hypoproliferative

Question 1

erythropoiesis in bone marrow does not match the demand for oxygen-carrying capacity (red cells) in the peripheral blood circulation

Answer 1

anemia

Question 2

in the most simplest term anemia is when there is

Answer 2

inadequate delivery of O2 to tissues

Question 3

of red cells in a ul of blood

Answer 3

RBC count

Question 4

measures the size of the red cell

Hct/RBC

Answer 4

MCV

Question 5

measures hemoglobin concentration within a single red cell

Hb/RBC

Answer 5

MCH

Question 6

hemoglobin concentration in a given volume of red cells

Hb/Hct

Answer 6

MCHC

Question 7

measures red cell size distribution

Answer 7

RDW

Question 8

orthostatic hypotension

Answer 8

decreased blood pressure upon standing

Question 9

youngest normal RBC entering circulation from the bone marrow

Answer 9

reticulocyte

Question 10

how does a reticulocyte looks like

Answer 10

large purplish cell in standard peripheral blood smear

Question 11

reticulocytes contains ____ remnants and ____ machinery precipitated and visualized with supravital stains

Answer 11

contains RNA remnants and ribosomal machinery

Question 12

wright stain

Answer 12

large purplish cells with no central pallor- reticulocytes

Question 13

normal reticulocyte count

Answer 13

1%

Question 14

absolute reticulocyte count

Answer 14

absolute number of red cells that are reticulocytes

Question 15

reticulocyte index

Answer 15

correct the measured retic count for the degree of anemia

retic. count (%) x patient’s Hct/ 40

Question 16

if the retic. index is <2 and/or if the absolute retic. count is less than normal

Answer 16

hypoproliferative anemia

Question 17

if the retic. index is elevated and/or is the absolute reticulocyte is increased in a patient with anemia

Answer 17

hyper-proliferative anemia

Question 18

microcytic

Answer 18

red cell size is smaller

Question 19

normocytic

Answer 19

red cell size is within normal

Question 20

macrocytic

Answer 20

red cell size is larger

Question 21

Fatigue, pallor, dyspnea (common to all anemias)

Hair loss

Pica

Restless legs

Spoon shaped nails (koilonychia)

Angular cheilitis

Swollen and sore tongue

Answer 21

symptoms for iron deficiency

Question 22

iron homeostasis is highly regulated

Answer 22

yep

Question 23

total body iron

Answer 23

4 grams

Question 24

iron is reduced to ferrous state by

Answer 24

duodenal cytochromeb – DCYtb

Question 25

how is iron tranported into the cell

Answer 25

divalent metal transporter 1 (DMT1)

Question 26

a ferrioxidase that re-oxidazes iron for release from enterocyte to plasma transferrin

Answer 26

hephaestin

Question 27

key transport protein in the exchange of FE from enterocyte ti transferrin

Answer 27

ferroportin

Question 28

iron transport protein in plasma circulation

Answer 28

transferrin

Question 29

key iron regulator and blocks iron transport at multiple sites, including intestinal epithelium and macrophages.

Answer 29

hepcidin

Question 30

Hepcidin is a protein synthesized in the _____ and forms a high affinity bond with TfR; which is capable of sensing the level of _______saturation.

Answer 30

Hepcidin is a protein synthesized in the liver and forms a high affinity bond with TfR; which is capable of sensing the level of transferrin saturation.

Question 31

Hepcidin synthesis is ________ in inflammation and secondary iron overload, and _________ in iron deficiency and hypoxia.

Answer 31

Hepcidin synthesis is increased in inflammation and secondary iron overload, and decreased in iron deficiency and hypoxia.

Question 32

as we know hepcidin is a central regulator of iron metabolism it binds to

Answer 32

ferroportin and down-regulates efflux of iron

Question 33

how does hepcidin regulates efflux of iron? (3)

Answer 33

1. decrease of iron absorption by enterocyte 2. decrease of ferroportin-mediated export from enterocyte into blood 3. decrease of iron from macrophages of RES

Question 34

iron storage forms (2) which is the main one?

Answer 34

1. ferritin-- main storage of iron in cells | 2. hemosiderin- insoluble form of iron that is no longer available for chemical rxn

Question 35

CBC in iron deficiency: 1. MCV 2. MCH 3. red blood count 4. retic. count

Answer 35

1. low MCV- microcytosis 2. low MCH- hypochromia 3. decreased red blood count 4. low retic. count

Question 36

diagnosis of Fe deficiency studies : 1. serum Fe 2. TIBC 3. Ferritin 4. Transferrin Sat

Answer 36

1. serum Fe is low 2. TIBC is high 3. ferritin is low 4. transferrin Sat is low

Question 37

treatment of Fe deficiency

Answer 37

1. oral 2. IV 3. transfusion

Question 38

Pb inhibits the _____ and also inhibits the breakdown of ____. this causes____

Answer 38

final steps in heme synthesis and also inhibits the breakdown of RNA. this causes RNA aggregates in RBC- basophilic stippling

Question 39

lead toxicity is what type of anemia?

Answer 39

microcytic hypoproliferative anemia - low MCV

Question 40

Symptoms: abdominal pain, anemia, neurological symptoms, fatigue, malaise, irritability what type of diagnostic test should we do?

Answer 40

Serum Pb level to check for Pb toxicity

Question 41

This form of anemia develops because there is functional rather than absolute iron deficiency. That is, the lack of iron in the circulation is not due to deficient dietary intake, but instead dysregulation of iron transport.

Answer 41

anemia of chronic disease

Question 42

anemia of chronic disease 1. associated with 2. ______ induces hepcidin expression leading to dysregulation of iron transport, utilization and storage 3. Fe release from enterocytes and macrophages is 4. decrease plasma Fe but normal

Answer 42

1. associated with inflammatory disorders 2. inflammatory cytokines induce hepcidin expression leading to dysregulation of iron transport, utilization and storage 3. Fe release from enterocytes and macrophages is inhibited 4. decreased plasma Fe but normal bone marrow iron stores

Question 43

anemia of chronic disease lab results: 1. Serum iron 2. TIBC 3. transferrin saturation 4. ferritin 5. MCV

Answer 43

1. low serum iron 2. decreased TIBC 3. normal transferrin saturation 4. increased or normal ferritin 5. normal or low MCV

Question 44

treatment of chronic disease of anemia

Answer 44

treat he underlying disorder

Question 45

megaloblastic anemia (2)

Answer 45

1. folate deficiency | 2. B12 deficiency

Question 46

megaloblastic anemia is what type of anemia

Answer 46

hypoproliferative macrocytic anemia

Question 47

___ is a water-soluble vitamin. Under normal conditions _____is absorbed throughout the proximal half of the small intestine, like most vitamins and minerals (with the notable exception of vitamin B12). _____ is a carrier of 1-carbon fragments (methyl groups) and is required for synthesis of purines, pyrimidines, and methionine. ____exists in various methylated forms, of which tetrahydrofolate (THF) is the biologically active form. ______ is conjugated with a series of glutamic acid residues, which controls its ability to be retained within cells.

Answer 47

Folate

Question 48

causes of folate deficiency (5)

Answer 48

1. dietary 2. malabsorption 3. increased demands such as pregnancy 4. drugs such as methotrexate 5. liver disease

Question 49

______absorption is more complex than folate absorption. Cobalamin ________ is bound by a series of transport (R-binder) proteins until it reaches the duodenum. After digestion of the B12-R binder complex by pancreatic enzymes in the duodenum (alkaline pH), free cobalamin is bound to Intrinsic Factor (IF), which is secreted by parietal cells of the stomach (acid pH). _____-IF complexes traverse the small intestine and are internalized at the terminal ileum through a specialized receptor. Cobalamin is a coenzyme for 2 enzymatic pathways: one is involved in amino acid metabolism and the other in the formation of methionine and the conversion of methyltetrahydrofolate to tetrahydrofolate. Thus adequate ____stores are required for adequate synthesis of biologically active folate.

Answer 49

vitamin B-12

Question 50

causes of vit. B-12 deficiency (5)

Answer 50

1. malabsorption- lack of intrinsic factor 2. gastrointestinal- ileal resection 3. transcobalamin II deficiency 4. NO toxicity 5. meds- metformin, proton pump inhibitors

Question 51

giant hypersegmented neutrophils

Answer 51

seen in folate and B-12 deficiency

Question 52

feared complication of B-12 deficiency

Answer 52

neuropathy and neural column degeneration

Question 53

Folate and Vit B12 deficiencies predispose to ________ defects in the fetus

Answer 53

neural tube

Question 54

labs in B-12 deficiency 1. Serum B-12 2. RBC folate 3. serum folate

Answer 54

1. serum B12 low 2. RBC folate normal/low 3. serum folate normal/high

Question 55

labs in folate deficiencies 1. Serum B-12 2. RBC folate 3. serum folate

Answer 55

1. Serum B-12 normal 2. RBC folate low 3. serum folate low

Question 56

evaluation of B12 deficiency (3)

Answer 56

1. increased homocysteine and methylmalonic acid levels in blood 2. endoscopy to evaluate for atropic gastritis 3. blood for parietal cell antibodies

Question 57

treatment for B-12 deficiency

Answer 57

administer both B12 and folate (large doses of folate will correct the hematologic picture bit not neuropathy)

Question 58

spinal cord damage is irreversible in B-12 deficient pt.

Answer 58

yep

Question 59

When the fine balance of iron uptake and iron loss is disturbed iron overload can occur, leading to disease. Transfusion is a common cause of iron overload.

Answer 59

yep

Question 60

hereditary hemochromatosis 1. mutation in 2. inheritance 3. allele prevalence 4. what happens 5. increased levels of 6. iron deposition 7. presentation

Answer 60

1. mutation in HFE gene chromosome 6 2. autosomal recessive 3. 1:300 4. excessive absorption of FE from GI tract- iron overload 5. increased transferrin saturation and ferritin 6. iron deposition in liver, heart and endocrine organs 7. presentation usually in adults