microcytic + macrocytic + normocytic anemias Flashcards Preview

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Flashcards in microcytic + macrocytic + normocytic anemias Deck (26):
1

causes of IDA

blood loss: menstruation, occult blood loss: colon cancer, peptic ulcer
poor iron intake
↑ iron demand: pregnancy (also see phsyiologic anemia of pregnancy: plasma volume increases faster than RBC mass)

2

>50 yo + IDA

r/o colon cancer with colonoscopy

3

IDA
esophageal webs (swallowing difficulty)
atrophic glossitis

Plummer-Vinson syndrome

4

causes of glossitis

vit. B deficiency:
B9 - folate
B12
IDA

5

defect in α globin: can be defect or deficiency
Hb: 2 α globins
2 α alleles on chrom 16: 2 copies of chrom from mom + dad → total 4 α alleles
Africans, Asians

alpha thalassemia

6

disease severity in alpha thalassemia

1 abnormal α allele: no anemia
2 abnormal α alleles: α thal trait/minor (no anemia) - most common type
3 abnormal α alleles:
hemoglobin H (ß globin pair up, most Hb = ß4)
4 abnormal α alleles: Hemoglobin Bart's (gamma pair, Hb = gamma4 = hydrops fetalis → death)

7

defect in ß globin: can be defect or deficiency
total 2 ß alleles
Mediterranean

beta thalassemia

8

disease severity in beta thalassemia

Minor: ↓ amount of ß globin:
minimal anemia
↑ HbA2
↑ HbF
Major: absent ß globin
↑ HbF
marrow hyperplasia "hair-on-end": making new Hb
"chipmunk facies"
severe anemia: need blood transfusion → 2° hemochromatosis

9

treatment for 2° hemochromatosis from blood transfusions

deferoxamine: iron-chelating drug

10

target cells

beta thalassemia

also: THAL
Thalassemia
Hemoglobin C disease
Asplenia
Liver disease

11

"hair-on-end" or "crew cut" appearance of skull

beta thalassemia major
sickle cell disease

12

defective heme synthesis can cause this type of anemia

sideroblastic anemia: ringed sideroblasts in bone marrow

13

causes of sideroblastic anemia

hereditary form: ALA synthase gene
chronic alcohol use
drugs:
seizure drugs
INH
chloramphenicol

14

iron not making heme:
↑ serum iron
↑ ferritin
ringed sideroblasts in BM

sideroblastic anemia

15

treatment of sideroblastic anemia

B6 supplement

16

defective iron utilization + mobilization

inflammatory state (IL-6): liver produces hepcidin → inhibits ferroportin in macrophages → iron trapped in macrophages (can't transfer to RBC precursors in bone marrow)
↓ serum iron, ↓ TIBC, N/↑ ferritin
RA
chronic infection
malignancy

anemia of chronic disease

begins as normocytic anemia → microcytic anemia

17

impaired DNA synthesis
↑ time for RBC precursor to mature
cytoplasm expands in process → macrocytic
hypersegmented neutrophils: nucleus has > 6 lobes
vitamin B9/B12 deficiency

megaloblastic anemia

18

differentiating causes of megaloblastic anemia + glossitis + ↑ homocysteine

folate:
no neuro sx
normal MMA
B12:
neuro sx: peripheral neuropathy, dementia
↑ MMA

19

cause of folate deficiency

malnutrition (alcoholics)
malabsorption
meds: MTX, trimethoprim
high folate requirement: hemolytic anemia, pregnancy

20

causes of B12 deficiency

malnutrition (VEGANS, alcoholics)
malabsorption: pernicious anemia, chron disease, diphyllobothrium latum (fish tapeworm)

21

deficiency of UMP synthase for pyrimidine synthesis
orotic acid in urine
NO ↑ NH4
megaloblastic anemia

orotic aciduria

22

pancytopenia: anemia, leukopenia, thrombocytopenia
hypocellular BM + FATTY infiltration

aplastic anemia

23

anemia: fatigue, malaise, pallor
thrombocytopenia: purpura, petechiae, bleeding
leukopenia: infections

aplastic anemia

24

causes of aplastic anemia

radiation (cancer pt)
benzene
drugs: chloramphenicol, cancer drugs (alkylating, anti-metabolites)
viral infection: parvovirus B19, EBV, HIV esp in SICKLE CELL PATIENT (sensitive to these viruses)
Fanconi anemia: inherited defect of DNA repair
idiopathic - following acute hepatitis

25

no epo made

renal failure

26

diagnosis of beta thalassemia minor

hemoglobin electrophoresis: look for high HbA2

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