Anemias Flashcards
(144 cards)
1
Q
What is an impoverished condition of the blood caused by ____ in ____, ____, or ____
A
Anemia
reduction in RBC, Hgb, or BOTH
2
Q
It is considered to be present if the hemoglobin conc. of the hematocrit is ____ the lower limit of the ___ reference interval for the individual’s age, sex, and geographic location
A
Anemia
below; 95%
3
Q
Anemias is defined as a _____
Resulting in ______ to the tissue’s
A
decrease in erythrocytes and hemoglobin
decreased oxygen delivery
4
Q
Anemias can be classified morphologically using
A
RBC indices (MCV, MCH, MCHC)
Etiology/ Cause
5
Q
RBC indices that is more accurate than MCH for Anemia
A
MCHC
6
Q
Anemia is suspected when the hemoglobin level is
A
<12 g/dL in men
<11 g/dL in women
7
Q
Anemia is mainly caused by:
A
Decreased RBC production
Increased RBC destruction
8
Q
Decreased RBC production
A
problems in site of production in long bones
9
Q
Increased RBC destruction
A
healthy BM, but are easily destroyed (e.g. thalassemia)
10
Q
Total production of RBC
A
Total Erythropoiesis
11
Q
Total production of RBC & can be measured through: Total production of RBC & can be measured through:
A
- M:E ratio
- Fecal urobilinogen – color of stool (stercobilin pigment) is from the product of RBC thru bilirubin synthesis
- Plasma iron Turnover
12
Q
Production of RBC that reaches the circulation of peripheral blood
A
Effective Erythropoiesis
13
Q
Production of RBC that reaches the circulation of peripheral blood (it reaches its lifespan of 120 days). Measured through:
A
- RBC Turnover Utilization of Iron
- RBC Lifespan
- Reticulocyte Count
14
Q
General Clinical Signs & Symptoms of Anemia
A
- Low hemoglobin concentration & Blood Volume
- Fatigue
- Dyspnea on exertion
- Faintness
- Vertigo
- Palpitation
- Headache
15
Q
Common Clinical Signs & Symptoms of Anemia
A
- Pallor
- Rapid Bounding Pulse
- Low Blood Pressure (80/70-60 mmHg)
- Normal: 120/80 mmHg
- Warning: 140/90 mmHg
- Slight Fever
- Some Dependent Edema (rare)
- Systolic Murmurs
16
Q
Morphologic Classification of Anemia (3)
A
- Macrocytic normochromic anemia
- Microcytic hypochromic anemia
- Normocytic normochromic anemia
17
Q
In Macrocytic normochromic anemia, it is the presence of abnormal erythroblast in BM w/ delayed maturation
A
Megaloblastic Anemia
18
Q
Causes (inherited/ lifestyle) of Macrocytic normochromic anemia
A
- Vitamin B12 deficiency
- Folic Acid Deficiency
- Abnormalities of Vit B12 or folate metabolism
- Inherited disorders of DNA synthesis
- Drug-induced disorders of DNA synthesis
19
Q
It is pernicious anemia
A
Vit. B12 deficiency
20
Q
Nutritional megaloblastic anemia
A
Folic acid deficiency
21
Q
Laboratory findings of Macrocytic normochromic anemia
A
- Red cells are macrocytic – MCV is >95 fL and often as high as 120-140 fL (Normal: 80-96 fL)
- Macrocytes are typically oval shape
- Reticulocytes count is low in relation to the degree of anemia
- Total white cell count and platelet counts may be moderately reduced, especially in severely anemic patients
22
Q
TRUE or FALSE
In Macrocytic normochromic anemia, Peripheral smears have increased RBC in morphology despite:
- the DROP of Hgb, Hct and RBC count
A
FALSE
Peripheral smears have NORMAL RBC in morphology despite:
- the DROP of Hgb, Hct and RBC count
23
Q
TRUE or FALSE
In Macrocytic normochromic anemia, Peripheral smears have normal bone marrow activity:
– increased of Reticulocyte count
– w/o increased red cell or hgb breakdown
A
FALSE
INCREASED bone marrow activity:
– increased of Reticulocyte count
– w/o increased red cell or hgb breakdown
24
Q
In Macrocytic normochromic anemia, it shows macrocytic, normoblastic cells
A
Non-Megaloblastic Anemia
25
Non-megaloblastic anemia causes (6)
1. Accelerated erythropoiesis
2. Increased membrane surface area
- 1 RBC = 23 Potassium
3. Obscure causes (hypoplastic & aplastic anemias)
4. Alcohol
5. Liver disease
6. Cytotoxic drugs (e.g. metronidazole)
26
In Macrocytic normochromic anemia, MCV has a value of
> 96 fL
27
In Macrocytic normochromic anemia, MCHC has a value of
Normal
28
Microcytic hypochromic anemia has
Small RBC size
Decreased Hemoglobin
29
Causes of Microcytic hypochromic anemia
1. Iron deficiency (IDA)
2. Disorder of globin synthesis as in thalassemia
3. Disorders of porphyrin & heme synthesis as in sideroblastic anemia
4. Other disorders of iron metabolism
30
In Microcytic hypochromic anemia, peripheral smear are:
- Anisocytosis & Poikilocytosis
- Microcytic – since many are smaller than the nucleus of the lymphocyte
- Hypochromic – with increased central pallor
- Presence of elliptocytic & pencil-shaped forms
31
In Microcytic hypochromic anemia, MCV has a value of
< 80 fL
32
In Microcytic hypochromic anemia, MCHC has a value of
< 30%
33
Causes of Normocytic normochromic anemia
1. Recent blood loss
2. Overexpansion of plasma volume as in pregnancy
3. Hemolytic diseases
4. Hypoplastic BM (aplastic anemia)
5. Infiltrated BM (leukemia)
6. Endocrine abnormality
7. Chronic disorders
8. Renal disorders
9. Liver diseases
34
A Normochromic, normocytic anemia w/ Effective Erythropoiesis has
INCREASED Reticulocyte Count
35
INCREASED Reticulocyte Count (3)
a. Acute Blood Loss
b. Hemolytic Anemia
c. Response to specific therapy in nutritional anemia
36
Acute Blood Loss (3)
- Very acutely, with hypovolemia
- May have normal blood count
- Will become anemic w/ volume replenishment
37
Increased reticulocyte production cannot keep pace with loss of RBCs peripherally
Hemolytic Anemia
38
Laboratory findings in Normocytic normochromic anemia
1. Plasma volume and red cell volume are REDUCED in proportionate amount
2. Normal Hct
3. Reduced platelet count
4. Reduced plasma fibrinogen
5. Neutrophilic leukocytosis is present
6. Normocytes and normochromic cells are present
39
CLASSIFICATION OF ANEMIA ACCORDING TO CAUSE
- Anemia due to Impaired Red Cell Production
- Anemia due to Blood Loss – Post Hemorrhagic Anemia
- Anemia due to Accelerated Red Cell Destruction – Hemolytic Anemia
40
ANEMIA DUE TO IMPAIRED OR DEFECTIVE PRODUCTION OF ANEMIAS
1. Iron Deficiency Anemia (IDA)
2. Anemia of Chronic Dse (ACD)
3. Sideroblastic Anemia
4. Thalassemia
5. Lead poisoning
6. Porphyrias
7. Megaloblastic Anemias
8. Aplastic Anemia
9. Myelophthisic (Bone Marrow Replacement) Anemia
41
MOST COMMON FORM OF ANEMIA (DOH)
Iron Deficiency Anemia (IDA)
42
Iron Deficiency Anemia (IDA) is a _____
Microcytic/ hypochromic anemia
43
Iron Deficiency Anemia (IDA) is LOW in
Serum iron, ferritin, hemoglobin/ hematocrit, RBC indices, reticulocyte count
44
Iron Deficiency Anemia (IDA) is HIGH in
RDW (variations in RBC sizes) and TIBC
45
Inability to use available NORMAL red blood cells
Impaired release of storage iron associated with increased HEPCIDIN levels
Associated with persistent infections, chronic inflammatory disorders (arthritis, gout)
Anemia of Chronic Disease (ACD)
46
Anemia of Chronic Disease (ACD) is a ____
Normocytic/ normochromic anemia, or slightly microcytic/ hypochromic anemia
47
Anemia of Chronic Dse (ACD) is INCREASED in
ESR, Ferritin
48
Anemia of Chronic Disease (ACD) is DECREASED in
Serum Iron and TIBC
49
Caused by blocks on the protoporphyrin pathway resulting in defective hemoglobin synthesis and iron overload
Two RBC populations (dimorphic) are seen
Sideroblastic Anemia
50
Excess iron accumulates in the mitochondrial region of immature erythrocytes (ringed sideroblasts)
Sideroblastic Anemia
51
Sideroblastic Anemia is a ____
Microcytic/ Hypochromic anemia
52
Sideroblastic Anemia is INCREASED in
Ferritin and Serum iron
53
Sideroblastic Anemia is DECREASED in
TIBC
54
Is an INHERITED blood disorder that causes your body to have less hemoglobin than normal
Thalassemia
55
Multiple blocks in the protoporphyrin pathway
Normocytic/ normochromic anemia with characteristic course basophilic stippling
Lead poisoning
56
Lead poisoning is a ____
Normocytic/ normochromic anemia
57
Group of INHERITED disorders characterized by a block in the protoporphyrin pathway
Hematologic findings are insignificant
Photosensitivity, abdominal pain, CNS disorders
Porphyrias
58
Heme precursors before the block accumulate in the tissues, and large amounts are excreted in urine/feces
Porphyrias
59
Defective DNA synthesis
Caused by either Vitamin B12 deficiency or folic acid deficiency
Megaloblastic Anemias
60
Megaloblastic anemias are defective DNA synthesis causes _____; RNA synthesis is ____, so the cytoplasm is _____
abnormal NUCLEAR MATURATION
normal
not affected
61
In megaloblastic anemias, nucleus matures slower than the cytoplasm and is called
Asynchronism
62
Megaloblastic Anemias is a _____
Macrocytic/ Normochromic anemia
63
Bone marrow failure
Aplastic Anemia
64
Aplastic Anemia is DECREASED in
Hemoglobin/ hematocrit and reticulocytes
65
Aplastic Anemia is a _____
Normocytic/ Normochromic anemia
66
Hypoproliferative anemia caused by replacement of bone marrow hematopoietic cells by MALIGNANT CELLS or FIBROTIC TISSUE
Myelophthisic (Bone Marrow Replacement) Anemia
67
Myelophthisic (Bone Marrow Replacement) Anemia is a _____
Normocytic/ Normochromic anemia
68
ANEMIA DUE TO BLOOD LOSS – Post Hemorrhagic Anemia
1. Acute Blood Loss
2. Chronic Blood Loss
3. Acute Post- Hemorrhagic Anemia
4. Chronic Post- Hemorrhagic Anemia
69
Sudden loss of blood resulting from trauma or other severe forms of injury
Acute Blood Loss
70
Acute Blood Loss is a ____
Normocytic/normochromic anemia (if the px w/ acute bleeding was healthy before the episode)
71
In Acute Blood Loss, this may occur due to increased number of reticulocytes
Transient macrocytosis
72
Gradual, long-term loss of blood, often caused by GI bleeding
Chronic Blood Loss
73
Chronic Blood Loss is a ______
But becomes ______caused by gradual loss of iron
Normocytic/normochromic anemia (initially)
Microcytic/hypochromic
74
If blood is lost over a short period of time in amount sufficient to cause anemia
Acute Post- Hemorrhagic Anemia
75
Acute Post- Hemorrhagic Anemia is DECREASED in
Hgb, Hct, & RBC count
76
Acute Post- Hemorrhagic Anemia is INCREASED in
BM Activity, without increase red cell or hgb breakdown
77
TRUE or FALSE
In Acute Post- Hemorrhagic Anemia, PBS shows ABNORMAL red cells
FALSE
It shows NORMAL red cells
78
Usually in women reaching their menopausal pd
Chronic Post- Hemorrhagic Anemia
79
If blood is lost in small amount over an extended period of time, both the clinical and hematologic features that characterize acute post-hemorrhagic anemia are lacking
Chronic Post- Hemorrhagic Anemia
80
Chronic Post- Hemorrhagic Anemia is NORMAL/ SLIGHTLY DECREASED in
WBC Count
81
Chronic Post- Hemorrhagic Anemia is NORMAL/ SLIGHTLY INCREASED in
Platelet count
82
TRUE or FALSE
In Chronic Post- Hemorrhagic Anemia, PBS result in Reticulocyte count may be normal or slightly increased
TRUE
83
TRUE or FALSE
In Chronic Post- Hemorrhagic Anemia, PBS RBC at first normochromic and normocytic and gradually formed red cells become microcytic and hypochromic
TRUE
84
ANEMIA DUE TO ACCELERATED RED CELL DESTRUCTION
Hemolytic Anemia
85
HEMOLYTIC ANEMIA MAY BE DUE TO:
Intrinsic Hemolytic Anemia
Extrinsic Hemolytic Anemia
86
defect or red cell itself, usually hereditary & grouped as membrane, metabolic, or hemoglobin defects
Intrinsic Hemolytic Anemia
87
factor outside the red cell & acting upon it. Almost always ACQUIRED
Extrinsic Hemolytic Anemia
88
INTRINSIC HEMOLYTIC ANEMIAS: DUE TO “MEMBRANE” DISORDERS
1. Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia
2. Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome
3. Hereditary Elliptocytosis/ Ovalocytosis
4. Hereditary Pyropoikilocytosis
5. Hereditary stomatocytosis (Hydrocytosis)
6. Hereditary Acanthocytosis (Abeta- lipoproteinemia)
7. Rhnull Disease
8. High Phosphatidyl Hemolytic Anemia
89
Inherited a a non-sex-linked dominant trait
Most common in North Europeans
Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia
90
Spherocytes die prematurely
Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia
91
Very rare chronic and acquired defect
SPLENOMEGALY
Nocturnal hemoglobinuria occurs DURING sleep or AFTER awakening
Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome
92
Chronic intravascular hemolysis
pH of plasma is low due to red cells
Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome
93
ACIDOSIS (due to CO2 retention)
Hemosiderinuria is a feature
Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome
94
Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome is POSITIVE in
Sucrose hemolysis test or Ham’s Acidified Serum Test or Sugar Water Test
95
Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome is LOW in
WBC & Platelet Count
96
TRUE or FALSE
In Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome, Peripheral smears is ELEVATED in Reticulocyte Count
TRUE
97
TRUE or FALSE
In Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome, Peripheral smears has Normocytic, normochromic anemia present
TRUE
98
Inherited dominant trait
Associated with severe hemolytic anemia in infants
Defect involves the impaired association of spectrin dimers resulting in FREE, UNCONNECTED dimers
Hereditary Elliptocytosis/ Ovalocytosis
99
Hereditary Elliptocytosis/ Ovalocytosis is INCREASED in
Osmotic Fragility Test
100
Hereditary Elliptocytosis/ Ovalocytosis has the presence of
Autohemolysis of red cells
101
TRUE or FALSE
In Hereditary Elliptocytosis/ Ovalocytosis, Peripheral smears has Non-hypochromic elliptocytes are ABUNDANT on blood films Count
TRUE
102
Rare, moderately severe congenital hemolytic anemia
Inherited as recessive autosomal traits
Occurs in blacks
Hereditary Pyropoikilocytosis
103
TRUE or FALSE
In Hereditary Pyropoikilocytosis, PBS has Microcytosis, Striking Micro-poikilocytosis & Fragmentation
TRUE
104
Rare congenital anemia
Inherited as recessive autosomal trait caused by INCREASED Na and DECREASED K due to increased permeability of membrane
Hereditary stomatocytosis (Hydrocytosis)
105
In Hereditary stomatocytosis (Hydrocytosis) about _____ red cells appear as _____
10-30%
mouth like
106
Caused by absence of beta-lipoprotein
Associated w/ plasma lipid abnormalities
Hereditary Acanthocytosis (Abeta- lipoproteinemia)
107
Hereditary Acanthocytosis (Abeta- lipoproteinemia) has LOW
total lipid, cholesterol & phospholipids
108
Sample used in Hereditary Acanthocytosis (Abeta- lipoproteinemia)
EDTA
109
Autohemolysis occurs
Presence of MILD ANEMIA
Hereditary Acanthocytosis (Abeta- lipoproteinemia)
110
In Hereditary Acanthocytosis (Abeta- lipoproteinemia) RCT ranges from
Normal to Increased
111
Inherited due to gene suppression or presence of silent Rh gene (Xo)
Membrane abnormalities due to absence of all Rh-Hr antigens on the red cells outer layer
Rh negative mother & Rh pos baby
Rhnull Disease
112
Rhnull Disease has HIGH
Reticulocyte Count
113
Rhnull Disease is INCREASED in
Autohemolysis & Osmotic Fragility
114
TRUE or FALSE
In Rhnull Disease, Peripheral smears has Mild, chronic normocytic normochromic hemolytic anemia
TRUE
115
TRUE or FALSE
In Rhnull Disease, Peripheral smears shows stomatocytes & spherocytes
TRUE
116
Inherited; Represents an imbalance in the membrane phospholipids in the red cells
Anemia may increase due to infection or under condition of stress
High Phosphatidyl Hemolytic Anemia
117
TRUE or FALSE
In High Phosphatidyl Hemolytic Anemia, Peripheral smears it causes SEVERE anemia w/ morphologically normal cells
FALSE
causes MILD anemia w/
morphologically normal cells
118
INTRINSIC HEMOLYTIC ANEMIAS: DUE TO “METABOLIC” DISORDERS
1. G6PD Deficiency
2. Pyruvate Kinase Deficiency
3. Pyrimidine-5- Nucleotidase (PN) Deficiency
4. Glucose Phosphate Isomerase Deficiency
5. Other Diseases
- Triosephosphate Isomerase, Hexokinase and Diphosphoglycerate Mutase Deficiency
- Glutathione synthase, glutathione peroxidase and glutathione reductase deficiencies
119
Inherited sex-linked
Complex heterogenous disorder w/c is ubiquitous
MOST COMMON defect seen in enzyme deficient hemolytic anemia
G6PD Deficiency
120
Seen in black
With mild hemolytic conditions
Type A of G6PD Deficiency
121
Seen in Mediterranean race
more susceptible to severe oxidant hemolysis compared to Type A
Type B of G6PD Deficiency
122
most delicate
life threatening and occurs within an hour after eating fava beans
Favism of G6PD Deficiency
123
G6PD Deficiency Laboratory tests
Methyl violet or crystal violet stains Dye Reduction test
124
Inherited disorder
MOST COMMON RED CELL ENZYME DEFICIENCY involving the Embden-Meyerhof Glycolytic Pathway
Pyruvate Kinase Deficiency
125
PK converted to _____ to _____ in the EMP w/ the production of ATP
phosphoenolpyruvate
pyruvate
126
In Pyruvate Kinase Deficiency, RBC loses its flexibility due to ____
decreased ATP
127
Seen commonly in children
Mild to moderately hemolytic anemia w/ splenomegaly
Pyruvate Kinase Deficiency
128
TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is notable red cell abnormalities until after splenomegaly
FALSE
There NO notable red cell abnormalities until after splenomegaly
129
TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is Echinocytes/ Spiculated RBCs
TRUE
130
TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is regularly contracted red cell
FALSE
there is IRREGULARLY contracted red cell
131
TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears nucleated red cells may be prominent
FALSE
CRENATED red cells may be prominent
132
INHERITED; caused by an abnormality in nucleotide metabolism
Acquired occurs in LEAD POISONING & responsible for the BASOPHILIC STRIPPING
Pyrimidine-5- Nucleotidase (PN) Deficiency
133
Pyrimidine-5- Nucleotidase (PN) Deficiency laboratory findings:
____ is observed
Reticulocytosis
134
Pyrimidine-5- Nucleotidase (PN) Deficiency laboratory findings is _____ demonstration of ______ Nucleosidase activities
Positive
decreased
135
This causes an abnormality in ANAEROBIC GLYCOLYSIS (dec. O2 content) causing a moderately severe anemia
Glucose Phosphate Isomerase Deficiency
136
Glucose Phosphate Isomerase Deficiency Laboratory findings is that Reticulocyte count may be significantly
INCREASED
137
TRUE or FALSE
In Glucose Phosphate Isomerase Deficiency, Peripheral smear the red cell does not show
FALSE
The red cell SHOWS
138
ANISOCYTOSIS & POIKILOCYTOSIS
Glucose Phosphate Isomerase Deficiency
139
Triosephosphate Isomerase, Hexokinase and Diphosphoglycerate Mutase Deficiency
other enzyme deficiencies in anaerobic glycolysis
140
Glutathione synthase, glutathione peroxidase and glutathione reductase deficiencies (3)
- Also show hemolytic anemia
- These enzymes are required in the HMP like G-6-PD
- Hemolysis increase due to oxidant drug
exposure or infection
141
Causes of EXTRINSIC HEMOLYTIC ANEMIA (5)
1. Chemical agents
2. Physical agents
3. Vegetable and animal poisons
4. Infectious agents
5. Presence of autoantibodies, isoantibodies or drug-related antibodies causes
142
Causes of EXTRINSIC HEMOLYTIC ANEMIA which are drugs and chemicals
Chemical agents
143
Causes of EXTRINSIC HEMOLYTIC ANEMIA which are heat and trauma
Physical agents
144
Causes of EXTRINSIC HEMOLYTIC ANEMIA which are malarial parasite, bacteria (causes sepsis/ bacteremia)
Infectious agents
