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Heme/Onc > Anemias > Flashcards

Anemias Flashcards

(51 cards)

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1
Q

What is the best indicator of red cell production?

A

reticulocyte count

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2
Q

For the kinetic classicfication of Anemia, what falls under inadequate production of RBC?

A

Hypoproliferative
* Impaired RBC production. Lower than expected numbers of RBC precursors in the marro

Ineffective erythropoiesis
* impaired RBC production despite increased bone marrow RBC precursors. Assembly line “rejects” via apoptosis defective RBC precursors

Can see with: Missing ingredients, low signal (EPO) some meds, infections, inflammation, autoimmunity, genetic, primary marrow disorder

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3
Q

For the kinetic classification of Anemia, what falls under increased RBC destruction or loss (RBC precursors & retics high)

A
  • hemolysis : shortened lifespan of circulating RBC
  • blood loos
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4
Q

MCV > 100

A

macrocytic anemia

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5
Q

MCV < 80

A

Microcytic anemia

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6
Q

MCV 80-100

A

Normocytic Anemia

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7
Q

Variation in RBC shape?

A

poikilocytosis

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8
Q

variation in RBC size

A

anisocytosis

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9
Q

cell with large, pale centers (less hemoglobin per cell)

A

hypochromia

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10
Q

what are some conditions that cause macrocytosis?

A
  • recticulocytosis
  • Folate deficiency
  • B12 deficiency
  • primary bone marrow problem (myelodysplasia, leukemia, multiple myeloma, MGUS
  • Liver disease, EtOH
  • thyroid disease
  • medications (hydroxyurea)
  • genetic conditions
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11
Q

Conditions that cause normocytosis?

A
  • anemeia of kidney disease
  • anemia of chronic disease
  • mixed anemia
  • early blood loss
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12
Q

conditions that cause microcytosis?

A
  • Iron deficiency
  • thalassemia
  • anemia of chronic disease
  • hereditary spherocytosis
  • lead poisoning
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13
Q

If the bone marrow is responding to the anemia appropriately, what would you expect the reticulocytes to be?

A

High

Bone marrow is adequately trying to correct anemia

think blood loss or hemolysis

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14
Q

if the bone marrow is not responding to anemia appropriately, what you expect reticulocyte count to be?

A

Low
(bone marrow might be struggling

think ineffective erythropoiesis of hypoproliferation

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15
Q

what would be the lab findings in iron deficiency anemia

A
  • Decreased ferritin, increased TIBC, Decreased serum iron

Lab findings
*hypochromic
*microcytic
*High RDW (anisocytosis)

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16
Q

symptoms of iron deficiency?

A
  • fatigue
  • pallor
  • atrophic glossitis
  • pica (eating dirt or ice)
  • koilonychia (spooned nails)
  • brittle nails
  • restless legs
  • cheilosis (cracking, crusting around the mouth)
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17
Q

what are some causes of iron deficiency?

A
  • blood loss (GI bleed secondary to PUD or NSAID use or cancer)
  • pregnancy and lactaton
  • malabsorption (celiac, h. pylori, bariatric surgery, PPI
  • poor nutritional intake
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18
Q

diminished or absen synthesis of globin chains (alpha or beta)

A

Thalassemia

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19
Q

what labs would you expect in thalassemia?

A
  • hypochromia
  • smear: target cells- could have basophilic stippling
  • normal iron studies or high serum iron and ferritin
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20
Q

how do you diagnosise thalassemia?

how do you treat thalassemia?

A

Hgb electrophoresis

transfusions (RBC transfusion every 3-4 weeks, chelation of their iron)
stem cell transplant is curative, but morbid

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21
Q

due to deficient alpha chain synthesis (excess beta chains)

Study These Flashcards
A

alpha thalassemia

22
Q

Due to a deficiency of beta chains (excess of alpha chains)

Study These Flashcards
A

beta thalassemia

23
Q

what is beta thalassemia major? what are the symptoms

Study These Flashcards
A

a severe transfusion dependent childhood disease, seen in the first year of life
sx: Pallor, jaundice and dark urine, hemolysis, irritability, anemia, abdominal swelling from hepatosplenomegaly

24
Q

what is beta thalassemia minor?

Study These Flashcards
A

mild anemia- but child is able to live full life

25
* microcytic * hypochromic anemia * ring sideroblasts are seen on prussion blue stained bone marrow aspirate smear * can be congenital vs acquired
sideroblastic anemia
26
* normocytic anemia with marked reticulocytosi * clinical sx: tachycardia, tachypnea, hypotension (decreased intravascular volume)
hemorrhage: acute blood loss
27
* seen in chronic immune activation/ chronic infection and malignancy * sustained systemic inflammation alters iron utilization in the marrow, supresses hematopoiesis, and blunts the response of EPO to anemia
Anemia of chronic disease
28
what labs would you see in anemai of chronic disease?
* normocytic, normochromic * may be microcytic in 1/3 cases * **normal or elevated ferritin** * **serum iron usually low, TIBC low**
29
* macrocytic * megaloblastic anemia (hypersegmented neutrophils) * sx: parasthesia, weakness, and unsteady gait; may have neurologic changes that +/- reversibility
B12 deficiency
30
diagnosis and treatment of B12 deficiency
Dx: * Low B12, or Normal B12 w High MMA tx: * Parenteral B12 for absorptive issue, oral or parenteral for diet related
31
what is pernicous anemia? how can you diagnose it?
B12 deficiency due to lack of intrinsic factor (loss of parietal cells which make the intrinsic factor or lack of ileum which absorbs it) * antibodies to intrinsic factor or parietal cells can diagnose pernicious anemia
32
* megaloblastic anemia * macrocytic anemia * hypersegmeneted neutrophils * Serum B12 is normal, MMA is normal, homocysteine is elevated
Folate deficiency
33
What are symptoms of folate deficiency? what are some causes?
* fatigue, presyncope but no neuro defects * dietary factors- no enough folate, alcoholism * folate is needed in pregnancy to reduce the incidence of neural tube defects
34
compare and contrast the causes of folate and B12 deficiency
folate * malnutrition * pregnancy/lactation * malabsorption * drugs (e.g, TMP sulfa, methotrexate) * alcohol * chronic hemolytic anemai B12 * malabsorption (pernicious anemia, gastrectomy, pancreatic insufficiency, small intestine resection, chrons * inadequte intake (strict vegan)
35
if your patient had a decrease in plasma volume due to dehydration, what would you see on the CBC?
mildly elevated WBC, RBC, plt
36
what are the hereditary hemolytic anemias?
hereditary spherocytosis G6PD deficiency thalassemia sickle cell
37
what are the "trauma" hemolytic anemias?
TTP, HUS, DIC
38
* an inherited abnormality of the RBC, defect in the structural membrane proteins * the abnormal cells are sperichal and are removed by the spleen resulting in reduced red cell life
Herediatry spehreocytosis
39
symptoms, diagnosis and treatment of hereditary spherocytosis?
sx: jaundice, pallor, splenomegaly dx: spherocytes on blood smear, pincer cell (mushroom shaped) negative direct antiglobulin test (DAT), elevated reticulocyte count tx: supportive care to splenectomy in severe
40
* Autosomal recessive genetic defect * abnormal production of beta-globin subunit of Hgb (qualitive defect) * onset/presentation: often in the first year of life when HgbF falls * splenomegaly is from increase sequestration and destruction of abnormally shaped cells
Sickle Cell Disease
41
* rare condition that occur after the bone marrow becomes damaged * labs: **complete absence of hematopoiesis (decreased RBC, WBC &Plt) decreased reticulocytes**
aplastic anemia
42
how do you diagnose and treat aplastic anemia? what are some causes
dx: bone marrow biopsy tx: depends on severity ( supportive transfusions/observation, transplant, horse ATG+cyclosporine) causes: acute or chronic; exposure to agents like benzene, viral infection, pregnancy, idiopathic, certain antibiotics- sulfa, chloramphenicol
43
* one of the most common causes of aquired hemolytic anemia- autoantibody to your own RBCs * can be caused by viral infection, SLE or other autoimmune conditions, lymphoproliferative disorder/cancer, drugs (PCN, methyldopa)
Autoimmune hemolytic anemia
44
what lab levels would you expect in autoimmune hemolytic anemia
* anemia * MCHC increased (spherocytosis) * reticulocytes elevated * elevated indirect bilirubin, LDL, direct coombs test
45
differentiate between cold and warm hemolytic anemia. How are they treated?
Cold- IgM antibodies that react with RBC surface at temps below core temp of body * direct coombs test positive (usually IG-, C3+) Warm- IgG antibodies attack RBC * direct coombs test positive (usually IG+, C3-) TX: warm needs steroids and treatment of underlying issue, cold sometimes needs chemo
46
* most common enzyme deficiency. X-linked recessive disorder seen in black males and some mediterranean populations * clinically patients are healthy until oxidative stress causes hemolysis. * oxidative drugs and fava been intake, infection --> episodic hemolysis * **Enzyme catalyzes NADP to NADPH, without it, NADPH is unable to protect RBC from destruction from oxidative stress**
G6PD deficiency
47
what labs would you expect to see in G6PD deficiency?
* increased reticulocytes * indirect bilirubin (both increaed during hemolytic episode) * G6PD will be low between hemolytic episodes * smear: **BITE CELLS & HEINZ BODIES**
48
other labs to considerer in microcytic anemia?
ferritin, iron studies, stool guiacs, hemoglobin electrophoresis
49
other labs to consider in normocytic anemia?
creatinine, erythropoietin, ESR
50
other labs to consider in macrocytic anemia?
B12, folate, methlmalonic acid, homocysteine
51
other labs to consider with hemolysis?
hepatoglobin, bilirubin, LDH, direct antiglobulin test (coomb's) smear

Heme/Onc (8 decks)

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