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N935 Advanced Pathophysiology > hematologic - anemias > Flashcards

hematologic - anemias Flashcards

(91 cards)

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1
Q

erythrocyte definition

A

red blood cell

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2
Q

reticulocyte definition

A

immature erythrocyte (day 1 or 2 in the bloodstream)

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3
Q

anemia definition

A

deficient number of RBCs

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4
Q

mean corpuscle volume

A

size of RBC

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5
Q

normocytic

A

normal sized cells

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6
Q

microcytic

A

smaller than normal size cells

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7
Q

macrocytic

A

larger than normal size cells

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8
Q

hemoglobin

A

four folded globin chains (2 alpha and 2 beta)

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9
Q

hemolytic anemia

A

abnormal hemolysis (breakdown) of RBCs

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10
Q

RBC primary function

A

transport hemoglobin which transports oxygen to the tissue

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11
Q

CO2 + H2O —>(carbonic anhydrase)

A

H2C03 –> HCO3 + H

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12
Q

what enzyme do RBCs contain and what does it do

A

carbonic anhydrase - catalyzes the reaction between CO2 and H2O to form carbonic acid (H2Co3)
and transports CO2 in the form of HCO3 to the lungs for removal

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13
Q

where are RBCs produced

A

in the bone marrow

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14
Q

any condition that decreases oxygen transport to tissues will stimulate

A

erythropoietin (glycoprotein formed in the kidneys)

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15
Q

erythropoiesis definition

A

RBC production and maturation

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16
Q

erythropoiesis process

A

pluripotent hematopoietic stem cell –> proerythroblast –> erythroblast –> reticulocyte –> erythrocyte

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17
Q

what percent of circulating RBCs are reticulocytes?

A

about 1%

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18
Q

anemia definition

A

reduced number of circulating RBCs = decreased oxygen carrying capacity

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19
Q

according to the WHO anemia is defined as Hgb concentration as ___ for women and ___ for men

A

12 g/dL for women

<13 g/dL for men

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20
Q

what does a physiologic anemia mean?

A

decreased Hct in relation to increase in plasma volume in pregnant women

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21
Q

polycythemia definition

A

increase in circulating RBCs

increased blood viscosity

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22
Q

some causes of anemia (broad/general terms)

A

blood loss
decreased production of RBCs
increased destruction of RBCs

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23
Q

symptoms of anemia

A

fatigue, tachycardia, SOB, dizziness, paleness, coldness, muscle weakness, splenomegaly, angina/chest pain, hypotension, yellowing of skin or eyes

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24
Q

in acute blood loss the body replaces the fluid portion of plasma in

A

1-3 days leaving a low concentration of RBCs

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25
in acute blood loss when does the RBC concentration return to normal usually?
within 3-6 weeks
26
in chronic blood loss patients
cannot absorb enough iron from the gut to make Hgb as rapidly as it is lost so RBCs are much smaller and have little Hgb inside them (microcytic hypochromic anemia)
27
"10/30 rule"
transfuse if the Hgb level is <10g/dL or the Hct is <30%
28
clear evidence to Hgb levels below ____ benefit from transfusion
6 g/dL
29
active coronary artery disease may require
lower transfusion thresholds
30
RBC transfusions can transmit
hep B, C, HIV
31
EBL <15%
rarely requires transfusions
32
EBL 30%
replacement with crystalloids/albumins
33
EBL 30-40%
RBC transfusion
34
EBL >50%
massive transfusion (will need FFP and plts too)
35
types of anemia from decreased RBC production
iron deficiency, autoimmune
36
types of anemia from increased destruction of RBCs
thalassemia, hemolytic anemia, sickle cell
37
types of anemia from blood loss
acute or chronic
38
types of anemia from infection
Malaria (destroys RBCs), Babesia (in ticks - RBC hemolysis), Parvovirus (fifth disease) - inhibits erythropoiesis
39
Microcytic anemia
MCV <80 fL | iron deficiency, thalassemia
40
Normocytic anemia
MCV 80-100 fL | sickle cell, CKD, acute blood loss, aplastic anemia, GSPD deficiency
41
Macrocytic/Megaloblastic anemia
defects in nuclear maturation | folic acid and vit B12 deficiency, liver disease, alcoholism
42
iron deficiency anemia definition
nutritional deficiency in iron (shocker), depletion of iron stores from chronic GI bleed or menstruation for example
43
iron deficiency impairs
red cell maturation and diminishes red cell production
44
iron deficiency produces what kind of anemia
microcytic hypochromic anemia
45
treatment of iron deficiency anemia
oral iron, IV iron, RBC transfusion
46
Hemolytic anemia definition
accelerated destruction (hemolysis) of RBCs (removed too quickly or lysed too early)
47
which type of disorders do you commonly see hemolytic anemia in?
immune disorders
48
RBC lifespan
<120 days
49
blood tests seen with hemolytic anemia
increased immature erythrocytes/reticulocytes unconjugated hyperbilirubinemia/jaundice increased lactate dehydrogenase decreased haptoglobin
50
what is lactate dehydrogenase and where does it come from
it is an enzyme that is released from lysed RBCs
51
what is haptoglobin
a plasma protein that binds free hemoglobin
52
sickle cell anemia is what kind of disorder
an autosomal recessive disorder caused by a single amino acid substituition in B globin that creates sickle hemoglobin
53
what is the most common familial hemolytic anemia?
sickle cell anemia
54
what anemia is actually protective against malaria in heterozygotes?
sickle cell anemia
55
heterozygous
2 different alleles of a gene (carrier)
56
homozygous
2 copies of the same allele for a gene
57
sickle cell anemia pathogenesis
mutation in B globin that leads to the polymerization of sickle hemoglobin into long, stiff chains when it is deoxygenated
58
the most important variable that determines whether HbS containing red cells undergo sickling is
the intracellular concentration of other hemoglobins
59
HbA
normal hemoglobin
60
HbF
fetal hemoglobin
61
newborns with sickle cell anemia are asymptomatic until HbF
falls at 5-6 months of age
62
sickling of RBCs leads to what kind of anemia
chronic hemolytic anemia
63
consequences of sickling RBCs
ischemic tissue damage with episodic pain, spleen auto infarction
64
treatment for sickle cell
hydroxyurea - raises HbF levels, stem cell transplants
65
how does hydroxyurea work
causes intermittent cytotoxic suppression of erythroid progenitors and cell stress signaling which affects erythropoiesis kinetics and physiology leading to recruitment of erythroid progenitors with increased HbF level
66
what happens in autoimmune anemia
antibodies (IgG and IgM) are directed against a person's own RBCs
67
causes of autoimmune anemia
idiopathic, leukemias, infectious (mononucleosis), drug induced (PCN, quinidine)
68
treatment for autoimmune anemia
immunosuppression and steroids
69
Erythroblastosis fetalis
fetus inherits red cell antigenic determinants from the father that are foreign to the mother, the fetal red cells enter maternal circulation during the 3rd trimester and childbirth
70
in erythroblastosis fetalis the fetus is ____ and the mother is _____
RhD antigen positive; RhD antigen negative
71
once the fetal red cells enter maternal circulation what happens in mom's second pregnancy
the mother is sensitized to the paternal red cell antigens and leads to production of IgG anti D red cell antibodies that cross the placenta and cause hemolysis of fetal red cells
72
what is Rh factor?
Rhesus (Rh) factor is a protein found on the surface of RBCs | it is genetically inherited
73
factor in Rh factor refers to
the Rh (D) antigen only
74
the Rh (D) antigen is the most
immunogenic of all the non ABO antigens
75
when any Rh incompatibility is detected the mother
receives Rhogam at 28 weeks gestation and at birth to avoid the development of antibodies towards the fetus
76
what adverse effects can babies develop from erythroblastosis fetalis
jaundice, hemolytic anemia, edema, hepatomegaly, CHF, kernicterus
77
G6PD deficiency
X linked genetic disease | metabolic enzyme involved in the pentose phosphate pathway which is important in RBC metabolism
78
G6PD deficiency can be precipitated by
infection, DKA, medications, fava beans
79
some oxidative drugs include
metoclopramide, PCN, sulfa, methylene blue, hypothermia, acidosis, hyperglycemia, infection
80
treatment for G6PD deficiency
no cure, avoid triggers, treat hemolytic episdoes with hydration and blood transfusions
81
polycythemia
sustained hypoxia results in compensatory increase in RBC mass and Hct increased blood viscosity
82
significant polycythemia is when the Hct is
>55-60% | threatens vital organ perfusion and put at risk for venous/arterial thromboses
83
physiologic polycythemia
people who live at high altitudes of 14k-17k where the atmospheric oxygen is low
84
polycythemia vera
stem cell or myeloproliferative disorder in which the HCt may be as high as 60-70% mutation of the JAK2 gene which doesn't stop the production of RBC when there are already too many
85
polycythemia vera produces
excess erythrocytes and number of platelets and leukocytes may also be increased
86
signs and symptoms of polycythemia vera
cyanosis, HA, dizziness, GI symptoms, hematemesis, melena
87
relative polycythemia can be caused from
dehydration, diuretics, vomiting
88
effects of PCV
total blood volume increases , viscous and engorged vessels, and marrow fibrosis
89
30% of patients with PCV will die from
thrombotic complications
90
PCV treatment
minimize risk of thrombosis, phlebotomy, myelosuppressive drugs (hydroxyurea)
91
anesthesia and PCV
risk for thrombosis so reduce HCt prior to surgery (phlebotomy and hydration) continue hydroxyurea

N935 Advanced Pathophysiology (15 decks)

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