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IBI Test 3 > B3.083 Big Case Anemia > Flashcards

B3.083 Big Case Anemia Flashcards

(71 cards)

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1
Q

definition of anemia

A

defined as decreased red cell mass

usually decrease hematocrit, hemoglobin, RBC

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2
Q

describe the progression of normal Hb levels at various ages

A

decreases from neonates to 3 months
slowly increases over childhood
levels out at about age 10
men > women

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3
Q

most common cause of anemia worldwide

A

iron deficiency anemia

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4
Q

what given reticulocytes their bluish color

A

RNA in cytoplasm

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5
Q

what are the 3 stages of RBC development

A

normoblast (nucleated RNC)
reticulocyte
mature RBC

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6
Q

what cell type recycles old/damaged RBCs?

A

macrophages

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7
Q

what happens to iron from old RBCs?

A

transported in circulation from macrophages to bone marrow via transferrin

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8
Q

signs and symptoms of anemia

A

pallor
conjunctival pallor
fatigue
chest discomfort, palpitations

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9
Q

3 primary causes of anemia

A
  1. decreased RBC production
  2. increased RBC destruction
  3. bleeding
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10
Q

how do you check to see if bone marrow is working?

A 
other blood counts
reticulocyte count (best indicator)
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11
Q

RBC lifespan

A

120 days

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12
Q

how many RBCs normally replaced each day?

A

1/120 or 1%

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13
Q

how long are newly released RBCs identifiable as reticulocytes?

A

a day

1% of circulating RBCs

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14
Q

normal absolute reticulocyte count

A

50,000

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15
Q

why are reticulocytes released earlier in most types of anemia?

A

anemia causes EPO levels to rise

EPO stimulation leads to early release

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16
Q

result of EPO stim on retic count

A

can potentially double reticulocyte count even in absence of increased RBC production

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17
Q

what is an expected retic count for an anemic patient with a normal bone marrow

A

50000 x 2 x 2 = 200000
doubles release rate
live for 2 days instead of 1

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18
Q

retic count >200000

A

adequate marrow function in anemic pt

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19
Q

retic count >300000

A

hemolysis likely

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20
Q

retic count <100000 in anemic

A

suboptimal RBC production

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21
Q

RPI

A

retic production index
makes corrections for Hct and RBC lifespan
RPI = retic % x (HCT/45) x (1/RMT)
where RMT is retic maturation time

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22
Q

RPI = 1

A

individual without hemolysis or blood loss

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23
Q

RPI > 2-3

A

increased

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24
Q

RPI < 2 in an anemic

A

inappropriately low

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25
what are two causes of inadequate RBC production (retic normal or low)
1. hypoproliferative: impaired RBC production, lower than normal RBC precursors in marrow 2. ineffective erythropoiesis: impaired RBC production despite increased marrow RBC precursors
26
what are two causes of increased RBC destruction
hemolysis | blood loss
27
red cell indices
Hgb Hct RBC count
28
MCV
mean corpuscular volume Hct/RBC count primary classification of anemia
29
MCH
Hgb/ RBC count
30
MCHC
Hgb/Hct
31
macrocytic
MCV > 100 | defective DNA synthesis or reticulocytosis
32
microcytic
MCV < 80 | decreased Hgb production
33
normocytic
MCV 80-100
34
poikilocytosis
variation in RBC shape
35
aniscytosis
variation in RBC size | RDW quantifies this variability
36
how much iron/day is eaten/absorbed
10-15 mg/day in diet 5-10% absorbed more absorbed in iron def, pregnancy, erythroid hyperplasia, hypoxia
37
can you absorb Fe2+ or Fe3+ better
Fe2+ | ability to regulate absorption is limited
38
where does iron absorption occur
proximal small intestine
39
describe the pathways of iron transport and storage
Fe2+ absorbed and oxidized to Fe3+ Fe3+ bound tightly to transferrin in blood Fe3+ is transferred to cells and reduced to Fe2+ form, then inserted into heme or stored storage iron (Fe3+) bound to ferritin
40
ferritin in blood
correlated with body iron stores
41
what is hepcidin and what does it do?
peptide produced in the liver | interacts with ferroportin to inhibit iron release from villus enterocytes and macrophages (less iron in blood)
42
what is ferroportin
iron transport channel that moves iron from cells into blood
43
what modulates hepcidin levels
high plasma iron or inflamm = more hepcidin low iron = less hepcidin (more iron let into blood) HFE gene modulates production
44
reasons for decreased hepcidin
iron def HFE mutation ineffective erythropoiesis liver disease
45
why does hepcidin increase in inflammation
make less iron available to pathogen
46
lab tests used to assess iron status
serum iron TIBC serum ferritin
47
serum iron
transferrin | bound iron being transported in the blood
48
TIBC
total iron binding capacity | total amount of transferrin in the blood
49
transferrin saturation
serum iron/TIBC (%)
50
serum ferritin
reflect body iron stores
51
when is serum iron low
iron def | inflammation
52
when is TIBC high
iron def
53
when is TIBC normal or low
inflammation
54
when is serum ferritin low
iron def
55
when does serum ferritin increase
inflammation | acute phase reactant
56
sTfR
soluble transferring receptor | circulating protein derived from cleavage of the membrane transferrin receptor on erythroid precursor cells
57
what does sTfR concentration in serum indicate
directly proportional to erythropoietic rate inversely proportional to tissue iron availability similar to serum transferrin usually increased in iron def patients
58
what is the sTfR-ferritin index
sTfR/log[ferritin] sTfR reflects erythropoiesis ferritin reflects tissue iron stores high index - sign of iron deficiency
59
sTfR-ferritin index in patients with ACD
<1
60
sTfR-ferritin index in patients with iron def anemia or iron def plus ACD
>2
61
where is most of your iron located
RBCs
62
how much iron / day is required for erythropoiesis
20 mg most recycled from old RBCS 1-2 mg new from gut 1-2 mg lost via sloughing of enterocytes
63
what are 3 pathogeneses of iron def
1. blood loss 2. failure to meet increased requirements 3. inadequate absorption
64
what is the usual cause of iron def anemia
chronic blood loss | women - menstrual blood
65
characteristics of iron def anemia
``` microcytic, hypochromic retic count not increased anis- and poik- in more severe cases serum ferritin usually low serum iron low, TIBC high ```
66
describe the evolution of iron def anemia
1. depletion from stores 2. depletion or stores and transport 3. all stores and transport gone, erythron iron starts to decrease
67
treatment for iron def anemia
most patients are initially with oral iron unless there is an absorptive problem dietary sources + FeSO4 BID severe = RBC transfusion
68
indication for iv iron
severe symptomatic anemia requiring accelerated erythropoiesis failure of oral from gi intolerance of absorption issues cancer w chemo associated anemia chronic renal disease heavy ongoing bleeding
69
when do different lab tests reflect oral iron therapy
peak retic count 7-10 d increased Hb and Hct 14-21 d normal Hb and Hct 2 mo normal iron stores 4-5 mo
70
other causes of microcytic anemia
iron withheld from red cell precursors (inflamm) globin gene defects (thalassemias) defects in heme synthetic pathways (sideroblastic)
71
lab findings in anemia of inflamm
normocytic or mild microcytic not many shift cells low serum iron, normal or low TIBC, normal or high ferritin relatively low EPO level for degree of anemia

IBI Test 3 (19 decks)

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