Hypoproliferative Anemia Flashcards Preview

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Flashcards in Hypoproliferative Anemia Deck (34):
1

What are some different ways someone could have iron deficiency anemia (IDA)?

Iron depletion in diet
Lost in chronic blood loss or malabsorption leading to decreased iron stores and incorporation into hemoglobin

2

How does IDA present on PB smear?

Microcytic, hypochromic anemia with pronounced anisopoikilocytosis

3

What is particularly important with a diagnosis of IDA in someone >50 yo?

GI carcinoma until proven otherwise

4

How does anemia of chronic disease occur?

Increased hepcidin levels from inflammatory markers
Blocks the transfer of iron from marrow macrophages to sideroblasts

5

How does anemia of chronic disease present on PB smear?

Normocytic, normochromic (80%)
Microcytic (20%)

Increased serum ferritin
Decreased TIBC

6

What is the most common anemia of hospitalized patients?

Anemia of chronic disease

Seen in inflammatory, infectious and neoplastic conditions

7

What is the treatment for anemia of chronic disease?

Treat the underlying disorder
EPO/iron therapy

8

What is anemia of renal failure? How does it appear on PB smear?

Decreased EPO secondary to kidney disease --> decrease erythropoiesis

Normocytic, normochromic

9

What two deficiencies can lead to megaloblastic anemia/

Folate or vitamin B12 deficiency

10

How do folate or vitamin B12 deficiency lead to anemia?

Impair DNA synthesis (specifically thymidine) which produces nuclear to cytoplasmic asynchrony in erythroid and granulocytic maturation

11

How does Megaloblastic anemia appear on PB smear?

Macrocytic
Macroovalocytes
Hypersegmented neutrophils
Nuclear to cytoplasmic asynchrony in marrow

12

How can you differentiate if megaloblastic anemia is caused by folate or vit B12?

Neurologic deficits in vitamin B12

13

What is aplastic anemia?

Suppression of BM pluripotent stem cells likely by autoreactive T cells

Normocytic, normochromic

Pancytopenia

14

What are some things that can cause aplastic anemia?

Exposure to toxins, drugs, infectious agents

15

What is myelophthisic anemia?

Cytopenias related to marrow infiltration by a carcinoma or storage disorder

16

What do you see on PB smear in myelophthisic anemia?

Tear drop cells
Leukoerythroblastic reaction (immature cells in PB)

17

What causes anemia of liver disease?

unknown
Seen with chronic hepatitis and cirrhosis

18

Why does anemia of liver disease look like on PB smear?

Macrocytic

19

What causes pure red cell aplasia?

Unknown but thought to be autoimmune destruction of erythroid precursors in the marrow

20

What are some things associated with pure red cell aplasia?

Thymic hyperplasia, thymoma, large granular lymphocytic leukemia, autoimmune disease

21

What are some things that may cause a megaloblastic anemia?

Dihydrofolate reductase deficiency (methotrexate)
Thymidylate synthetase deficiency (5-FU)
Folate deficiency
Vitamin B12 deficiency

22

Explain how we take in vitamin B12.

Bound to protein in food
Released in stomach by HCl & pepsin
Binds mainly to R-protein
In duodenum, R protein degraded, releasing B12 which then binds IF
Complex of B12:IF binds receptor and absorbed in terminal ileum

23

What are some things that may cause impaired absorption of B12?

IF deficiency, Ileal resection, pancreatic insufficiency
Decreased intake
Increased requirement
Tapeworm (diphyllobothrium lathum)

24

What are some clinical manifestations of vit B12 deficiency?

Megaloblastic anemia/Pernicious anemia
Subacute combined degeneration--dorsal and lateral tract demyelination, parasthesias, spastic paraparesis, sensory ataxia

25

What is pernicious anemia?

Deficiency of B12 secondary to IF abnormalities

26

What would the lab findings look like in pernicious anemia?

Low vit B12 levels
Low retics
Auto-antibody to IF or parietal cells (if pernicious anemia)
Elevated methylmalonic acid (substrate that needs B12)

27

What are some causes of folate deficiency?

Decreased intake (alcoholism, poverty)
Increased requirements (growth, pregnancy, states of high cell turnover, hemolytic anemias, leukemias)
Defective absorption (jejunal resection/malabsorption)
Folic acid antagonists

28

What are some clinical presentations of folate deficiency?

Megaloblastic anemia
Neural tube defects (spina bifida occulta)

29

What shouldn't you treat vit B12 deficiency with folate?

Anemia will reverse, neurological manifestations will not

30

Differentials for microcytic, hypochromic anemia

IDA
Thalassemia
Anemia of chronic disease

31

What are some of the different uses of iron in the body?

Component of heme (80%)
Component of myoglobin, cytochromes, catalases (20%)
Storage

32

What are some causes of IDA?

Dietary lack (milk-fed infants)
Impaired absorption (duodenum)
Increased requiredment
Chronic blood loss (GI sources, menstrual)

33

What are some ways iron is absorbed and transported?

Heme iron --> heme iron transporter
Non-heme iron --> reduced by duodenal cytochrome c (vit D, DMT-1)
Mucosal ferritin
Ferroportin transporter --> regulated by Hepcidin
Hephaestin --> oxidized to 3+, binds transferring to cells

34

What is TIBC essentially equivalent to?

Transferrin