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1
Q

What are 2 causes of iron deficiency anemia

A

o Most common nutritional deficiency

o Chronic Blood loss

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2
Q

Characteristics of the cells in iron deficiency anemia

A

o Microcytic hypochromic
o Small cells and pale
o Loss of iron or decrease ingestion of iron

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3
Q

Characteristics of iron

A

o Iron is absorbed through the GI tract and you normally lose some each day
o Iron is recycled when RBC die
o Look at iron levels and iron storage
o Iron is stored in the liver in the form of ferratin
o Iron is low during Iron Deficiency Anemia

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4
Q

Characteristics of ferratin

A
  • Ferratin is directly related to iron levels
  • Found in the bone marrow, liver, spleen, and skeletal muscle
  • Ferratin varies directly with iron
  • Ferratin can be low or normal
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5
Q

Characteristics of transferrin

A
  • A blood protein that transports iron from one place to another by binding to it
  • Made by the liver
  • High transferrin in Iron Deficiency Anemia
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6
Q

What is Total iron binding capacity

A

• The degree to which the potential transporting capacity is occupied by actual plasma iron

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7
Q

Does iron defiency anemia have high/low transferrin levels

A

High- the are inversely related to iron levels
o The body is trying to deliver more iron to the bone marrow
• Refection of the liver making more transport iron

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8
Q

What are symptoms of Iron deficiency anemia

A

o Fatigue
o Weakness
o SOB
o Pallor

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9
Q

Treatment of iron deficiency anemia

A

Oral Iron supplements

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10
Q

What are causes of megaloblastic/macrocytic anemia

A

-B12 or folic acids deficiency

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11
Q

What is necessary for DNA synthesis

A

B12 and folic acid

o No B12 or folic acid=no DNA production= Decreased production of cells

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12
Q

Does RNA synthesis stop when DNA syntheisis stops?

A

o DNA synthesis stops but RNA synthesis continues so you get fewer cells with a large nucleus and abundant cytoplasm

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13
Q

What do the cells look like

A

• Characterized by macrocytic cells

o The cells are enlarged because of the lack of folate and B12

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14
Q

Who is at risk for macrocytic anemia?

A

o Vegetarians- they lack B12

o People who lack intestinal absorption- can’t absorb B12 so your body is short

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15
Q

Why would you lack intestinal absorption?

A

 Crones Disease
 Gastric Bypass
 Short Bowel Syndrome
-or lack intrinsic factor

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16
Q

What does intrinsic factor do?

A

 Necessary for the absorption of B12
 Protein secreted by the gastric mucosa
 IF binds to the dietary B12 and travels to the ilium to be absorbed

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17
Q

What are situations when you have a problem with intrinsic factor?

A
  • Gastrectomy
  • Resection of the ileum
  • Inflammatory Bowel Disease
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18
Q

What is another effect of B12 deficiency?

A

Pernicious Anemia

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19
Q

Characteristics of Pernicious Anemia

A
  • Autoimmune disease that features autoantibodies against your gastric mucosal cells and IF
  • Inability to produce IF
  • These cells ensure that dietary B12 will not be absorbed by the ilium
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20
Q

What are characteristics of anemia of chronic disease?

A
  • Low output of RBC by the bone marrow, but have the ability and the nutrients to have functional RBC
  • Depresses bone marrow production
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21
Q

When is anemia of chronic disease typically seen?

A

Renal failure and cancer

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22
Q

What are 3 pathological mechanisms of anemia of chronic disease?

A

o RBC survival is shortened
o Erythropoiesis is impaired
o Iron reutilization is impaired

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23
Q

Characteristics of the cells in anemia of chronic disease

A

-Normocytic normochromic anemia

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24
Q

Characteristics of Aplastic Anemia

A

• Bone marrow failure
• Results in pancytopenia
• Failure to produce all marrow elements
o Red cells, white cells, and megakaryocytes

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25
What are side effects of aplastic anemia
o Hemorrhage due to low platelets | o Infection bc Low WBC
26
How are the cells in aplastic anemia
normocytic normochromic
27
What can cause aplastic anemia
• Can be idiopathic, autoimmune, or hypocellular bone marrow, lots of fat content
28
Characteristics of polycythemia
• Excessive number of red cells in the blood
29
How many types of polycythemia are there?
2
30
What are the types of polycythemia
o Relative | o Absolute
31
Describe relative polycythemia
 Caused by low plasma volume |  Loss of fluid causes concentration of RBC
32
Examples of relative polycythemia
* GI loss, fluid loss, dehydration, diuretic | * Less fluid Higher amount of stuff inside
33
Describe absolute polycythemia
 The number of RBC is increased
34
What are the 2 kinds of absolute polycythemia?
- Primary | - Secondary
35
Describe primary polycythemia
o Over-production by the bone marrow | o Occurs with a bone marrow malignancy called Polycythemia Vera
36
Describe secondary polycythemia
o Conditions outside the bone marrow that stimulate the marrow to produce RBC
37
What are examples of secondary polycythemia
- Chronic hypoxia, lung disease, COPD, high altitudes | - They need to increase their affinity for O2 in blood to get oxygen to the tissues
38
What are characteristics of bleeding disorders
-Vascular or platelet deficiency
39
What can cause platelet malfunctions?
``` o Toxins o Drugs o Marrow Failure o Hypersplenism o Immune thrombocytopenia ```
40
How long do anti-inflammatories damage the platelets for?
The life of the drug
41
How does aspirin damage platelets?
• Blocks cyclooxygenase • Helps form thryoboxance A2 o This will cause you to thin your blood and not clot as easy
42
What are 3 things that excessive bleeding is associated with?
- Fragile blood vessels - Low platelet count/defective platelet function - Decreased coagulation factor activity
43
Describe intravascular clotting
o Intravascular clotting is always abnormal and secondary to another disease
44
What can cause coagulation factor deficiency?
* Liver disease * Genetic Defects * Intravascular Coagulation
45
What are 2 examples of thrombotic disorders?
* Lupus Anticoagulant | * Factor V Leiden
46
Describe lupus anticoagulant
Autoimmune antibody that can’t go into coagulation
47
Describe factor V leiden
o Commonly seen with young girls on birth control | o Familial history is important
48
o Decreased number of leukocytes
• Leukocytopenia
49
o Decreased number of T and B lymphocytes o Seen in AIDS o Viral problems can cause this
• Lymphopenia
50
o Decreased numbers of neutrophils | o More susceptible to infections
Neutropenia
51
What can cause neutropenia
- Acute inflammation - Drug induced- many chemos and other medications because it is generalized - Autoimmune or idiopathic - More susceptible to bacterial and fungal infections - Respiratory tract is the most common site of infection - Accelerated removal of neutrophils - Malignancy because it crowds the marrow and then neutrophils can’t be formed
52
o Characteristic of mono |  Causes hepatomegaly and splenomegaly
• Lymphocytosis
53
o Increase in peripheral WBC
• Leukocytosis
54
o Immature forms are released into blood flow
Left Shifts
55
o When immature neutrophils are released into the blood in response to something that could be malignant
• Band neutrophils
56
o Enlarged lymph nodes | o Lymphoma can present here (because the job is to filter)
• Lymphadenopathy
57
What can cause lymphadenopathy?
 Infection  Autoimmune  Anything that effects immune system can enlarge them
58
o Inflammation of lymph nodes
• Lymphadenitis
59
o Severe neutropenia | o Neutrophils less than 200
• Agranulocytosis
60
o Increase in WBC in the blood | o Don’t see malignant cells in the blood (in tumor form)
• Leukemia
61
o Increase in the WBC in the tissues | o See malignant cells (in tumor form)
• Lymphoma
62
What lineage line does lymphoid neoplasms effect
• Lymphoid Line= T and B cells
63
Describe acute lymphoblastic leukemia
o Common in children o Down syndrome patients are 20% more prone to this o 80% are B cell types o T cells are more aggressive o See a lot of lymphocytes o Cells infiltrate liver, spleen, lymph nodes o If a little kid comes in with a fever that won’t go away- run a CBC
64
Describe chronic lymphoblastic leukemia
o B cell lineage is most common o T cells are more aggressive o A gene defect that stops lymphocytes for apoptosis  If B cells are effected it stops B cells and antibodies o Males more than females o Around 60 years old o Have lymphadenopathy and splenomegaly and lymphocytosis
65
Describe lymphoma
o Specifically malignancy of lymph tissue so the blood work will not effect that, tissue is ABNORMAL o Lymph tissue normally has follicular pattern o If you have lymphoma- you lose follicular pattern o Looks like CLL- but in lymphoma your blood counts are normal o Small cell lymphocytic lymphoma and CLL are essentially the same disease
66
Describe Hogdkins Lymphoma
o Solid tumors or cells derived from lymphoid cells o Between 10-30 and over 50 years old o Maybe Epstein Barr
67
What type of Hogdkins Lymphoma is most common
o Nodular Sclerosis Type is most common and least aggressive
68
Characteristics of Hodgkins lymphoma
o Staged by where the node travels o Cervical and mediastinal regions o Painless lymphadenopathy o Mostly only lymph node involvement o Reed Sternberg Cells – characteristic of Hodgkins Lymphoma o Deficiency in cell mediated T cell immunity
69
Describe non-Hodgkins Lymphoma
• T cell and Diffused Type is going to be worst prognosis • Diffused Type- more aggressive o Uniform pattern without pattern of lymph node • Follicular Type- less aggressive • Can involve other organs o Seen in lungs, GI tract and bone
70
Describe multiple myeloma
* Commonly effects elderly * Cancer of plasma cells * Get plasma cell proliferations that increase the growth of plasma cells * Have excess immunoglobulins * Have high protein in blood and urine
71
How do you see a spike in immunoglobulins?
* Do electrophoresis on blood and see spike of immunoglobulins * IgG is produced in an unregulated fashion * IgA is 25% of the time
72
What specific protein is elevated in multiple myeloma
• Elevated Bence Jones protein are light chains of the antibody that are produced and secreted into the urine= MULTIPLE MYELOMA
73
What effects does multiple myeloma have on the body?
o Renal Failure/Kidney disease- Starts as acute and goes chronic - Filtered by kidney and results in kidney damage - • Increase osteoclastic activity
74
How does increase in osteoclastic activity effect the body?
o Increases Ca levels o Hypercalcemia o Punch out lesions (occurs in the spine and skull)
75
Why does pancytopenia result from multiple myeloma?
because the bone marrow is too crowded to produce other things
76
How do you confirm multiple myeloma?
• Do a bone marrow biopsy
77
What immunoglobulin does Waldenstrom effect
- IgM | - Causes headaches, dizziness, and sluggishness
78
General characteristics of acute phases
• Characterized by Blasts • Abrupt onset presenting with hemorrhage or infection of immature forms of cells • Bone pain and tenderness (because of fast infection of bone marrow • Liver and spleen enlarged • Headaches, vomiting • Leukostosis- sluggish blood flow because increased number of WBC in the cell line o Sluggish blood flow causes confusion in the brain because less blood is getting there
79
General characteristics of chronic phase
• More mature malignant cells
80
Describe acute myeloid leukemia
* Primary disease or evolution from chronic myeloproliferative disorder * Primary is more aggressive and rapid
81
Characteristics of chronic myeloid leukemia
• Philadelphia chromosome | o Shortened chromosome 22 and a translocation from chromosome 9
82
T/F- You can have CML as a primary disease or because of myeloproliferative disorders
True
83
What are examples of the myeloproliferative disorders?
o Polycytemia vera o CML o Essential thrombocythemia o Myelofibrosis
84
What is a characteristic of polycythemia vera?
 Increased RBC
85
What is a characteristic of CML?
 Malignant granulocytes
86
What is a characteristic of Essential thrombocythemia
 Malignant megakaryocytes
87
What does myelofibrosis cause?
 Cell changes  Replacement of bone marrow filled with adipose tissue  Usually the end/fatal stage  Normal to fibrous tissue
88
What are the 2 disorders of the spleen and a characteristic of each?
``` oSplenomegally- enlarged spleen -Infection oHyperspleenism -Overactivity of spleen -Recieveing an elevated amount of WBC ```
89
What are 2 disorders of the thymus
- Hereditary | - Myasthenia gravis
90
Example of a hereditary thymus disorder
 DeGeorge Syndrome | • No maturity of T cells
91
Example of myasthemia gravis thymus disorder
 Associated with thymomas | • Mostly benign (no malignant potential)

Pathophysiology (18 decks)

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