1. Lose blood 2. Destroy too much blood (intracorpusular or extracorpuscular reasons) 3. Make too little blood - too few building blocks - Too few erythroblasts (aplastic anemia) - Not enough room

- hypochromic, microcytic anemia - anisocytosis - poikilocytosis - decreased reticulocytes - increased platelets

- decreased serum iron - increased TIBD - decreased ferritin

- decreased serum iron - increased Total iron binding capacity - decreased ferritin only ID will make this low

Anemia- Krafts Flashcards by Morgan Mensink

Symptoms of Anemia

Pale skin/mucous membranes
Jaundice
Tachycardia
Breathlessness 
Dizziness
Fatigue

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Koilonychia

Spoon shaped nails

in IDA

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3 ways to get anemic

Lose blood
Destroy too much blood (intracorpusular or extracorpuscular reasons)
Make too little blood
- too few building blocks
- Too few erythroblasts (aplastic anemia)
- Not enough room

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3 Morphologic Groups of Anemia

Weird Size
Weird Shape
Normal size and shape

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Weird Size

Iron- deficiency anemia
Thalassemia
Megaloblastic anemia

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Iron Deficiency Anemia

Most important cause–> GI bleeding
Microcytic, hypochromic anemia
increased anisocytosis (varying cell sizes) & poikilocytosis (abnormal shape)
Abnormal iron studies

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Iron:
Absorption?
Circulation?

Absorbed in duodenum

Carried in circulation by transferrin

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Iron:
Absorption?
Circulation?

Absorbed in duodenum

Carried in circulation by transferrin

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Hemoglobin

4 globin chains (2 alpha, 2 beta)

4 heme molecules
-iron only binds O2 in ferrous (Fe2+) state

Fe3+/ferric state=methemoglobin

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Ferritin vs hemosiderin?

Ferritin is quick iron storage

Hemosiderin is long term

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Causes of iron deficiency

Decreased iron intake (bad diet/absorption)

Increased Iron loss( GI bleed, menses, hemorrhage)

Increased iron requirement (prego)

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IDA in premenopausal women?

IDA in everyone else?

premen women–> MENORRHAGIA

everyone else–> GI BLOOD LOSS

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Signs/symptoms of IDA:

Asymptomatic
Fatigue, dizziness
Signs: pale, spoon nails, smooth tonue
Pica

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First sign of ID?

Poikilocytosis: see elliptocytes –cigar shaped cells

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Blood smear in IDA?

hypochromic, microcytic anemia
anisocytosis
poikilocytosis
decreased reticulocytes
increased platelets

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Bone marrow biopsy findings in IDA?

erythroid hypoplasia (not as many RBC as you would expect)
dyserythropoiesis (funny looking RBCs)
decreased iron stores

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Labs in IDA? **

decreased serum iron
increased TIBD
decreased ferritin

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Labs in IDA? **

decreased serum iron
increased Total iron binding capacity
decreased ferritin *** only ID will make this low

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Do look at what lab test first for diagnosis of IDA?

Ferritin

DECREASED in IDA!

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Tx of IDA?

Figure out why they are iron deficient

-give oral iron

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Megaloblastic anemia

THINGS TO KNOW

Defective DNA synthesis
Nuclear/cytoplasmic asynchrony (nuc lags behind in maturity)
decreased B12/folate
Macocytic anemia with oval macrocytes and hypersegmented neutrophils

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Megaloblastic anemia

Retarded DNA syn & unimpaired RNA syn —–>

BIG BIG Cells

Immature nucleus
Mature cytoplasm

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B12 sources & absorption

Study These Flashcards

Meat, dairy, cereal. (NOT veggies, dude!)

Need IF secreted by parietal cells to get absorbed in distal ileum

Causes of B12 Deficiency

Study These Flashcards

diet
lack of IF (pernicious anemia)
pancreatic damage
Ileal damage
Tapeworm

Megoloblastic symptoms?

Atrophic glossitis --beefy tongue, lack of papilli

Long term B12 def

Subacute combined degeneration -sensory & motor probs Need B12 to convert homocysteine --> methionine

Folate: sources & absorption

Green leafy veggies | -Absorbed in jejunum

Causes of folate def

diet alcohol abuse jejunal damage drugs

What will you see in a blood smear with megalobastic anemia?

- macrocytic anemia - oval macrocytes - Hypersegmented neutrophils (*only happens with this)

What will you see in a blood smear with megaloblastic anemia? Labs?

- macrocytic anemia - oval macrocytes - Hypersegmented neutrophils (*only happens with this) MCV >100

What do you see in BM biopsy with megaloblastic anemia?

- megaloblastic erythroblasts | - megaloblastic neutrophils

Weird Shaped Anemias? Hemolytic anemias!

- HS - AIHA - Sickle cell anemia - G6PD deficiency - MAHA

Weird Shaped Anemias? Hemolytic anemias!

- HS - AIHA - Sickle cell anemia - G6PD deficiency - MAHA

Symptoms of acute hemolytic anemia

back, abdominal, limb pain headache malaise, fever jaundice, pallow, tachycardia

Types of hemolytic Anemia

1. Chronic (hereditary) -well compensated 2. Acute (acquired) 3. Inherited- defects in RBCs 4. Acquired -infection or drug related

Bottom line of hemolytic anemia, you'll see signs of both:

increased RBC destruction --------> Increased RBC production

Signs of Increased RBC Destruction

- increased serum bilirubin - increased LDH - Decreased haptoglobin

Signs of Increased RBC PRODCUTION:

- Reticulocytosis | - Nucleated RBCs in blood

Signs of Increased RBC PRODCUTION:

- Reticulocytosis | - Nucleated RBCs in blood

Labs test in hemolytic anemia

1. direct antiglobulin test (DAT)- look for Abs on RBC surface by using a anti-human globulin (+ = immune process) 2. Osmotic fragility test: +=spherocytes present

Morphology of hemolytic anemia

- Normochromic, normocytic anemia - Spherocytes - Poikilocytes: targets, sickles, fragmented

How to diagnose Hemolytic anemia

Look for signs of destruction & production | Determine cause with DAT (immune vs non immune)

Tx of hemolytic anemia

Depends on cause Acute: tx shock Splenectomy if needed

Hereditary Spherocytosis (HS)

- Tons of spherocytes - Defect in RBC cytoskeleton (spectrin) - Splenectomy is curative

Triad of Hereditary Spherocytosis

1. anemia 2. jaundice 3. spenomegaly

Pathogeneisis of HS:

- abnormal RBC cytoskeleton - loss of surface area - spleen removes spheres (macrophages)

HS Morphology

- mild normochromic, normocytic anemia | - numerous spherocytes

HS tx:

Splenectomy

Autoimmune Hemolytic Anemia (AIHA) Warm and cold types THINGS TO KNOW

- IgG bind to RBCs - destruction happens in spleen - Spherocytes

Pathogenesis of WAHA

IgG coats RBCs --->Macs eat whole cell OR nibble and cell becomes spherocytes Get Splenomegaly

WAHA dx and tx

Dx: DAT (direct antiglobulin test) Tx: steroids and maybe splenectomy

WAHA dx and tx

Dx: DAT (direct antiglobulin test) Tx: steroids and maybe splenectomy

Cold AIHA | THINGS TO KNOW:

-IgM, complement bind at colder temp areas, hands ears feet. falls off in warm body parts - some intravasulcar hemolysis (b/c of complement) - mostly spleen - Agglutination: IgM forms petamers and clumps RBCs up (bridges RBCs)

Clinical signs of Cold AIHA

chronic hemolysis aggravated by cold. Pallor, cyanosis in cold body parts

Morphology of Cold AIHA

Red cell agglutinates (from IgM) | Rare spherocytes

Cold AIHA dx and tx

Dx: DAT positive for complement (doesn't pick up IgM) tx: keep patient warm, treat underlying cause

Anemia- Krafts Flashcards

(56 cards)