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Clinical Medicine 1 > Hematology 2- B12, Folic Acid, Aplastic Anemia 10/21/16 > Flashcards

Hematology 2- B12, Folic Acid, Aplastic Anemia 10/21/16 Flashcards

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1
Q

What type of cytic anemia with B12, Folic Acid, and Aplastic Anemia?

A

Macrocytic anemia

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2
Q

MCV over 100 and below 115 is…

A

Macrocytic

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3
Q

MCV over 115 is…

A

Megaloblastic

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4
Q

After determining PT has macrocytic anemia what to check next?

A

Reticulocyte count high or low

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5
Q

What does reticulocyte count check?

A

Gives idea as to bone marrow function. High is due to high output and pushing immature cells out=reticulocytosis

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6
Q

What is reticulocytosis?

A

Increase in reticulocytes (immature RBCs)

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7
Q

Normal Reticulocyte count range?

A

2.0-3.0

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8
Q

If Macrocytic and low Reticulocyte count then what to check? (Hint: 2 things)

A

Check if Hypersegmented Neutrophils and MCV above or below 115.

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9
Q

If Macrocytic, low Reticulocyte, Hypersegmented Neutrophils, and MCV above 115?

A

B12 or Folate deficiency

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10
Q

If Macrocytic, low Reticulocyte, no Hypersegmented Neutrophils, and MCV below 115? (Hint: If not d/t meds or liver, thyroid, DS)

A

Probable myelodysplasia

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11
Q

What causes Macrocytic Anemia?

A

Abnormal DNA metabolism, shift to immature cells when anemic and pushing out immature cells too early, bone marrow disorder, lipid abnormalities, unknown dz

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12
Q

If Megaloblastic MCV above 115 two common causes?

A

B12 or Folate deficiency

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13
Q

If Macrocytic MCV above 100 common causes?

A

Reticulocytosis, alcoholism, liver dz, hypothyroid, meds, aplasic anemia

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14
Q

What stains blue in reticulocytosis?

A

RNA

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15
Q

B12 or Folate deficiency has MCV above what? High or low Reticulocyte count?

A

MCV over 115 (Megaloblastic). Low Reticulocyte.

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16
Q

Myelodysplasia MCV, Ret count, segmented?

A

MCV above 100 macrocytic, low ret count, not hypersegmented neutrophils.

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17
Q

90% of alcoholics have an MCV between what and what?

A

100-110

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18
Q

Alcoholic Macrocytic anemia resolves after how long of not drinking?

A

2-4 months

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19
Q

Alcoholics are commonly deficient in what even if taking supplements and will still be macrocytic?

A

Folic acid deficient

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20
Q

Macrocytic and hypothyroidism do to what?

A

Unknown. Check liver function, thyroid function, and vitamin deficiency.

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21
Q

What is the cause of medication-induced macrocytic anemia?

A

Combo antiretroviral therapy for HIV. Inhibition of various pathways. Hydroxyurea for sickel cell dz.

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22
Q

Myelodysplastic Syndromes due to issues of what? Causes inappropriately low response of what?

A

Issues of bone marrow itself. Inappropriately low reticulocyte response.

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23
Q

Aplastic Anemia is failure of what?

A

Bone marrow failure

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24
Q

What happens to all 3 cell lines in Aplastic Anemia?

A

Very low. Peripheral Pancytopenia.

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25
Which 3 cell lines are low in Aplastic Anemia?
Platelets, RBCs, WBCs
26
Epi of Aplastic Anemia?
2-4 M/yr in US. 2-3x higher in East Asia. Men and women equally.
27
Distribution of Aplastic Anemia?
Biphasic. 10-25, over 60 years.
28
What are the two "phases" of injury to pluripotent stem cells in Aplastic Anemia?
1. Damage to stem cells from viruses/drugs/chemo/radiation/toxins 2. Autoimmune response against stem cells Both cause pancytopenia!
29
What is the major cause of autoimmune Aplastic Anemia?
Idiopathic
30
Which two drugs are major causes of acquired Aplastic Anemia?
Chloramphenicol and Sulfonamides
31
What is Fanconi Anemia?
Defect in DNA repair pathway. Cause congenital Aplastic Anemia.
32
What is Dyskeratosis congenita?
Defect in maintenance of hematopoietic stem cell | telomere length maintenance. Cause congenital Aplastic Anemia.
33
What are the 4 steps in Aplastic Anemia?
1. Inciting event 2. Aberrant immune response 3. Destruction of hematopoietic stem cells 4. Clinical disease
34
After destruction of hematopoietic stem cells how long until pancytopenia seen? Which cells die first?
Weeks to month. WBCs die first, so infection seen first.
35
Aplastic Anemia clinical presentation?
- Weakness and fatigue - Cardiopulmonary compromise - Progressive anemia - Mucosal and skin bleeding - Infection
36
What is common cause of death in Aplastic Anemia?
Invasive fungal infection
37
Profound neutropenia causes...?
Recurrent infections
38
Thrombocytipenia causes....?
Mucosal hemorrhage
39
Aplastic Anemia causes what in premenopausal women?
Increased menstural flow
40
Is PE for Aplastic Anemia helpful?
Not very
41
What 2 most common PE findings in Aplastic Anemia?
Pallor, Pepechiae
42
What 3 things should NOT be seen in Aplastic Anemia?
1. Hepatosplenomegaly 2. Lymphadenopathy 3. Bone tenderness
43
CBC shows what in Aplastic Anemia?
Pancytopenia. Anemia can be severe.
44
Are abnormal cells present in Aplastic Anemia?
NO!
45
Reticulocyte Count/Index in Aplastic Anemia?
Decreased
46
Diagnostic criteria for Moderate Aplastic Anemia?
- Bone marrow cellularity below 30% - Absence of severe cytopenia - Depression of at least two of three blood elements below normal
47
Diagnostic criteria for Severe Aplastic Anemia (sAA)?
- Bone marrow biopsy 25% below normal, OR | - BM bx 50% below norm with less than 30% hematopoietic AND very low reticulocyte, neutrophil, or platelet count
48
Diagnostic criteria for Very Severe Aplastic Anemia (vsAA)?
- sAA criteria met | - Absolute neutrophil count (ANC) below 200
49
3 essentials for Aplastic Anemia dx?
1. Pancytopenia 2. No abnormal hematopoietic cells circulating or in BM 3. Hypocellular bone marrow
50
Tx for mild to moderate Aplastic Anemia?
- Supportive - EPO or darbeopoetin - Myeloid growth factors - Transfusions - Abx or antifungals
51
Tx for severe Aplastic Anemia?
Under 20=Bone marrow t/p | Under 50=Immunosuppressive therapy
52
Aplastic Anemia IST suggested regimen?
Horse antithymocyte globulin(ATG) plus cyclosporin A (CsA)
53
Untreated Aplastic Anemia 1 year mortality rate?
70% mortality rate
54
Severe Aplastic Anemia (sAA) survival rates if correctly treated?
80-90%
55
What is most common cause of congenital Aplastic Anemia?
Fanconi Anemia
56
Eti of Fanconi Anemia?
Autosomal recessive disorder->defect in DNA repair pathway. Increased incidents of malignancies.
57
Presentation of Fanconi Anemia
Congenital abnormalities: fused digits
58
Fanconi Anemia tx?
Allogeneic hematopoietic cell transplant
59
MCV of B12 and Folate deficiencies?
110-115. Megaloblastic.
60
What is B12 involved in what can cause neurological issues?
Myelin production
61
Megaloblastic anemia is when MCV is above what? What do RBCs look like?
MCV above 110. Macroovalocytic RBCs w/segmented neutrophils.
62
Megaloblastic anemia and bone marrow?
- Erythroid hyperplasia | - Megaloblastic morphology
63
Most common causes of Megaloblastic anemia?
- Faulty food intake/being a vegan | - Preggers
64
Pernicious Anemia epi?
1:7500, over 40 y/o.
65
How long are B12 stores?
3 years
66
What produces Intrinsic Factor? Job?
Parietal cells in stomach. Absorbs B12 in terminal ileum.
67
Where is B12 and IF absorbed?
Terminal ileum
68
B12 cofactor for what 2 important functions?
1. Myelin synthesis | 2. Nucleic acid synthesis
69
Pernicious Anemia eti?
Autoimmune. Antibodies destroy parietal cells, causing atrophic gastritis, and neutralizing IF.
70
Pernicious Anemia causes higher risk for what?
Gi/gastric cancers. Endoscopy when diagnosed, monitor for occult blood.

Clinical Medicine 1 (8 decks)

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