Anemia intro

Question 1

Definition of Anemia

Answer 1

Reduction in total RBC, amount of Hg, or circulating RBC mass

Question 2

Clincal signs of anemia

Answer 2

Pallor, fatigure, syncope, dyspnea, tachycardia, palpitations, heart murmurs, CHF, postural hypotension

Question 3

Scleral icterus

Answer 3

Hemolysis

Question 4

Smooth tongue with glossitis

Answer 4

Pernicious anemia, severe iron deficiency

Question 5

Petechiae

Answer 5

Thrombocytopenia, marrow replacement/failure

Question 6

Koilonychia

Answer 6

Iron deficiency

Question 7

Lymphadenopathy

Answer 7

Hematolymphoid malignancy, infection

Question 8

Splenomegaly

Answer 8

hematolymphoid malignancy, infectious Mono

Question 9

Skin ulcers

Answer 9

sickel cell disease

Question 10

Massive splenomegaly

Answer 10

Chronic myeloid leukemia, myelofibrosis

Question 11

Hepatosplenomegalywith ascites

Answer 11

liver disease

Question 12

Subacute combined degeneration of spinal cord

Answer 12

pernicious anemia

Question 13

Delayed achilles tendon reflex

Answer 13

hypothyrodism

Question 14

General causes of anemia

Answer 14

Blood loss, hemolysis, insufficient production of erythrocytes

Question 15

Anemia Classification by morphology

Answer 15

RBC size, RBC shapes, proliferation index

Question 16

Increased reticulocytes

Answer 16

Marrow is responding to anemia by producing more RBCs

Question 17

No increased reticulocytes

Answer 17

Marrow is not responding appropriately to anemia

Question 18

Iron deficiency anemia

Answer 18

Typical S/S. Pale nail bed color. Pica. Koilonychia. Glossitis

Question 19

Morphology of iron deficiency anemia

Answer 19

Microcytic hypochromic anemia, anisocytosis, poikilocytosis (elliptocytes with pencil cells), decreassed reticulocyte count**, mild thrombocytosis

Question 20

Anemia of chronic disease

Answer 20

about 1-2 months after chronic disease onset.

Question 21

Path of anemia of chronic disease

Answer 21

Immune-driven cytokine respone. Cytokine mediated disturbences in iron homeostasis( decreased absorp. Increased iron shunting into macrophages). CytoK mediated inhibition of erythroid precursor proliferation/differentiation in marrow

Question 22

Morphology of anemia of chronic disease

Answer 22

Microcytic hypochromic anemia or normocytic normochromic anemia with normal RDW. Low reticulocyte count

Question 23

Disorders of globin synthesis

Answer 23

Thalassemias, abnormal globin chains

Question 24

Thalassemias

Answer 24

Heterogeneous group of inheritied disorders charac. Reduced globin chain synthesis

Question 25

Morphology of beta thalassemia major

Answer 25

Marked anisocytosis/poikilocytosis. Many nucleated RBCs. Polychromasia. Severe microcytic hypochromic anemia

Question 26

Normochromic normocytic anemias

Answer 26

Anemia of chronic disease. Sickle cell. Early iron deficiency. Vit B12/folate def. Medication/toxin effect. Hereditary anemias

Question 27

Macrocytic Megablastic Marrow Causes

Answer 27

Folate/vitamin B12/Copper def. Drug effect

Question 28

Non-megaloblastic marrow macrocytic causes

Answer 28

Drug effect, alcohol abuse, hypothyrodism, myelodysplastic neoplasms, aplastic anemia

Question 29

Megaloblastic anemia

Answer 29

Usually from vit B12/folate def. Impaired DNA synthesis so cells divide more slowly. Ineffective hematopoiesis

Question 30

Causes of B12 def

Answer 30

Pernicious anemia, gastrectomy, pancreatic damage, ileal disease/resection, fish tapeworm, bacterial overgrowth

Question 31

Pts with increased B12 requirement

Answer 31

Pregnancy, hyperthyrodism, advanced cancer, chronic infection

Question 32

Folate def causes

Answer 32

Diet, alcoholism, malabsorption, intestinal disease, anticonvulsants, oral contraceptives

Question 33

Pts with increased folate req

Answer 33

pregnancy, infancy, advanced cancer, marked increased hematopoiesis

Question 34

S/S of megaloblastic anemia

Answer 34

Anemia with mild jaundice. Glossitis. Angular stomatitis. Mild symptoms of malabsoprtion. Purpura due to thrombocytopenia

Question 35

Long standing, untreated B12 deficiency

Answer 35

spinal cord degeneration

Question 36

Megaloblastic anemia morphology

Answer 36

Oval macrocytes. Hypersegmentaed neutrophils. Rare teardrop cells, schistocytes, or spherocytes may be seen

Question 37

Intravascular hemolysis

Answer 37

Direct lysis of RBCs within circ system. Extracorpuscular defects

Question 38

Extravascular hemolysis

Answer 38

Premature removal of RBCs by reticuloendothelial system

Question 39

RBC destruction releases what?

Answer 39

Heme, Globin, Iron, Lactate dehydrogenase

Question 40

Methemalbumin

Answer 40

Binding of free hemoglobin to transferrin and albumin. Most commonly seen in intravascular hemolysis

Question 41

Intravascular hemolysis clincal/lab findings

Answer 41

Anemia, hemoglobinemia, hemoglobinuria, hemosiderinuria, decreased plasma haptoglobin, jaundice

Question 42

Sickle cell disease

Answer 42

Hemoglobin S results from single point mutation on beta-globin gene that promotes polymerization of hemoglobin in conditions of low O2 tension or dehydration

Question 43

Sickle Cell clincal findings

Answer 43

Chronic hemolysis, chronic tissue hypoxia, infarcts, skin ulcers, severe pain, tissue damage, functional autosplenectomy, osteomylitis with Salmonella species

Question 44

Morphology of sickle cell

Answer 44

Normochromic normocytic anemia. Sickle cells. Anisopoikilocytosis. Polychromasia/reticulocytosis. Howell-Jolly boides after splenic infarcts/autosplenectomy

Question 45

Hereditary spherocytosis

Answer 45

Northern Euro decent. Basic defect in spectrin (anchors membrane to cytoskeleton). Cells gradually become spherical

Question 46

S/S of herditary spherocytosis

Answer 46

Anemia, intermittent jaundice, splenomegaly

Question 47

Morphology of hereditary spherocytosis

Answer 47

Variable normochromic normocytic anemia. Many spherocytes. Polychromasia/reticulocytosis

Question 48

Warm Autoimmune Hemolytic Anemia

Answer 48

Pt Ab to own RBC antigens. IgG Ab binds to RBC at 37º and are phagocytosed.

Question 49

Morphology of warm AIHA

Answer 49

Anisopoikilocytosis, spherocytes (and micro), marked polychromasia, nucleated RBCs

Question 50

Microangiopathic hemolytic anemia causes

Answer 50

TTP. HUS. DIC. Mechanical heart valves. Vasulitis, disseminated cancer. Malignang hypertension. (aka RBC fragment syndrome)