Anemia Part 4 Flashcards

(139 cards)

1
Q

WHAT ARE THE FACTORS ASSOCIATED WITH ANEMIA DUE TO IMPAIRED OR DEFECTIVE PRODUCTION

A
  1. Disorders of Iron Metabolism and Heme Synthesis
  2. Bone Marrow Failure
  3. Defects of DNA metabolism
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2
Q

Enumerate the different disorders associated with Iron Metabolism and Heme Synthesis

A

Iron Deficiency Anemia
Sideroblastic Anemia
Anemia of Chronic Disease
Iron overload

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3
Q

Example of condition wherein there is a bone marrow failure

A

Aplastic Anemia

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4
Q

Example of Defects of DNA metabolism

A

Megaloblastic Anemia
Non-megaloblastic anemia

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5
Q

Most common anemia in the US

A

IRON DEFICIENCY ANEMIA

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6
Q

A disorder characterized with insufficient iron for high synthesis

A

IRON DEFICIENCY ANEMIA

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7
Q

A disorder associated with inadequate intake, increases need, impaired absorption or chronic blood loss

A

IRON DEFICIENCY ANEMIA

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8
Q

IRON DEFICIENCY ANEMIA MAY ARISE FROM:

A

Pregnancy
Normal growth
Menstruating women, Blood loss, Intravascular hemolysis
GI disorders (tumors, ulcers, hemorrhoids, aspirin ingestion, alcoholism)
Parasitic infections
March hemoglobinuria (Marching/Runner’s anemia)

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9
Q

Enumerate the different clinical symptoms associated with Iron Deficiency Anemia

A

Fatigue, dizziness, pallor
Pica
Angular cheilosis
Glossitis
Koilonychia

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10
Q

It is an inflammatory condition that causes cracking, crusting, and scaling of the corners of the mouth. Also known as Perleche or angular stomatitis

A

Angular cheilosis

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11
Q

Inflammation of the tongue

A

Glossitis

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12
Q

Koilonychia is also know as __?

A

spoon nails

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13
Q

Also known as spoon nails

A

Koilonychia

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14
Q

Nails with a spoon-shaped dent on them. Usually a sign of iron deficiency

A

Koilonychia

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15
Q

In Iron Deficiency anemia, RBC count, hemoglobin, hematocrit, RBC indices, reticulocyte count are all (increased, decreased)

A

decreased

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16
Q

Iron Deficiency Anemia (LABORATORY FINDINGS)

RDW: ___

A

> 15%

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17
Q

Iron Deficiency Anemia (LABORATORY FINDINGS)

RBC: ____, ________

A

Microcytic, hypochromic

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18
Q

Poikilocytosis present in the laboratory findings of iron deficiency anemia

A

target cells, elliptocytes

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19
Q

chronic bleeding

A

Thrombocytosis

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20
Q

Enumerate the different IRON STUDIES

A

Serum Iron
Total Iron Binding Capacity (TIBC)
Transferrin Saturation (% Saturation)
Serum Ferritin
Free Erythrocyte Protoporphyrin (FEP)

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21
Q

measure of iron bound to transferrin

A

Serum Iron

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22
Q

indirectly measures transferrin concentration by measuring its ability to bind iron

A

Total Iron Binding Capacity (TIBC)

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23
Q

percentage of iron binding sites occupied by iron

A

Transferrin Saturation (% Saturation)

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24
Q

reflection of body’s tissue iron stores

A

Serum Ferritin

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25
measurement of protoporphyrin without iron.
Free Erythrocyte Protoporphyrin (FEP)
26
Measures as zinc protoporphyrin (ZPP) using hematofluorometer’
Free Erythrocyte Protoporphyrin (FEP)
27
Serum Iron is the measure of iron bound to _____
transferrin
28
Free Erythrocyte Protoporphyrin (FEP) is the measurement of _____ without _____
protoporphyrin, iron
29
INADEQUATE INTAKE: Amount of iron loss per day
1mg/day
30
INADEQUATE INTAKE: Amount of iron replacement
1 mg/day
31
T/F: Inadequate iron over time will lead to depleted iron stores
True
32
Inadequate iron over time will lead to depleted iron stores and will result to ____
Inability to produce Hb
33
INCREASED NEED happens when iron intake becomes (inadequate, adequate) to meet the needs of expanding erythron
inadequate
34
INCREASED NEED in iron deficiency anemia happens during:
Rapid growth (infancy, childhood, adolescence) Pregnancy
34
EXAMPLE OF IMPAIRED ABSORPTION IN IRON DEFICIENCY ANEMIA
Malabsorption (celiac disease) Matriptase-2 protein mutation Decreased stomach acidity Drugs (stomach acid reducers)
35
T/F: Excessive loss of Hb in the body will result to RAPID hemorrhage or hemolysis
FALSE; slow
36
Example of Chronic blood loss
Heavy menstrual bleeding, fibroid tumors, GI bleeding bec of ulcers and tumors, kidney stones, and PNH
37
IDA: (choices: Low, High, Normal, Variable) Serum Iron = ___ Serum Ferritin = ____ TIBC = ___ Transferrin Saturation = ___ FEP/ZPP = ___
Low Low High Low High
38
Sideroblastic Anemia: (choices: Low, High, Normal, Variable) Serum Iron = ___ Serum Ferritin = ____ TIBC = ___ Transferrin Saturation = ___ FEP/ZPP = ___
High High Normal/Low High High
39
Lead Poisoning: (choices: Low, High, Normal, Variable) Serum Iron = ___ Serum Ferritin = ____ TIBC = ___ Transferrin Saturation = ___ FEP/ZPP = ___
Variable Normal Normal Normal High
40
ACD/ACI: (choices: Low, High, Normal, Variable) Serum Iron = ___ Serum Ferritin = ____ TIBC = ___ Transferrin Saturation = ___ FEP/ZPP = ___
Low Normal/High Low Low High
41
Thalassemia (choices: Low, High, Normal, Variable) Serum Iron = ___ Serum Ferritin = ____ TIBC = ___ Transferrin Saturation = ___ FEP/ZPP = ___
Normal/High Normal/High Normal High/Normal Normal
42
What is the new term for ANEMIA OF CHRONIC DISEASE
: Anemia of Chronic inflammation
43
Associated with an increased level of Hepcidin and Inability to use iron
ANEMIA OF CHRONIC DISEASE
44
ANEMIA OF CHRONIC DISEASE is associated with:
Infections (HIV, TB) Inflammation (RA, SLE) Malignancies (Cancer, Hodgkin Lymphoma)
45
In ANEMIA OF CHRONIC DISEASE, RBC appears as
normocytic, normochromic or slightly microcytic, hypochromic anemia
46
In ANEMIA OF CHRONIC DISEASE, RBC appears Hemoglobin, serum iron, TIBC are all (increased, decreased)
decreased
47
In ANEMIA OF CHRONIC DISEASE, ESR is (increased, decreased)
increased
48
In ANEMIA OF CHRONIC DISEASE, ferritin _____
Normal to increase
49
Blocks in protoporphyrin pathway
SIDEROBLASTIC ANEMIA
50
Iron overload in bone marrow
SIDEROBLASTIC ANEMIA
51
Example of Hereditary (X-linked, autosomal)
Porphyrias
52
SIDEROBLASTIC ANEMIA: Acquired:
Primary Sideroblastic Anemia (RARS) Secondary Sideroblastic Anemia
53
Enumerate the different Secondary Sideroblastic Anemia
Lead Antitubercular drugs Chloramphenicol Alcohol Chemotherapeutic drugs
54
Erythroblasts with iron deposits surrounding the nucleus
Ring/Ringed Sideroblast
55
Stain used in Ring/Ringed Sideroblast
Prussian blue
56
Iron accumulation in mature RBCs
Siderocyte/Pappenheimer Body
57
Stain used in Siderocyte/Pappenheimer Body
Perl’s Prussian Blue Wright Stain
58
SIDEROBLASTIC ANEMIA Appearance of RBC in the peripheral smear
Microcytic, Hypochromic
59
Interferes with conversion of aminolevulinic acid (ALA) to porphobilinogen
Lead
60
Interferes with incorporation of iron and protoporphyrin
Lead
61
Lead inhibis ____
pyrimidine 5’-nucleotidase
62
Lead interferes with incorporation of _____ and _____
iron; protoporphyrin
63
Other term for lead poisoning
Plumbism
64
T/F: Lead poisoning occurs mostly in adults
F; children
65
Clinical symptoms of Lead Poisoning (Plumbism)
Abdominal pain Muscle weakness Gum lead line that forms from blue/black deposit of lead sulfate
66
LEAD: The conversion of ______ to ______ by ALA dehydratase; the result is the accumulation of _____.
aminolevulinic acid (ALA) Porphobilinogen (PBG) aminolevulinic acid
67
ALA dehydratase is also called as
PBG synthase
68
LEAD The incorporation of iron into protoporphyrin IX by _____; the result is accumulation of ___ and _____ in the _______.
ferrochelatase iron protoporphyrin mitochondria
69
Lab Findings of Lead Poisoning RBC: Initially: ______; __________ Chronic exposure: ______; __________ ____________
normocytic; normochromic microcytic, hypochromic Basophilic stippling
70
Urine ALA in lead poisoning is (increased, decreased)
increased
71
RBC Protoporphyrin in lead poisoning is (increased, decreased)
increased
72
RBC Protoporphyrin is measured using
FEP
73
associated color in porphyria
purple
74
Group of inherited disorders characterized by impaired protoporphyrin production
Porphyria
75
Clinical Symptoms of Porphyria
Photosensitivity Fluorescence in teeth and bone Psychosis Wine-red color of urine
76
Enzyme affected in Congenital Erythropoietic Porphyria (CEP) – Gunther’s Disease
Uroporphyrinogen III synthase deficiency
77
Enzyme affected in Erythropoietic Protoporphyria (EPP)
Ferrochelatase deficiency
78
Enzyme affected in X-linked Erythropoietic Protoporphyria (XLEPP)
ALA-synthase (gain-of-function)
79
Inheritance associated with Congenital Erythropoietic Porphyria (CEP) – Gunther’s Disease
Autosomal recessive
80
Inheritance associated with Erythropoietic Protoporphyria (EPP)
Autosomal recessive
81
Inheritance associated with Erythropoietic Protoporphyria (XLEPP
X-linked
82
Clinical Symptoms of Congenital Erythropoietic Porphyria (CEP) – Gunther’s Disease
Skin redness hemolytic anemia skin photosensitivity splenomegaly
83
Clinical Symptoms of Erythropoietic Protoporphyria (EPP)
Photosensitivity mild anemia
84
Clinical Symptoms of X-linked Erythropoietic Protoporphyria (XLEPP)
Photosensitivity mild anemia (microcytic, hypochromic)
85
Porphyrins (RBC) in Congenital Erythropoietic Porphyria (CEP) – Gunther’s Disease
↑↑↑ Uroporphyrinogen I ↑↑ Coproporphyrinogen I
86
Porphyrins (RBC) in Erythropoietic Protoporphyria (EPP)
↑↑↑ Free Protoporphyrin
87
Porphyrins (RBC) in X-linked Erythropoietic Protoporphyria (XLEPP)
↑ Free protoporphyrin
88
Most common form of iron overload disease
Hereditary Hemochromatosis
89
Hereditary Hemochromatosis is caused by a mutation in ___
HFE gene
90
Regulates the amount of iron absorbed from food
HFE gene
91
Clinical Symptoms of Hereditary Hemochromatosis
Arthritis, Liver cirrhosis Congestive heart failure Impotence Bronze skin Diabetes Thyroid deficiency
92
Treatment for Hereditary Hemochromatosis
Phlebotomy
93
Fatal bone marrow failure syndrome
APLASTIC ANEMIA
94
APLASTIC ANEMIA has no response in _____
erythropoietin
95
Features of APLASTIC ANEMIA
Pancytopenia Reticulocytopenia Bone Marrow Hypocellularity Depletion of hematopoietic stem cells
96
Etiology of Aplastic Anemia: How many % are acquired?
80-85%
97
Etiology of Aplastic Anemia: How many % are inherited?
15-20%
98
The Pathophysiology of Bone Marrow Failure includes:
Destruction of hematopoietic stem cells as a result of injury by drugs, chemicals, radiation, viruses, or autoimmune mechanisms; Premature senescence and apoptosis of hematopoietic stem cells as a result of genetic mutations; Ineffective hematopoiesis caused by stem cell mutations or vitamin B12 or folate deficiency; Disruption of the bone marrow microenvironment that supports hematopoiesis; Decreased production of hematopoietic growth factors or related hormones; Loss of normal hematopoietic tissue as a result of infiltration of the marrow space with abnormal cells.
99
RBC appearance in Aplastic Anemia
normocytic, normochromic
100
Hemoglobin, retics, WBC, platelets are all (increased, decreased) in aplastic anemia
decreased
101
Hemoglobin level in Aplastic anemia
<10 g/dL
102
T/F: Bone Marrow is Severely Hypocellular in aplastic anemia
TRUE
103
T/F bone marrow in aplastic anemia is decreased to absent erythroid, granulocytic and megakaryocytic cells
TRUE
104
Characterized by aplastic anemia, physical abnormalities and cancer susceptibility
Fanconi Anemia
105
Clinical features of Fanconi Anemia
Low birth weight Skin hyperpigmentation (café-au-lait spots) Short stature
106
Characterized by pancytopenia, mucocutaneous abnormalities, and bone marrow failure
Dyskeratosis congenita
107
Characterized by pancreatic insufficiency, cytopenia, skeletal abnormalities, and hematologic malignancies
Shwachman-Bodian-Diamond Syndrome
108
Shwachman-Bodian-Diamond Syndrome Peripheral smear: ________, _______ (%)
Neutropenia, pancytopenia (25%)
109
Erythropoietic disorder May be acquired or inherited
PURE RED CELL APLASIA (PRCA)
110
transient erythroblastopenia of childhood (acquired or inherited)
acquired
111
Diamond-blackfan anemia (acquired or inherited)
inherited
112
RBC appearance in PRCA
Normocytic, normochromic (macrocytic)
113
Reticulocytes in PRCA (increased, decreased)
decreased
114
WBC and platelets in PRCA (increased, decreased, normal)
normal
115
bone marrow in PRCA
Erythroid hypoplasia
116
Associated with Defective DNA synthesis
MEGALOBLASTIC ANEMIA
117
MEGALOBLASTIC ANEMIA is Caused by
Vitamin B12 (cobalamin) and folate deficiency
118
Peripheral Smear results in MEGALOBLASTIC ANEMIA
RBC: macrocytic; normochromic with Oval macrocytes, teardrops Howell-Jolly Bodies nucleated RBC basophilic stippling Pappenheimer bodies Cabot Rings Hypersegmented neutrophils
119
Hemoglobin, hematocrit, retics count are all (increased, decreased) in MEGALOBLASTIC ANEMIA
decreased
120
Lactate dehydrogenase, total and indirect bilirubin, iron are all (increased, decreased) in MEGALOBLASTIC ANEMIA
increased
121
Vitamin B12 (Cobalamin) Deficiency is aka
Pernicious anemia, Addison’s anemia
122
Causes of Vitamin B12 (Cobalamin) Deficiency
Intrinsic factor deficiency Malabsorption, Diphyllobotrium latum infection, total gastrectomy, total vegetarian diet
123
Example of intrinsic factor deficiency in Vitamin B12 (Cobalamin) Deficiency
Autoimmune deficiency H. pylori infection
124
Clinical findings in Vitamin B12 (Cobalamin) Deficiency
Pernicious anemia Achlorhydria Weakness and numbness Sore tongue (glossitis) GI disorders CNS problems
125
Hemoglobin, hematocrit, RBC, RBC indices are all (increased, decreased)
decreased
126
Peripheral Smear in Vitamin B12 (Cobalamin) Deficiency
Macrocytosis, Anisocytosis, Poikilocytosis Basophilic stipplings nRBC Hypersegmented neutrophils Bone Marrow: dominated with megaloblastic cells
127
Causes of Folic Acid Deficiency
Poor dietary intake Malabsorption syndrome Pregnancy Drugs
128
Example of drug that can cause folic acid deficiency
Methotrexate
129
Example of drug that can cause folic acid deficiency
Methotrexate
130
T/F: The clinical findings of Folic Acid Deficiency is similar to pernicious anemia (without CNS involvement)
True
131
T/F: The clinical findings of Folic Acid Deficiency is similar to pernicious anemia (without CNS involvement)
True
132
What are The Causes of MEGALOBLASTIC
Vitamin B12 deficiency Folic acid deficiency Pernicious anemia
133
What are The Causes of NON-MEGALOBLASTIC
Liver disease Alcoholism Bone marrow failure
134
Hypersegmented Neutrophils is (present, absent) in megaloblastic
present
135
Hypersegmented Neutrophils is (present, absent) in non-megaloblastic
absent
136
Shape of Macrocytes in megaloblastic
oval
137
Shape of Macrocytes in non-megaloblastic
round
138
MCV in megaloblastic
≥120 fL