Intro to Anemias (Exam 2) Flashcards by Julia Gumirov

Q

What is directly proportional to the amount of hemoglobin and size of RBC?

A

MCH

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Q

What are the 3 classes of anemias based on RBC indices?

test q

A

1) microcytic hypochromic (decreased MCV, MCH, and MCHC)
2) normocytic normochromic (normal MCV, MCH, and MCHC)
3) macrocytic normochromic (increased MCV and MCH, normal MCHC)

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Q

What are the general signs and symptoms of all anemias?

test q

A

-pallor
-heart palpitations
-muscular weakness
-fatigue
-rapid heart rate
-heart attack
-dizziness
-chest pain
-fainting
-SOB

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Q

What does a CBC show for someone to be diagnosed with anemia?

A

decreased RBC, Hb, Hct

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Q

A CBC shows decreased RBC, Hb, and Hct. What test is needed next for an official diagnosis?

A

RBC indices

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Q

What anemia category is thalassemia?

A

microcytic hypochromic (decreased MCV, MCH, and MCHC)

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Q

What anemia category is iron def anemia?

A

microcytic hypochromic (decreased MCV, MCH, and MCHC)

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Q

What anemia category is lead poisoning?

A

microcytic hypochromic (decreased MCV, MCH, and MCHC)

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Q

What are the 2 subcategories for normocytic normochronic anemias?

A

hemolytic and nonhemolytic

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Q

What anemia category is sickle cell disease?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is HgbSC and HgbC?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is G6PD?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is PNH?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is HDN?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is hereditary spherocytosis?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is microangiopathic anemia?

A

hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is aplastic anemia?

A

non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is myelophthisic anemia?

A

non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is hemorrhagic anemia?

A

non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)

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Q

What anemia category is vit B12 and vit B9/folate def?

A

macrocytic normochromic (increased MCV and MCH, normal MCHC)

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Q

-blood disorder characterized by abnormal production of hemoglobin
-inherited in an autosomal recessive pattern
-not enough globin chains are made***
-chains are normal in structure but not enough of them

A

thalassemia

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Q

What are the 2 types of thalassemia?

A

alpha and beta (based on which globin chain is affected)

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Q

What is another name for beta thalassemia?

A

thalassemia major or hemoglobin F disease

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Q

Is thalassemia congenital or acquired?

A

congenital

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-inherited blood disorder -autosomal recessive -reduced or absent production of beta globin chains** -sometimes called hemoglobin F disease bc of increased amounts of HbF

beta thalassemia/thalassemia major

beta thalassemia/thalassemia major results in 2 things. What are they?

1) poor erythropoiesis 2) excessive destruction of RBCs= hemolysis

beta thalassemia/thalassemia major is common in who?

mediterraneans, middle eastern, asian descent

What anemia has these lab findings? -severe anemia with extremely low RBC, Hgb, and Hct -microcytic hypochromic -polychromasia -increased reticulocyte count -anisocytosis -poikilocytosis -target cells -decreased osmotic fragility

beta thalassemia/thalassemia major

What would hemoglobin electrophoresis show for beta thalassemia/thalassemia major? test q

-increased HbF -increased HbA2 -absent or severely reduced HgA

What anemia has these signs and symptoms? -severe anemia -distortion of skull, facial bones, and long bones -slow growth -cardiac dysfunction and failure due to iron deposits in cardiac muscle -hepatomegaly -splenomegaly -prehepatic/ hemolytic jaundice (unconjugaed bilirubin)

beta thalassemia/thalassemia major

What are the most common imagining findings for beta thalassamia/thalassemia major?

compensatory bone marrow expansion and iron overload seen on Xray, MRI, or CT scan

What anemia has these xray findings? -cortices of skull and long bones are thinned= osteoporosis= fractures -skull has hair on end appearance -spine has honeycomb pattern -hemolytic facies: frontal bossing, maxillary hypertrophy, malar prominence test q

beta thalassamia/thalassemia major

What are the 2 ways we get the iron we need?

diet and RBC breakdown

hemoglobin breaks down to

heme, AAs, and iron

T/F: heme is reused for heme synthesis

true

What form does iron have to be in to be absorbed in gut?

ferrous form

most iron in food is in what form?

ferric form

What enhances iron solubility?

stomach acidity

Once released in blood, ferrous iron is bound to and carried by? test q

transferrin (iron biomarker!!)

Where does most iron go once its in the blood?

bone marrow for erythropoiesis (and what doesn't, gets stored)

Transferrin is a protein that transports iron through the blood to tissues like....

liver, spleen, and bone marrow

Iron is converted to and stored as a protein iron complex called? test q

ferritin

Most iron is stored where? test q

liver

excess iron, not stored as ferritin, deposited most commonly in macrophages

hemosiderin

What are the 10 steps of iron metabolism?

1) RBC breakdown (heme->iron and bilirubin) and dietary iron 2) stomach acidity enhances absorption 3) iron absorbed into intestinal cells 4) ferric -> ferrous form in intestines 5) iron released from intestines in ferrous form 6) ferrous iron bound to transferrin 7) some carried to organs 8) some iron combines with apoferritin to form ferritin 9) ferritin stored in liver (some stored within cells as hemosiderin) 10) iron released as needed

What are the specific tests for iron deficiency? test q

-serum iron -serum ferritin (storage form) -TIBC (total iron binding capacity)/transferrin -transferrin saturation

Serum iron reflects only the...

iron bound to transferrin

decrease in serum iron indicates....

-iron def anemia*** -chronic blood loss -malignancies -active collagen diseases -chronic infections preventing iron usage from storage areas

increase in serum iron indicates....

-hemosiderosis*** -hemochromatosis*** -intravascular hemolysis

What iron test reflects iron stores in the body?

serum ferritin (bc ferritin stores iron)

What is a reliable early indicator of iron deficiency anemia?

serum ferritin bc it reflects iron stores

decrease in ferritin=

iron def anemia (no iron= no stored iron)

increase in ferritin indicates.....

-iron overloading diseases like hemosiderosis and hemochromatosis -megaloblastic anemias and hemolytic anemias

Which iron test measures the percentage of transferrin that is saturated with iron? test q

transferrin saturation increased levels of iron will saturate the transferrin low iron= no iron to saturate transferrin*** we like to have about 45% saturation in normal cases

decreased transferrin saturation indicates....

iron def anemia or chronic illness bc theres no fe or low fe to saturate

increased transferrin saturation indicates....

-hemosiderosis -hemochromatosis -hemolytic anemias -iron overdose

If iron levels are low, what does that mean for the binding sites? test q

increased binding sites are available

Which iron test is this? -measures the ability of transferrin to bind to iron -measures the amount of iron that circulating transferrin could bind if fully saturated

total iron binding capacity (TIBC)/ transferrin

increased number of binding sites =

iron def anemia or blood loss

T/F: ferritin can be elevated in cases of inflammation, infection, or other chronic disease, even when iron stores are low

true

What is the most common anemia in the US?

iron def anemia

We need iron to make hemoglobin, iron deficiency impairs....

heme synthesis

What are the 3 broad causes of iron def?

1) inadequate iron supply (consumption of foods low in iron or impaired absorption of iron) 2) increased iron requirements due to physiologic stress (kids growing, pregnancy, lactation, menstruation) 3) increased iron requirements due to pathologic causes (chronic blood loss)

Iron def anemia in an adult is almost always due to....

chronic blood loss

What are the 3 most common causes of blood loss for adults? test q

1) menstrual bleeding 2) chronic bleeding in males and post-menopausal females (cancers, ulcers) 3) test for occult blood in stool (fancy name for blood in stool= melena) , the test for diagnosis is called guaiac test

What are the 3 signs and symptoms of iron def anemia?

1) cheilitis 2) koilonychia 3) glossitis

What is cheilitis?

inflammation around mouth

What is koilonychia?

"spoon nails"

What is glossitis?

inflammation of tongue

What are the 3 weird cravings (pica) that people with iron def anemia have?

1) geophagia (dirt) 2) pagophagia (ice) 3) xylophagia (paper)

What anemia would have these lab results? -decreased RBC, HGB, HCT -decreased MCV, MCH, and MCHC -decreased serum iron, ferritin, and transferrin saturation -increased transferrin/TIBC

iron def anemia

What is a rare form of iron def anemia that mostly occurs in postmenopausal women and presents in a triad?

plummer-vinson syndrome

What is the triad of plummer-vinson syndrome?

1) esophageal webs (must perform barium swallow to see webs) 2) dysphagia (difficulty swallowing) 3) iron def anemia

Which anemia is this? -microcytic hypochromic anemia -iron is inadequately used to make hemoglobin, despite normal amounts of iron -dysfunctional heme synthesis

sideroblastic anemia

What is another name for lead poisoning?

plumbism

What does lead do to the body?

-lead replaces calcium in bones -interferes with heme synthesis= microcytic hypochormic anemia -causes interstitial nephritis -interferes with neurotransmitters -high levels affects BBB and leads to encephalopathy, seizures, and coma

Lead replaces what in bones?

calcium

What are the 5 major effects of lead poisoning?

1) anemia 2) damage to the CNS 3) slowed growth and development 4) learning and behavioral problems 5) hearing and speech problems

What is lead poisoning caused by?

inhalation of lead dust or fumes, or ingestion of lead

Children are at an increased risk of lead poisoning because..... test q

-incomplete development of BBB -children frequently put their hands in mouth and eat items that are not food

What are some signs and symptoms of lead poisoning? test q

-headaches*** -abdominal pain*** -irritability -reduced sensations -aggressive behavior -difficulty sleeping -poor appetite -constipation -anemia

Burton's lines are thick black-blue lines visible along the margin of the gums and at the base of teeth. What patients have Burton's lines?

chronic lead poisoning

What anemia would have these lab findings? -blood serum lead levels -basophilic stippling of RBCs seen on blood smear

lead poisoning

What is the definitive way to know if someone has lead poisoning?

blood serum lead levels

Is there any safe level of lead?

NO