Anemia defined
Reduction in one or more of the major RBC measurements,
Hemoglobin concentration
Hematocrit
RBC count
Signs and symptoms of anemia
Tiredness
Fainting
Shortness of breath
Pallor
Tachycardia
Worsening of angina
Anemic symptoms more likely in
Severe anemia
Elderly
Sudden drop in HgB concentration
Other coexisting pathologies like cardiorespiratory disease
Iron deficient anemia
Most common world wide
Without iron there is defective hemoglobin synthesis
Microcytic (MCV is decreased
Hypochromatic (MCH and MCHC are decreased)
“Pencil cells”
Reduced rate of hemoglobin synthesis increases cell division making smaller cells and less hemoglobin makes them appear pale
Causes of iron deficiency
Blood Loss
Decreased Iron absorption (problem with GI tract or drug inhibition
Dietary (vegans and elderly patients)
Increased iron requirements (like pregnancy and growth spurts
Vitamin B12 deficiency Anemia
Decreased vitamin B12 produce RBCs that are macrocytic (MCV elevated) (Megaloblastic anemia)
DNA synthesis requires B12 and folate and so without these its impaired and cannot undergo mitosis as frequently but RNA and protein synthesis still work so they just get filled
Causes of B12 deficiency
Lack of intrinsic factor-this causes “Pericious anemia”
Either an autoimmune attack on intrinsic factor or on the parietal cells in the stomach (chronic atrophic gastritis)
Causes of B12 deficiency
Dietary (vegans)
Total or partial gastrectomy or other stomach procedures (on the rise with surgical weight loss procedures to lose weight
Folate deficiency anemia
Causes similar symptoms to B12 deficiency
Folate deficiency anemia causes
Poor nutrition: poverty elderly, alcoholics
Increased requirements: pregnancy
Malabsorption: inflammatory diseases of the intestines
Drugs: interfering with absorption(antiepileptics or oral contraceptives
Acute blood loss anemia
Large volumes of blood are lost in a short timespan
Increased heart rate
Low blood pressure
Blood counts are normal because rbcs and plasma are lost together and anemia develops after blood volume is restored with fluids
Chronic blood loss anemia
Unrecognizable loss from gastric ulcer or heavy menstrual flow
Chronic disease anemia
Renal failure and many many more
Acquired autoimmune hemolytic anemia
RBCs die faster than bone marrow can keep up. Instead of 120 days of life can die in as little as 20 day, sometimes patients can keep up and not even be anemic
Can be acquired or inherited
Inherited anemia
Hereditary anemias are virtually all hemolytic in nature can be broken into three categories
Red cell membrane ( hereditary spherocytosis or elliptocytosis)
Red Cell enzymes ( G6PD deficiency )
Hemoglobin molecules (sickle cell disease, thalassemias
Spherocytosis
Caused texts in genes or spectrin, ankyrin, band 3 proteins, protein 4.2 nd others
Tested for with MCHC which is elevated
Or with red cells distribution width (RDW) which if elevated favor this diagnosis
Hereditary elliptocytosis
Same as spherocytosis
G6PD deficiency
The most common red cell enzyme disorder in the world
Symptoms of G6PD deficiency
Heinz bodies
Bite cells
Sickle Cell Anemia
Result of a point mutation in the beta globulin gene changing amino acid number 6(flu to val)
New gene referred to as hemoglobin
Sickle cell crises
Sickle cells are more adherent to vascular endothelium leading to vascular occlusion
On a completely separate note
RBCs have reduced life span and chronic hemolysis
Thessalonians
Arises as a result of diminished or absent production of one or more globin chains
Results RBCs being microcytic and hypochromic
Leukemias
Cancer that occurs in white blood cell precursors
Differences in acute and chronic leukemia
Acute-so fast
Chronic slow may not need therapy for years
Acute myeloid leukemia
Cancer of the myeloid like of stem cells. Rapid growth of abnormal WBCs accumulate in bone marrow nad interfere with normal blood cell production
Most common acute leukemia affecting adults
Acute myeloid leukemia symptoms
Tiredness, shortness of breath and anemia
Increased susceptibility to infections due to decreased WBC
Bruising and bleeding due to lack of platelets
Bone pain- accumulation of leukemia cells in long bones
Respiratory and neurological symptoms- due to WBCs in the blood causing hyperviscosity and blood sludging
Acute lymphoblastic leukemia
Cancer of the lymphoid line of stem cells, characterized by the rapid growth of abnormal WBCs that accumulate in the bone marrow and interfere with the production of normal blood cells
Most common in childhood 2-5 years
Similar to AML
Chronic myeloid leukemia
Cancer of the myeloid line of stem cells
Common in adults 40-60 years old
Philadelphia chromosome
Philadelphia chromosome
Where parts of chromosome 22 an chromosome 9 swap places
High tyrosine kinase activity
3 phases of chronic myeloid leukemia
Chronic phase
Accelerated phase
Blast crisis (looks like acute)
Chronic lymphoblastic Leukemia
Cancer of lymphoid line
Most common adult leukemia in western society
Hodgkin’s Lymphoma
Itchy skin
Night sweats
Unexplained weight loss
Enlarged lymph nodes
Splenomegaly
Hepatomegaly
Reed Sternberg Cells
“Popcorn cells”
Typically seen when you biopsy a lymph node of hodgkins lymphoma
B lymphocytes that can’t produce antibodies
Non-Hodgkins lymphoma
Anything but a hodgkins lymphoma
Kell (K)
Peptides that are highly immunogenic but not as Rh you are either + or -
Duffy (Fy)
Two main antigens Fya and Fyb you can be either positive or negative for both Ie Fy(a+b-), Fy(a-b-)
Lewis antigens
Like Duffy La and Lb
3 types of adverse transfusion reactions
Hemolytic
Non-hemolytic
Allergic
Transfusion reactions
Volume overload
Transfer of bacteria