anemias Flashcards
(130 cards)
1
Q
What is the most common cause of microcytic anemia
Pica
Basophilic stippling (associated with what 3 things)
Heinz bodies with 2 disorders
A
Iron deficiency is the most common cause of microcytic anemia
Pica – eating non food items including dirt, paper, hair etc
Basophilic stippling (associated with Beta thalassemia, lead poisoning and sideroblastic anemia)
Heinz bodies with Alpha thalassemia and G6PD
2
Q
4 causes of anemia
A
RBC destruction, decreased RBC production, bleeding, systemic disease
3
Q
4 hypochromic microcytic anemias
A
fe def, thalessemia, sickle cell, long standing anemia of a chronic disease
4
Q
how do macrocytic anemias develop
A
megaloblastic or nonmegaloblastic causes
5
Q
microcytic anemia with MCV<80
A
thalassemia or fe def anemia
6
Q
MCV >100
A
macrocytic anemia
7
Q
MCV>125
A
megaloblastic except for those associated with myelodysplastic syndromes
8
Q
3 common sx of anemia
A
fatigue, HA, exertional dyspnea
9
Q
5 sx of acute anemia
A
rapid onset of tachycardia, orthostatic hypoTN, faintness, pale and cold extremities
10
Q
sx of chronic anemia
A
hyperkinetic circulation(large pulse volume and tachycardia)
11
Q
5 sx of pronounced anemia
A
beefy red tongue, cheilosis, koilonychia, pallor, jaundice
12
Q
smooth tongue and other mucosal changes indicate what
A
nutritional deficiencies
13
Q
3 signs of a primary hematologic disease
A
lymphadenopathy, bone tenderness, hepatosplenomegaly
14
Q
what is fe def anemia
A
inadequate supply of fe for synthesis of hemoglobin
15
Q
primary cause of fe def anemia
A
blood loss(GI tract, asa, NSAIDs)
16
Q
hemoglobiuria, fe sequestration, intravascular hemolysis can all cause what
A
fe def anemia
17
Q
Hgb nml values
A
men 15.5 +/- 2 and women 13.5 +/- 2
18
Q
Hct nml values
A
46 +/-6 % men
41 +/-6 % women
19
Q
what is plummer-vinson syndrome
A
formation of esophageal webs in severe deficiency
20
Q
smear shows anisocytosis and poikilocytosis and hypochromic microcytic
A
iron def anemia
21
Q
smear shows hypochromic cells, target cells, and nucleated red cells
A
severe hypochromic microcytic anemia
22
Q
plasma ferritan level <30
A
fe def anemia
23
Q
platelet count in severe anemia
A
elevated
24
Q
In hypochromic microcytic anema, describe the serum fe, total iron binding capacity, and transferrin saturation
A
serum iron decreases to less then 30, total iron binding capacity elevated, transferrin decreases to less thatn 15%
25
mean corpuscular hgb nml
26-34
26
MCV nml
80-100
27
mean corpuscular hgb concentration nml
31-36
28
red cell distribution width nml
11.5-14.5
29
corrected reticulocyte count nml
.5-2.5%
30
what is a thalassemia syndrome
hereditary anemias in which synthesis of alpha or beta globin chains is reduced, resulting in defective hemoglobinization of RBCs
31
what causes alpha thalassemia and who does it occur in
gene deletion. SE asian or chinese origin
32
what causes beta thalassemia and who does it occur in
point mutation. mediterranean population
33
most prominent feature of thalassemia anemia
microcytosis out of proportion to the degree of anemia
34
describe alpha thalassemia anemia withone alpha globin chain and when all 4 chains are deleted
hemoglobin H disease(symptomatic). stillbirth after hydrops fetalis
35
symptoms in alpha thalassemia
none usually
36
what is cooley anemia
beta thalassemia anemia
37
why does beta thalassemia problems start at 4-6 months
switch from fetal hgb to adult hgb
38
problems seen in beta thalassemia anemia
severe anemia, facial abnormalities, jaundice, osteopenia, pathologic fractures, bone deformities, hepatosplenomegaly, jaundice, growth retardation
39
fe levels and hgb levels in thalassemia
fe levels nml and hgb 3-6
40
how to confirm thalassemia anemia
hgb electrophoresis
41
tx for hgb H disease
folic acid supplements. avoid fe and oxidative drugs
42
dapsone, primaquine, quinidine, sulfamonimides, and nirofurantoin examples of what
oxidative drugs
43
4 things that can happen with iron overload
hemosiderosis, heart failure, cirrhosis, and endocrinopathies
44
tx for beta thalassemia anemia
transfusions to keep hgb conc at least 12
45
how to avoid hemosiderosis(iron overload)
parenteral deferoxamine or oral deferasirox
46
Hct 28-40, EP nml, smear shows target cells and acanthocytes, reticocyte nml
alpha thalassemia minor(trait)
47
Hct nml, EP nml, smear shows target cells and acanthocytes, reticocyte nml
alpha thalassemia minor(trait)
48
Hct 22-32%, EP hgb H, smear shows target cells and poikilocytes, reticocyte increased
alpha thalassemia H
49
Hct 28-40%, EP hgbA2 and F, smear shows target cells and basophillic stipping, reticocyte nml or increased
beta thalassemia minor
50
Hct low at 10%, EP hgb F and A2, smear shows target cells, poikilocytes, basophillic stippling, nucleated RBCs, reticocyte increased
beta thalassemia major
51
what is sideroblastic anemia
hypochromic microcytic anemia; acquired d/o with reduced hgb synthesis causing fe accumulation, especially in the mitochondria
52
3 causes of sideroblastic anemia
myelodysplasia, chronic alcoholism, and lead poisoning
53
what is myelodysplasia
bone marrow doesnt function normally and produces an inadequate number of blood cells
54
diagnostic test for sideroblastic anemia
prussian blue staining of bone marrow cells shows rigid sideroblasts
55
basophilic stippling of red cells
lead poisoning
56
hemocrit 20-30%, MCV varies, smear shows nml and hypochromic cells
sideroblastic anemia
57
tx of sideroblastic anemia
transfusion maybe, do not give erythropoietin
58
upregulation of hepcidin in response to inflammatory mediators, organ failure, impaired marrow function are causes of what
normocytic normochromic anemia
59
why is the anemia of renal disease severe
due to the reduced production of erythropoietin
60
how does aplastic anemia arise
from injury or abnormal expression of the pluripotent hematopoietic stem cell
61
t cell mediated autoimmune suppression of hematopoiesis, radiation, chemo, toxins, meds, and lupus can be causes of what
normochromic normocytic anemia
62
pancytopenia
Aplastic anemia is a condition where bone marrow does not produce sufficient new cells to replenish blood cells. aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets.
63
bone marrow in pancytopenia
hypocellular
64
2 causes of macrocytic anemia
hemorrhage and hemolysis
65
5 types of macrocytic anemia
folic acid def, B12 def, hemolytic, G6PD def, sickle cell
66
phenytoin, bactrim, seizure drugs, and sulfasalazine examples of what
folic acid antagonists
67
daily requirement of folic acid
50-100 mg/dL
68
3 cases in which u should increase folic acid intake
pg, hemolytic anemia, exfoliative skin disease
69
sx of folic acid def anemia
sore tongue(glossitis), vague GI sx, NO neurologic sx
70
macro-ovalocytes and hypersegmented polymorphonuclear cells are pathognomic for what
folic acid def anemia
71
Howell-jolly bodies
nuclear DNA remnants typical for folic acid def anemia
72
what is diagnostic level of RBC folate
less then 150ng/mL
73
common cause of vit B12 def anemia and what does it lead to
pernicious anemia. leading to atrophic gastritis, increased risk of gastric carcinoma
74
danger of vit B12 def anemia
irreversible neurological damage(must treat before 6 months)
75
stocking glove paresthesias, loss of position, fine touch and vibratory sensations, cluminess, dementia, ataxia
neurologic findings in B12 def anemia
76
anisocytosis, poikilocytosis, macro-ovalocytosis, \*\*\*hypersegmented neutrophils\*\*\*
Vit B12 def anemia
77
what is schilling test
24 hr urine collection of radioactive vit B12
78
reticulocyte count reduced, LDH and indirect bilirubin elevated
serum MMA and homocystine levels?
Vit B12 def anemia
serum MMA and homocystine levels high
79
tx for pernicious anemia
lifelong B12 IM
80
what is oral cobalamin used for
vit B12 def
81
what is hemolytic anemia
continuous and episodic destruction of RBC
82
hereditary spherocytosis, elliptocytosis, paroxysmal nocturnal hemoglobinuria, G6PD def, methemoglobinemia, sickle cell
causes of intrinsic hemolytic anemia
83
autoimmune and lymphoproliferative diseases, drug toxicity, TTP, hemolytic uremic syndrome, DIC, valvular hemolysis, metastatic adenocarcinoma, vasculitides, infections, hypersplenism, and burns
extrinsic causes of hemolytic anemia
84
3 sx of hemolytic anemia
jaundice, gallstones, and pallor due to the decreased O2 delivery to the tissues
85
what can lead to a transient aplastic crisis and what is it a risk for
infection with parovirus B19. risk for inf with salmonella, pneumococcus is increased
86
what is the hallmark for hemolytic anemia
elevated reticulocyte count in the presence of falling or stable hct
87
smear reveals immature red cells, nucleated red cells, or morphologic changes
hemolytic anemia
88
what does transient hemoglobinuria indicate
intravascular hemolysis and may be accompanied by hemoglobinuria
89
unconjugated bilirubin(indirect) and total bilirubin levels in hemolytic anemia
elevated; may rise above 4mg/dL
90
what does serum LDH indicate in hemolytic anemia
microangiopathic hemolysis
91
tx of hemolytic anemia
treat underlying disorder
92
what is a autosomal recessive hemolytic anemia
sickle cell
93
what is sickle cell anemia mean
rbc's containing primarily hemoglobin S sickle under deoxygenated conditions
94
electrophoresis demonstrates hemoglobin S in red cells
sickle cell
95
X linked recessive disorder commonly seen in black men and mediterranean people
G6PD def
96
asa,dapsone, primaquine, quinadine, sulfonamides, nitrofurantoin
oxidative drugs which can cause episodic hemolysis in G6PD def
97
bite cells and heinz bodies
G6PD def. heinz bodies(denatured hemoglobin)
98
what is polycythemia vera
slowly progressive bone marrow disorder characterized by increased numbers of RBCs and increased total blood volume
99
JAK2 mutation diagnostic for what
polycythemia vera
100
unregulated expansion of red cell mass causes what
hyperviscosity in polycythemia vera. leads to decreased cerebral blood volume
101
secondary cause of erythrocytosis in polycythemia vera
chronic hypoxia caused by cig smoking and renal tumors
102
M/M of polycythemia vera result from what
commonly thrombosis; and bleeding, peptic ulcer disease, GI bleeding
103
polycythemia vera: median age, gender, survival
60 yrs old, 60%male, 11-15 years
104
polycythemia vera convert to what
myelofibrosis or chronic myeloid leukemia and rarely acute myeloid leukemia
105
diagnostic criteria for polycythemia
splenomegaly, normal arterial oxygen saturation, and an elevated red cell mass. absence of splenomegaly suggests secondary polycythemia
106
characteristic symptom and presenting sx of polycythemia vera
pruritis after bathing; epistaxis
107
plethora, systolic HTN, engorged retinal veins, and splenomegaly. also peptic ulcer disease is high; hyperuricemia
polycythemia vera
108
hemocrit levels of polycythemia vera at sea level
\>54% malesand \>51% females
109
peripheral smear shows neutrophilic leukocytosis, increased basophils and eosinophils and increased numbers of large bizarre platelets
epo levels
polycythemia vera
epo levels low
110
bone marrow is hypercellular, iron stores are absent, red cell morphology is nml, erythropoietin levels are low
polycythemia vera
111
treatment of polycythemia vera
what reduces the risk of thrombosis
phlebotomy
aspirin
112
corrected retic count
over 2%
under 2%
\> 2% means working marrow and bleeding or hemolysis
\< 2% means bone marrow failure to produce RBCs
113
chromosome 16 has what chains
2 alpha chains
114
chromosome 11 has what chains
2 beta, 2 delta, or 2 gamma chains
115
Hgb A
Hgb F
Hgb A2
All have 2 alpha
Hgb A(2 beta)
Hgb F(2 gamma)
Hgb A2(2 delta)
116
cardiac output in anemia
increased, may hear S3 gallop
117
hemogloburia without RBCs in sediment
hemolysis
118
Hct under 25%(severe) symptoms
brittle nails, cheilosis, smooth tongue, esophageal webs
119
name microcytic anemias
TICS
thalasemmia
iron def
chronic disease anemia
sideroblastic
120
ferritan level, serum iron, TIBC, transferrin in iron def anemia
ferritan less then 20
serum iron decreased to less than 30
TIBC elevated
transferrin saturation decreases to less than 15%
121
iron def anemia tx
ferrous sulfate 325 TID, slow escalating dose;
hct/hgb nml within 2 months but continue therapy for 6 months or longer to replenish stores
122
absorption and storage of B12 where
abs in terminal ileum and storage in liver
123
exam of mouth in B12 def
smooth tongue, glossitis, cheilosis
124
explain jaundice from hemolysis
chronic hemolysis causes what
from elevated indirect bilirubin
bilirubin gallstones and bone marrow expansion visible on radiographs
125
what hemolytic anemia cause delay pubert
sickle cell
126
direct and indirect Coombs test
direct: identify antibodies on RBC
indirect: identify antibodies in the pts serum
127
vascular occlusions, painful crises, strokes, chest syndrome, bone infarctions, AVN, splenic sequestration, delayed growth/puberty
sickle cell
128
sickle complications preciptated by
avoid what
red cell dehydration
acidosis
hypoxemia
stress, menses, temp changes
avoid high altitudes, deep sea diving
129
smear: howell jowell bodies, target cells, nucleated RBCs
sickle cell anemia
130
CBC in sickle cell anemia
WBC elevated and thrombocytosis
