12 malabsorption and megaloblastic anemia

10

What are some other conditions that cause B12 deficiency 

  • ileal disease or resection
  • bacterial overgrowth
  • intestinal parasites

11

Clinical presentation

  • typical symptoms of anemia 
  • glossitis, jaundice, splenomegaly
  • neuro findings: decreased vibratory and position sense, ataxia, paresthesias, confusion 

B12 deficiency anemia 

12

Peripheral smear

  • hypersegmented neutrophils (> 5 lobes)
  • anisocytosis (size)
  • poikilocytosis (shape)
  • macro-ovaocytes (large, oval RBC)

  • could be B12 deficiency anemia or folate deficiency anemia 

13

positive schilling test

  • detects antibodies to IF 
  • test for pernicious anemia 

14

elevated serum methylmalonic acid and homocysteine levels are common with which anemia 

pernicious anemia 

15

treatment of pernicious anemia 

  • Parenteral vitamin B12
    • daily injections of 1000 ug for 1 week
    • then weekly injections x 1 month
    • then monthly injections for life 
  • ***Do not treat with folic acid alone 

16

where does folic acid come from 

  • diet
  • fresh, leafy vegetables 

17

dailey requirement of folic acid normally? pregnancy?

  • daily requirement 200 ug/day
  • 400-800 ug/day in pregnancy 
  • **half life of 3 weeks 

18

folate deficiency occurs in what conditions 

  • alcoholism
  • end of pregnancy
  • anticonvulsant therapy 

19

Homocysteine levels and serum methylmalonic acid levels in folid acid deficiency

  • Homocysteine levels elevated
  • serum methylmalonic acid normal

20

treatment of folate deficiency 

  • 1 mg folic acid orally daily
  • 5 mg folic acid in patients with malabsorption 

21

Hemolysis 

destruction of RBCs

22

bone marrow cannot compensate for RBC survival time less than what?

  • 20 days...up to 5 times less than normal 
  • ** nml survival time=120days 

23

clinical presentation

  • usual features of anemia: pallor, SOB
  • jaundice
  • gallstones

hemolytic anemia 

24

patients with hemolytic anemia are at an increased risk of infection with?

  • salmonella
  • pneumococcus (give vaccine) 

25

intravascular hemolysis 

destruction of RBC within the blood stream

26

extravascular hemolysis 

destruction of RBC in the spleen 

27

lab findings

  • elevated reticulocyte count (polychromasia)
  • peripheral smear
    • immature RBC's nucleated RBCs
    • possible schistocytes (fragmented RBCs)
  • unconjugated biliruben increased
  • elevated serum LDH: Lactate dehydrogenase
  • plasma hemoglobin increased

Hemolytic anemia 

28

what lab value is low in intravascular hemolysis 

serum haptoglobin

  • mucoprotein produced in the liver which binds hemoglobin that has been released from lysed RBC

29

polychromasia

reticulocytosis 

30

G6PD deficiency can cause intravascular hemolysis. what would you see in peripheral smear

Heinz bodies 

31

common causes of intravascular hemolysis 

  • fragmentation syndromes
    • mechanical heart valve
  • G6PD deficiency
  • paroxysmal nocturnal hemoglobinuria 

32

positive osmotic fragility test is indicative of what disease 

hereditary spherocytosis 

33

common causes of extravascular hemolysis 

  • hereditary spherocytosis
  • sick cell anemia
  • autoimmune hemolytic anemia
  • incompatible blood transfusion
  • drug induced 

34

positive coombs test is indicative of 

autoimmune hemolytic anemia 

  • usually causes by IgG autoantibody 

35

presentation

  • normal MCV but smaller surface area
  • RBCs have dense, globular appearance and lack central pallor
  • RBC are poorly deformable and trapped in splenic sinusoids and phagocytized by splenic macrophages 

hereditary spherocytosis 

36

treatment of hereditary spherocytosis 

  • splenectomy 
    • restores RBC life span back to normal 
  • give pneumococcal vaccine
  • delay splenectomy until adulthood

37

sickle cell anemia is what type of genetic disorder 

autosomal recessive: need HbSS to show symptoms 

38

In sickle cell disease, when do RBC become sickle shaped 

when deoxygenated 

  • dehydration
  • hypoxia
  • high altitude
  • intense exercise 

39

when do signs and symptoms of sickle cell disease develop 

age 4-6 months with change from fetal hgb to adult hgb 

40

aplastic crisis 

sudden decrease in hemoglobin seen in chronic hemolysis 

41

what is the most common feature of sickle cell disease

  • pain crisis: vaso-occlusive ischemic tissue injury
    • pain in back, ribs, limbs lasting 5-7 days

42

diagnosis of sickle cell 

hemoglobin elecrophoresis reveals HbS

43

peripheral smeal of sick cell disease 

  • a few sickled RBC
  • howell-jolly bodies 

44

Why are RBCs normochronic and normocytic in sickle cell anemia 

it is an anemia of chronic disease 

45

treatment of sickle cell disease 

  • analgesics, fluids and oxygen in painful crisis
  • hydroxyurea to decrease incidence of painful crisis 
    • suppresses bone marrow function of all cell lines 

46

peripheral smear seen with autoimmune hemolytic anemia 

  • polychromasia
  • spherocytosis: sphere-shaped RBC
  • nucleated red cell 

47

treatment of hemolysis 

  • corticosteroids 
  • splenectomy is frequently advised
  • folic acid supplementation 

48

most antibodies to RBC are directed against?

the ABO/Rh blood grouping antigens 

49

aplastic anemia 

acquired abnormality of bone marrow stem cells

  • >50% idiopathic 
  • 20% drug exposure
  • 10% viral illness

50

what is the hallmark feature of aplastic anemia 

pancytopenia

  • anemia (reticulocytopenia)
  • leukopenia
  • thrombocytopenia

** bone marrow shows absense of precursor of these cells 

51

treatment of aplastic anemia 

bone marrow transplant or immunosuppressive tx