Anemias

Question 1

Microcytic anemia

Answer 1

seen with cheilosis, glossitis, hepatosplenomegaly, RLQ mass, positive stool for occult blood, brittle nails

• low MCV
• To confirm: test serum iron, total iron binding capacity, ferritin

Question 2

Microcytosis

Answer 2

MCV under 80 and usually represents impaired Hb synthesis

Question 3

Hypochromia

Answer 3

decreased mean cell Hb concentration (Hb/Hct)

• judged by central pallor
• in late not early iron def

Question 4

Plummer vinson syndrome

Answer 4

esophageal web associated with dysphagia

- result of iron def anemia

Question 5

Iron needs

Men, women, pregnant women?

Answer 5

Men = 1mg/day
Women/teens = 3mg/day
Pregnant women = 6 mg/day

Question 6

Where is iron absorbed in GI tract?

Answer 6

duodenum and proximal jejunum via DMT1 R

• regulated via hepcidin
• -> degrades ferropotin and blocks iron uptake

Question 7

what increases iron uptake?

Two substances

Answer 7

Ascorbate (Vit C) **

succinate

Question 8

Hemochromatosis (HFE)

Answer 8

mutations lead to iron absorption increase

–> OVERLOAD

Question 9

Transferrin

Answer 9

iron carrier protein

Question 10

Ferritin

Answer 10

storage form of iron (ferric iron and apoferritin)

Question 11

Hemosiderin

Answer 11

water insoluble Fe protein complex

Question 12

What do you use to stain urine to see hemosiderinuria?

Answer 12

Prussian blue

• tells you if Hb is in the urine
• due to intravascular hemolysis –> can lead to iron def

Question 13

Iron def treatment

Answer 13

Ferrous sulfate (oral) is best, but expect hepcidin levels to rise 24hrs after ingestion

• Give on empty stomach
• If you cant give oral, give IV iron

Question 14

Hg A composition

Answer 14

two alpha and 2 beta chains

- tetramer

Question 15

visualize Heinz body

Answer 15

methylene blue stain

- triggered by HgH disease

Question 16

Luspatercept

Answer 16

treat transfusion dependent thalassemia

- stimulate RBC production

Question 17

Serum methylmalonic acid

Answer 17

differentiate between Vit B12 def and folic acid def

Question 18

Macrocytic Anemia

Answer 18

hyperhsegmented neutrophils, impaired DNA synthesis, giant cells common

Question 19

Cobalamins and where they’re obtained

Answer 19

obtained via herbivores through plant

humans obtain through animal sources

Question 20

Transcobalamin

three types and what they do

Answer 20

TC 1 = R protein carrying 75% circulating Cbl (storage)

TC2 = transport Cbl to peripheral tissues

TC3 = increased in myeloproliferative disorders

Question 21

Folic Acid

and use?

Answer 21

metabolized to THF to act as catalytic acceptor - donor of one carbon units
- ex: methylation of deoxyuridylate to thymidylate

Question 22

Culling

Answer 22

removal of aged cells

Question 23

Phagocytosis in spleen

Answer 23

removal of cell surface proteins/Ab/complement

Question 24

Pitting

Answer 24

removal of RBC inclusions like Heinz body and Howell Jolly Body

Question 25

Polishing

Answer 25

removal of internal vesicles beneath membrane

Question 26

Hemolytic anemia definition

Answer 26

shortened RBC lifespan and appropriate reticulocyte response - can be hereditary or acquired - intrinsic vs extrinsic damage

Question 27

RBC membrane 2 proteins that make up cytoskeleton?

Answer 27

spectrin and actin | - spectrin and ankyrin keep it intact

Question 28

Fava beans

Answer 28

can trigger hemolysis