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Hematology > Chapter 8 > Flashcards

Chapter 8 Flashcards

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0
Q

Name six typical signs and symptoms of anemia:

A
  1. Tiredness/Fatigue/exercise intolerance
  2. Fainting
  3. Shortness of Breath
  4. Pallor
  5. Tachycardia/Palpitation
  6. Worsening of Angina
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1
Q

What is anemia?

A

Defined as a reduction in one or more of the major RBC measurements:

  1. Hemoglobin concentration
  2. Hematocrit
  3. RBC count
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2
Q

Does Severe Anemia normally occur in young or elderly people?

A

Elderly

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3
Q

What is the most common cause of anemia worldwide?

A

Iron deficiency anemia

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4
Q

A lack of iron in hemoglobin results in RBC that are both what?

A

Microcytic (MCV is decreased)

Hypochromic (MCH & MCHC are decreased)

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5
Q

A reduced rate of hemoglobin synthesis during iron deficient anemia results in what?

A

More cell division and subsequently smaller RBC

- Lower levels of hemoglobin in RBCs make them appear pale

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6
Q

What are the 4 most common reasons of Iron deficiency

A
  1. Blood Loss
  2. Decreased Iron Absorption
  3. Dietary
  4. Increased Iron requirements
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7
Q

In what groups of people are dietary causes of iron deficiency most common?

A

Vegans

Elderly

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8
Q

What is the most common cause of iron deficiency?

A

Blood loss due to Overt bleeding (traumatic hemorrhage) or Occult bleed (GI problems?) (hard to discern)

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9
Q

What two things may cause the iron deficiency related to less iron absorption?

A

A problem in the GI tract

A drug that inhibits absorption

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10
Q

Decreased Vitamin B12 levels produce RBC that are??

A

Macrocytic (MCV is elevated)

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11
Q

RBC that are enlarged due to vitamin B12 deficiency are often referred to as what?

A

Megaloblasts –> Megaloblastic anemia

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12
Q

Explain why RBC are larger when a decreased vitamin B12 is present

A

Dividing RBCs in the bone marrow require DNA synthesis in order to undergo mitosis. Vitamin B12 and Folate are needed during DNA synthesis. RNA synthesis however is not affected and continue protein synthesis. Proteins accumulate and red cells get larger

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13
Q

What are 3 causes to vitamin B12 deficiency

A
  1. Lack of Intrinsic Factors
  2. Dietary
  3. Total or Partial gastrectomy & other stomach problems
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14
Q

What is Pernicious Anemia?

A

Vitamin B12 deficiency due to decreased intrinsic factors

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15
Q

Lack of IF is usually due to what two things?

A
  1. Autoimmune attack on IF

2. Autoimmune attack on Parietal Cells in the stomach

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16
Q

A deficiency in what other vitamin causes anemia clinical symptoms similar to vitamin b12 deficiency?

A

Folate (Vitamin B9)

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17
Q

T or F, Folate and Vitamin B12 both need IF to be absorbed

A

False, Folate does not need IF to be absorbed

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18
Q

What are the 4 most common potential causes of Folate deficiency

A
  1. Poor Nutrition (poverty, elderly, alcoholics)
  2. Increased Requirements (pregnancy)
  3. Malabsorption (inflammatory diseases of GI)
  4. Drugs (interfering with absorption)
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19
Q

When blood volume is lost from the body in a short space, what are two general features of volume depletion?

A
  1. Increased Heart Rate

2. Low blood pressure

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20
Q

In Acute blood loss, when does the anemia actually occur?

A

RBC and plasma are lost together normally so hemoglobin and full blood count will be normal if taken immediately after blood loss. Anemia only develops once blood volume has been restored through movement of fluid from extravascular space to intravascular space. MCV remains normal. This is described as NORMOCYTIC

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21
Q

Anemia due to Chronic blood loss is closely associated with what other deficiency in the developed world?

Study These Flashcards
A

Iron deficiency anemia

22
Q

What anemia do many chronic diseases produce?

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A

Normocytic anemia

Reason is not known why… However, chronic renal failure is somewhat understood.

23
Q

Describe what happens in acquired autoimmune hemolytic anemia (AIHA)

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A

Hemolytic anemias are disorders in which the RBC are destroyed faster than normal. Instead of 120 days, they may live for only 20 days. Bone marrow must increase RBC production

24
Are hemolytic anemias inherited or acquired?
Can be either | - Most common is an autoimmune response directed against the RBCs own antigens
25
T or F, Hereditary anemias are virtually all hemolytic in nature
True, they can be classified by the pathological process causing decreased RBC lifespan
26
Inherited anemias can be grouped into what 3 groups that decrease RBC lifespan
1. Red Cell Membrane (hereditary spherocytosis) 2. Red Cell enzymes (G6PD deficiency) 3. Hemoglobin molecules (sickle cell disease)
27
What causes Hereditary Spherocytosis?
Defects in genes that code for spectrin (alpha and beta), ankyrin, band 3 protein, protein 4.2 and other membrane proteins
28
What two red cell index tests confirm hereditary spherocytosis?
Elevated MCHC | Elevated Red Cell Distribution Width
29
Describe the underlying causes of Hereditary Elliptocytosis
Same as Hereditary Spherocytosis. Defects in the same genes. End result is the same, the defects destabalize the cytoskeleton scaffolding of cells and the cells go poof
30
What is the Osmotic fragility test used for?
To detect spherocytosis and elliptocytosis
31
What is measured in the Osmotic fragility test?
Degree of red cell lysis caused by incubated red cells in NaCl solutions of varying strengths is measured
32
What is the most common enzymatic disorder of red blood cells in humans and who does it most commonly affect?
Glucose 6 phosphate dehydrogenase | It is an X-linked disorder so males are more commonly affected
33
Why is G6PD essential for keeping the RBC alive?
It is the only source of NADPH in red cells. NADPH maintains glutathione in its reduced form
34
In addition to typical findings associated with hemolytic anemias, what else do red cells show in G6PD deficiency?
1. Heinz Bodies - A cluster of denatured hemoglobin | 2. Bite cells - thought to result from the processing of cells through the spleen and removal of Heinz bodies
35
What causes Sickle Cell Anemia?
A point mutation on the B globin gene, resulting in a change of amino acid 6 (Glu-->Val). The resultant hemoglobin produced by the faulty gene is referred to as Hemoglobin S (HbS)
36
What things to do HbS do that cause these RBC to be problematic?
1. Do not flow well through small vessels 2. Are more adherent than normal RBC to vascular endothelium leading to vascular occlusion and Sickle cell crises 3. Reduced lifespan and result in chronic hemolysis
37
What causes Thalassemias?
arises as a result of diminished or absent production of one or more of the globin chains. Globin chains in excess precipitate with the RBC. This leads to hemolysis
38
How is Thalassemia classified?
It is classified after the gene affected | - when alpha globin gene is affected, it is called alpha-thalassemia.
39
The consequence of impaired production of globin chains leads to RBCs being what two things?
Microcytic | Hypochromic
40
What is leukemia?
It literally means white blood, so called because of the enormous numbers of white blood cells in the peripheral blood of patients. The cancer occurs with white blood cell precursors
41
Explain why acute or chronic leukemia is problematic
Progressive accumulation of abnormal white blood cells in the bone marrow and other organs which spill out into the peripheral blood. Increase in bone marrow failure and reduction of RBC and megakaryocytes
42
What is Acute Myeloid Leukemia (AML)?
Cancer of the myeloid line of stem cells, characterized by the rapid growth of abnormal WBCs that accumulate in bone marrow and interfere with the production of normal blood cells
43
What age group does AML most commonly affect?
It is the most common acute leukemia affecting adults and incidence increases with age.
44
What causes the symptoms of AML?
The symptoms are cased by replacement of normal bone marrow with leukemic cells, which causes a drop in RBCs, platelets and normal WBCs
45
5 Symptoms of AML?
1. Tiredness, shortness of breath, anemia --> due to reduced RBCs 2. Increased susceptibility to infection --> due to reduced WBCs 3. Bruising and Bleeding --> due to reduction of platelets 4. Bone pain -- >accumulation of leukemic cells in long bones 5. Respiratory and neurological problems --> hyperviscosity and sludging of blood due to large numbers of WBCs in blood
46
Describe Acute Lymphoblastic Leukemia (ALL)
Cancer of the lymphoid line of stem cells, characterized by rapid growth of abnormal WBCs that accumulate in the bone marrow and interfere with production of normal RBCs
47
What age groups is ALL most common?
Children 2-5 years old
48
Genetically, what mutation is occuring in people with Chronic Myeloid Leukemia (CML)
Presence of a Philadelphia Chromosome --> chromosomal translocation of chromosomes 9 and 22 - Leads to transcription of proteins with high tyrosine kinase activity
49
What three phases are in CML?
1. Chronic phase - usually asymptomatic, 85% of patients are in this phase 2. Accelerated phase - Severity of symptoms increase, Therapies used in chronic phase become less effective 3. Blast Crisis - Resembles an acute leukemia, rapid progression and short survival
50
What leukemia is the most common adult leukemia in western societies attacking people aged 60-80 years and has a male to female ration of 2:1 respectively
Chronic Lymphoblastic Leukemia
51
What is a lymphoma?
solid tumor masses and can originate within many different lymphoid tissues namely lymph node, spleen, GI tract, thymus or bone marrow
52
What type of cells are commonly found in people with Hodgkins Lymphoma?
Reed-Sternberg cells (popcorn cells) | - These are B-lymphocytes that have lost the ability to produce antibodies.

Hematology (6 decks)

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