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ClinMed_I > Lecture 1b > Flashcards

Lecture 1b Flashcards

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1
Q

What are some causes of erythropoiesis?

A

Low O2 delivery
EPO(Erythropoietin) stimulation
RBC proliferation and maturation
Reticulocyte release

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2
Q

How does EPO increase RBC production?

A

Binds to marrow erythroid precursors(pro erythroblasts) inducing cell maturation

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3
Q

What vitamins assist in proliferation of erythroblasts?

A

Folate and Vitamin B12

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4
Q

How does iron assist in RBC production?

A

Accumulation of hemoglobin

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5
Q

What are the characteristics of reticulocyte?

A

Immature RBC (non concave, slightly bluer)
Contains RNA (absorbed before maturing to a RBC)
4-5day lifespan (3 days in bone marrow 1-2days in blood)

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6
Q

What are the optimal conditions for erythropoiesis?

A

Normal EPO production
Normal erythroid marrow function
Adequate Hgb accumulation

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7
Q

What are the two approaches to anemia?

A

Kinetic approach and morphologic approach

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8
Q

Define kinetic approach.

A

Addresses the mechanism responsible for the fall in Hgb concentration

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9
Q

Define morphologic approach.

A

Categorizes anemias based on alterations in RBC characteristics and reticulocyte response

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10
Q

What mechanisms can cause anemia?

A

Decreased RBC production
Increased RBC destruction(hemolysis)
Blood loss

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11
Q

What is RBC production directly related to?

A

RBC destruction

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12
Q

What is the average daily RBC production amount?

A

1% of Red cell mass

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13
Q

What are common causes of decreased RBC production?

A

Lack of nutrients(iron, B12, folate)
Bone marrow disorders
Bone marrow suppression
Low levels of trophic hormones
Acute/chronic inflammation

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14
Q

What are some examples of bone marrow disorders?

A

Aplastic anemia
Pure RBC aplasia
Myelodysplastic syndromes
Tumor infiltration

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15
Q

What are some examples of bone marrow suppression?

A

Drugs
Chemotherapy
Irradiation

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16
Q

What are some causes of low levels of trophic hormones?

A

Chronic renal failure
Hypothyroidism
Hypogonadism

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17
Q

How does inflammation affect RBC production?

A

Decreases RBC production by affecting iron concentration, reduces EPO and decreases RBC lifespan

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18
Q

What are some causes of increased RBC destruction?

A

Inherited hemolytic anemias
Acquired hemolytic anemia
Hypersplenism(enlarged spleen)

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19
Q

What are some examples of inherited hemolytic anemias?

A

Hereditary spherocytosis
Sickle cell disease
Thalassemia major

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20
Q

What are some examples of acquired hemolytic anemias?

A

Coomb’-positive autoimmune hemolytic anemia
Thrombotic thrombocytopenia purpura(TTP)
Malaria
Paroxysmal nocturnal hemoglobinuria

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21
Q

What are some causes of blood loss(main cause of anemia)?

A

Gross blood loss
Occult blood loss
Iatrogenic blood loss
Under appreciated menstrual blood loss

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22
Q

What are some examples of gross blood loss?

A

Trauma
Surgery
Melena
Hematemesis
Severe menomotro

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23
Q

What are some examples of occult blood loss?

A

Slowly bleeding ulcer or carcinoma

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24
Q

What are some examples of iatrogenic blood loss?

A

Repeated diagnostic testing
Hemodialysis losses
Excessive blood donation

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25
What tests do we use to classify anemia?
MCV, MCH, MCHC
26
What is the normal range for MCV?
80-100 fL
27
What can cause macrocytic anemia?
Folate and B12 Deficiency Drugs interfering with nucleic acid synthesis(zidovudine and hydroxyurea) Abnormal RBC maturation (myelodysplastic syndrome, acute leukemia) Alcohol abuse(folate deficiency) Liver Disease
28
What can cause microcytic anemia?
Iron deficiency Alpha and beta thalassemia minor
29
Microcytic anemia is associated with what levels of MCHC?
low MCHC due to decreased HgB content in small RBC
30
What are the causes of normocytic anemia?
Chronic kidney diseases Anemia of chronic disease/inflammation Mild iatrogenic "hospital" anemia
31
What type of anemia is often required an evaluation by a peripheral smear?
Normocytic anemia
32
What are anemic symptoms related to?
Decreased O2 delivery to tissues
33
How does the body compensate when in an anemic state?
Increased in O2 extraction Increase in SV and HR (maintains O2 delivery util HgB falls below 5g/dL)
34
How much more O2 can the body extract from HgB?
25% to 60% 25% is normal extracting 60% usually in anemia/hypoperfusion
35
What are the common S/S of anemia?
Fatigue Tachycardia/dyspnea Palpitations Pulsations Bounding pulses Pallor
36
What are the S/S of anemia by volume depletion?
Fatigue Muscle cramps Dizziness/syncope Lethargy Hypotension/shock/death
37
What 4 questions do you ask when you suspect anemia?
1. Is patient bleeding? Where? 2. Evidence of increased RBC destruction? 3. Is there bone marrow suppression? Why? 4. Is Patient nutrient deficient in iron, folate, B12? Why?
38
What do you need to look at when a patient has an onset of symptoms?
New onset most often related to acquired d/o? Lifelong anemia likely inherited Compare recent to remote HgB&hematocrit/RBC indices
39
What recent symptoms can be a sign of anemia?
Unintentional weight loss Loss of appetite Fever Night Sweats
40
What medical conditions are associated with anemia?
Melena (upper GI bleed, bleeding ulcer) Large hematochezia (Lower acute GI bleed) Menorrhagia (Dysfunctional uterine bleeding) Renal failure RA CHF
41
What do you look for on the skin for signs of anemia?
Pallor, jaundice Petechiae, bruising
42
What do you look on the eyes for signs of anemia?
Pale conjuctiva, scleral icterus
43
What other physical signs do you look for in anemia?
Lymph nodes Abdomen (hepatosplenomegaly) Bony tenderness (sternum/anterior tibia) Stool for occult blood
44
How does volume affect the interpretation of a CBC?
HgB,Hct, RBC are all concentration and dependent on red cell mass(RCM) So if RCM is decreased and/or plasma vol is increased then RBC and H&H will be low (and vice versa)
45
What is hemoconcentration?
Decreased plasma vol, RBC and H&H elevated Example: Dehydration
46
What would an automatic reticulocyte count be preferred over manual?
More blood can be assessed However manual used if there are errors such as blood clots
47
What are reticulocyte count reported as?
Percentage of RBC
48
What is a reticulocyte index(RI) calculation? Whats the equation?
More accurate reflection of relic count in anemia patients RI = reticulocyte percentage × (patient's HCT/normal HCT) Normal RI <3%
49
Increased retic count is indicative of hemolysis, what other labs do we order to determine more?
Serum lactate dehydrogenase(LDH) Indirect bilirubin(unconjucated) Serum haptoglobin
50
What does an increase of LDH mean?
LDH is concentrated in RBCs so destruction of RBC will have increased LDH
51
What does an increase of indirect bilirubin mean? How do we calculate it?
Total bilirubin - direct bilirubin(conjugated) From the breakdown of HgB so signs of hemolysis
52
What does a decrease of serum haptoglobin mean?
Binds free HgB that is released from hemolyzed RBC So in increased hemolysis it binds to more HgB therefore low haptoglobin levels
53
What is the Coombs Test, Direct(Direct anti globulin test)? What is used to screen for?
Screened for autoimmune hemolytic anemia Assess presence of antibodies on the surface of RBC's, which ultimately causes RBC destruction
54
What can indicate a positive Coombs Test?
Autoimmune hemolytic anemia Hemolytic transfusion reaction Drug sensitizations Hemolytic disease of newborns (erythroblastosis fetalis)
55
What are some drug sensitizations for a positive Coombs test?
Methyldopa Levodopa Cephalosporins Penicillin Quinidine
56
What do we use to test for microcytic anemia?
Retic count Serum Iron Transferrin Total Iron binding capacity Transferrin Saturation Ferritin Peripheral Blood smear Coombs test
57
Where is iron found in the body?
65% bound to HgB 30% stored as ferritin or hemosiderin in spleen, bone marrow, and liver 4% bound up in myoglobin molecules <1% remains in cells throughout the body <0.1% bound to transferrin
58
What are ways humans lose iron?
Perspiration Epithelial cell desquamation Menstruation
59
What is serum iron a measure of?
Circulating iron bound to transferrin
60
What could cause decreased iron levels?
Iron-deficiency anemia Nephrosis Anemia of chronic disease and infection Chronic blood loss Malabsorption disorders
61
What can cause increased iron levels?
Hemochromatosis Excessive iron intake Hemolysis of erythrocytes Liver necrosis
62
What is the function of transferrin?
Major plasma transport protein for iron Carries iron from duodenum to marrow
63
Where is transferrin produced in?
Liver
64
What can cause decreased transferrin saturation?
Iron-deficiency anemia
65
What can cause increased transferrin saturation?
Hemochromatosis Iron overload Thalassemia RBC transfusions
66
What does the total iron binding capacity(TIBC) measure?
Blood's capacity to bind iron with transferrin Indirectly measures transferrin
67
What is function of Ferritin?
Body's major iron storage protein Iron molecules not used in marrow bind to ferritin
68
What can cause in increase of ferritin?
Iron overload Inflammation Liver disease
69
What measurement is the most reliable indictor of total-body iron status? Which test is even more accurate?
Ferritin Bone marrow is more accurate
70
Why is measuring ferritin better for diagnosing iron-deficiency anemia?
Its more specific and sensitive than iron concentration or TIBC
71
What labs to we measure for microcytic anemia?
Reticulocyte count Vitamin B12 Folate
72
Where is vitamin B12 found in?
Animal proteins
73
Where is vitamin B12 stored?
In the liver
74
What else is needed for vitamin B12 to be absorbed and where is it absorbed?
Needs intrinsic factor and absorbed in ileum
75
Where is folic acid found in?
Eggs Milk Leafy vegetabels Yeast Liver Fruits
76
Where is folate absorbed and stored?
Absorbed in upper 1/3 of intestine and stored in the liver
77
How does B12 affect folate?
B12 is needed to move folate into tissue cells
78
What is the difference between folate and folic acid?
Folate is naturally made Folic acid is synthetic
79
What labs do we need to evaluate normocytic anemia?
Reticulocyte count Workup based upon differential

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