BLOOD LECTURE 1: ANEMIA

Question 1

What are the components of blood, and what percent of the blood volume do they make up?

Answer 1

1. Plasma: 55%
2. RBCs: 45%
3. Buffy coat (WBCs, platelets): <1%

Question 2

What are the 2 categories of leukocytes?

Answer 2

Polymorphonuclear granular cells
Mononuclear cells

Question 3

What are the 3 types of PMN cells?

Answer 3

Neutrophils
Eosinophils
Basophils

Question 4

What are the 2 types of mononuclear cells?

Answer 4

Monocytes
Lymphocytes

Question 5

What is the precursor to all blood cells?

Answer 5

Pluripotent stem cell

Question 6

Pluripotent stem cells differentiate into which two precursor cells?

Answer 6

1. Myeloid stem cell
2. Lymphoid stem cell

Question 7

Myeloid stem cells are the precursor to which 5 types of cells?

Answer 7

1. Erythrocyte
2. Platelets
3. Mast cells
4. PMNs
5. Monocytes (macrophages)

Question 8

What is the precursor cell to platelets?

Answer 8

Megakaryocyte

Question 9

Lymphoid stem cells are the precursor to which 3 types of cells?

Answer 9

1. T cells
2. B cells
3. NK cells

Question 10

B cells further differentiate into what kind of cells?

Answer 10

Plasma cells

Question 11

What is the name for the iron containing compound found in erythrocytes?

Answer 11

Heme

Question 12

What is the globin part of hemoglobin composed of?

Answer 12

Protein

Question 13

Iron from heme is transported to the liver and then to the bone marrow via which carrier glycoprotein?

Answer 13

Transferrin

Question 14

Which 2 pigments from heme are disposed of through the liver and GI tract?

Answer 14

Bilirubin and biliverdin

Question 15

Iron transported to the liver by transferrin become what iron containing blood protein?

Answer 15

Ferritin

Question 16

What is the term for anemia where the red cell mass is normal but plasma volume is high?

Answer 16

Relative/dilutional anemia

Question 17

What is the term for anemia where there is a true decrease in erythrocyte numbers, either due to a decrease in production or an increase in breakdown?

Answer 17

Absolute anemia

Question 18

What are 3 reasons for decreased production/maturation of RBCs?

Answer 18

1. Diet
2. Genetics
3. Bone marrow disease

Question 19

What are 3 reasons for increased destruction of RBCs?

Answer 19

1. Autoimmune
2. Infection
3. Genetics

Question 20

Besides decreased production and increased destruction of RBCs, what is a 3rd reason for anemia?

Answer 20

Acute or chronic blood loss

Question 21

What is the main effect of anemia?

Answer 21

Tissue hypoxia

Question 22

What are 3 compensatory mechanisms to restore tissue O2?

Answer 22

1. Increased heartrate and cardiac output
2. Increased EPO
3. 2,3-BPG binds to deoxygenated HGB, which makes O2 detach from it easier so it will go into the tissues

Question 23

What are the symptoms of mild anemia?

Answer 23

Usually asymptomatic, although elderly with comorbid conditions may have symptoms

Question 24

What are 3 important signs of severe anemia?

Answer 24

1. Fainting
2. Chest pain/angina
3. MI

Question 25

What does hematocrit indicate?

Answer 25

The ratio of RBCs to plasma in a blood specimen

Question 26

What does the lab value mean corpuscular volume (MCV) indicate?

Answer 26

The average volume of 1 red blood cell in a specimen

Question 27

What is the difference between mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC)?

Answer 27

MCH: Average amount of HGB per each RBC MCHC: Average amount of HGB per volume of RBCs

Question 28

What is the name for immature RBCs?

Answer 28

Reticulocytes

Question 29

Which 2 lab tests detect hemolysis?

Answer 29

Bilirubin, lactate dehydrogenase

Question 30

Which lab tests can determine RBC morphology and the presence of parasites?

Answer 30

Blood smear

Question 31

What are 3 classifications of anemia based on cell size?

Answer 31

Normocytic, microcytic, macrocytic

Question 32

What are 2 classifications of anemia based on cell hemoglobin content?

Answer 32

Normochromic, hypochromic

Question 33

What are 4 kinds of anemia related to decreased erythrocyte production?

Answer 33

1. Iron deficiency 2. Megaloblastic 3. Chronic disease 4. Aplastic

Question 34

What are 4 kinds of anemia related to increased erythrocyte destruction?

Answer 34

1. Immune related hemolytic 2. Spherocytosis 3. Sickle cell 4. Thalassemias

Question 35

What are 4 possible causes for iron deficiency anemia with examples?

Answer 35

1. Iron loss (bleeding) 2. Insufficiency dietary intake/absoprtion (celiac) 3. Impaired iron storage (ferritin deficient, liver disease) 4. Increased iron requirement (pregnancy)

Question 36

What are 3 unique clinical manifestations of iron deficiency anemia?

Answer 36

1. Koilonychia 2. Atrophic glossitis 3. Pica

Question 37

What does the lab test iron binding capacity indicate?

Answer 37

Function of transferrin

Question 38

How does chronic disease cause anemia?

Answer 38

Inflammation suppresses RBC synthesis

Question 39

Why does CKD in particular cause anemia?

Answer 39

Impaired EPO production

Question 40

What is the primary cause of megaloblastic anemia?

Answer 40

Vitamin B12 or folic acid deficiency impairs DNA synthesis/RBC maturation

Question 41

What is the morphological appearance of RBCs in megaloblastic anemia?

Answer 41

Macrocytic, nucleated

Question 42

What is the consequence of the abnormal RBCs produced in megaloblastic anemia?

Answer 42

They are destroyed prematurely

Question 43

What are 3 reasons for vitamin B12 deficiency?

Answer 43

1. Diet/absorption (vegan, celiac) 3. Parasitic infection 4. Lack of intrinsic factor

Question 44

What is the term for anemia caused by lack of intrinsic factor?

Answer 44

Pernicious anemia

Question 45

What are 4 possible causes for lack of intrinsic factor?

Answer 45

1. Autoimmune attack of parietal cells 2. Gastric surgery 3. Chronic gastritis 4. Lifestyle factors

Question 46

What are 2 possible reasons for folate deficiency?

Answer 46

1. Pregnancy 2. Medication side effects

Question 47

What are 2 diagnostic results that would indicate pernicious anemia?

Answer 47

1. Autoantibodies against instrinsic factor/parietal cells 2. Gastric atrophy

Question 48

What are 2 ways megaloblastic anemia due to folate deficiency differ from megaloblastic anemia due to vitamin B12 deficiency?

Answer 48

1. Develops more rapidly 2. Fewer neurological symptoms

Question 49

Which type of anemia is due to injury/reduction of hematopoietic stem cells in the bone marrow?

Answer 49

Aplastic anemia

Question 50

What are 5 possible causes for aplastic anemia?

Answer 50

1. Idiopathic (most common) 2. Myelotoxins 3. Viral infection 4. Immune disorders 5. Genetic (Fanconi's)

Question 51

What are the 2 categories of hemolytic anemias based on etiology?

Answer 51

1. Intracorpuscular 2. Extracorpuscular

Question 52

What are 3 signs of hemolytic anemia?

Answer 52

1. Splenomegaly 2. Increased EPO 3. Accumulation of Hgb degradation products

Question 52

What are

Question 53

What are 3 signs of megaloblastic anemia?

Answer 53

1. Abdo pain, GI upset 2. Signs of hemolysis i.e. jaundice, splenomegaly 3. Neurocognitive changes

Question 54

What 2 CBC/blood smear results would indicate megaloblastic anemia?

Answer 54

1. High MCV 2. Macrocytic RBCs

Question 55

How are iron deficiency anemia, anemia of chronic disease, and megaloblastic anemia treated?

Answer 55

1. Supplements (iron, B12, folate) 2. Treat underlying condition 3. EPO (in CKD)

Question 56

What 2 CBC/blood smear results would indicate aplastic anemia?

Answer 56

1. Pancytopenia 2. Normocytic RBCs

Question 57

What other diagnostic study can be performed to diagnose aplastic anemia?

Answer 57

Bone marrow aspiration/biopsy

Question 58

What 2 CBC results would indicated hemolytic anemia?

Answer 58

1. Low RBCs 2. High reticulocytes

Question 59

Other than CBC findings, what 3 lab findings would indicate hemolytic anemia?

Answer 59

1. Elevated bilirubin 2. Elevated lactate dehydrogenase 3. RBC binding antibodies

Question 60

What are 3 general treatments for hemolytic anemias?

Answer 60

1. Blood transfusion 2. Splenectomy 3. Immunosuppressants

Question 61

What is used to prevent hemolytic anemia in pregnant Rh-negative women?

Answer 61

RhoGAM

Question 62

What type of hemolytic anemia involve a genetic mutation in membrane proteins, causing RBCs to become more fragile?

Answer 62

Spherocytosis

Question 63

What is the prognosis for spherocytosis?

Answer 63

Cured with splenectomy, but risk for infection

Question 64

Which type of hemolytic anemia involves a genetic mutation in Hgb beta chains, causing RBC distortion under hypoxic conditions?

Answer 64

Sickle cell anemia

Question 65

What causes hemolytic crisis in sickle cell anemia?

Answer 65

Sickled cells get stuck in microcirculation

Question 66

Other than general symptoms of hemolytic anemia, what is 1 major consequence of sickle cell anemia?

Answer 66

Ischemia and infarction of major organs

Question 67

Which diagnostic test is used to detect abnormal types of hemoglobin such as HbS?

Answer 67

Hemoglobin electrophoresis

Question 68

Other than general treatments for hemolytic anemias, what are 3 ways sickle cell anemia is treated?

Answer 68

1. Lifestyle changes (avoid infection and physical exertion) 2. Hydroxyurea: stimulates production of fetal Hgb 3. Bone marrow transplant

Question 69

Which type of hemolytic anemia involves genetic mutation of globin chain formation, impairing RBC structure and maturation?

Answer 69

Thalassemia

Question 70

Other than general symptoms of hemolytic anemias, what are 2 signs of thalassemia?

Answer 70

1. Iron overload 2. Skeletal changes

Question 71

What blood smear findings would indicate thalassemia?

Answer 71

Microcytic, hypochromic RBCs

Question 72

What are 2 ways to treat thalassemia?

Answer 72

1. BMT 2. Iron chelation