Pathoma Anemia section

Question 1

What is the MCV for microcytic anemia

Answer 1

MCV less than 80

Question 2

What is the MCV for normocytic anemia

Answer 2

MCV 80 - 100

Question 3

What is the MCV for macrocytic anemia

Answer 3

greater than 100

Question 4

What does MCV give you?

Answer 4

the size of the red blood cell

Question 5

What causes microcytic anemia

Answer 5

low Hb

Question 6

What is heme made of

Answer 6

iron and protoporphorin

Question 7

Anemia of chronic disease

Answer 7

iron locked away in the macrophages due to an inflammatory state

• low iron
• low heme

Question 8

Which anemia has a decrease in protophorin

Answer 8

sideroblastic anemia

- microcytic anemia

Question 9

What is thalasemia

Answer 9

decreased production of globin chain = decreased Hb

- microcytic anemia

Question 10

What are the 4 microcytic anemias

Answer 10

iron def., ACD, sideroblastic anemia, thalassemia

Question 11

Where does absorption of iron occur

Answer 11

duodenum, enterocytes transport iron into blood via ferroportin

Question 12

What is the role of ferroportin

Answer 12

key transporter that takes iron from the enterocyte and places it in the blood

Question 13

What does transferrin do

Answer 13

binds iron and transports it to liver and bone marrow macrophages and then stored in the cell bound to ferritin

Question 14

What is iron bound to when it is being stored?

Answer 14

ferritin

Question 15

What do you measure if you want to measure how many transferrin is in the blood

Answer 15

TIBC

Question 16

What would you use to calculate how much iron is present in the storage sites

Answer 16

serum ferritin

Question 17

How does a gastrectomy lead to iron def. anemia

Answer 17

Fe2+ is more easily absorbed

• acid maintains the Fe2+ state and more readily absorbed
• losing part of the stomach = decreased acid = decreased iron in the 2+ state

Question 18

What is the measure of storage iron?

Answer 18

ferritin

Question 19

What happens when ferritin go down

Answer 19

TIBC goes up, which shows a decrease in transferrin

Question 20

What are three features of iron deficiency

Answer 20

anemia, koilonychia (spoon shaped nails), pica (chew on abnormal things)

Question 21

What is the RDW in iron deficiency anemia

Answer 21

increased RDW = increased spectrum of size of RBC size

Question 22

What will the ferritin levels be in a patient with iron def. anemia

Answer 22

decreased ferritin

Question 23

What is the treatment for iron def anemia

Answer 23

ferrous sulfate to replace the iron

Question 24

Plummer-Vinson syndrome

Answer 24

iron def. anemia

• beefy red tongue
• anemia
• dysphagia

Question 25

hepcidin

Answer 25

sequesters iron in storage sites, locks iron in | - heme is low, so it results in microcytic anemia

Question 26

what will be the levels of ferritin in ACD

Answer 26

high ferritin, so you will have low TIBC (low number of transferrin in the blood)

Question 27

What type of anemia is ACD

Answer 27

microcytic anemia but can also sometimes be normocytic

Question 28

What is the treatment of ACD

Answer 28

exogenous EPO

Question 29

What causes sideroblastic anemia

Answer 29

decreased protoporphyrin = microcytic anemia

Question 30

What does ALA synthase catalyze

Answer 30

Succinyl Coa to ALA

Question 31

What is the rate limiting step in the production of ALA

Answer 31

ALA synthase

Question 32

What is a cofactor for ALA synthase

Answer 32

vitamin B6

Question 33

What does ALA dehydrogenase catalyze

Answer 33

ALA to prophobilinigen

Question 34

What is the role of ferrochelatase

Answer 34

catalyzes the reaction of protoporhyrin and iron to heme in the mitochondria

Question 35

Where is the iron present in sideroblastic anemia

Answer 35

iron is trapped in the mitochondria

Question 36

What is the most common cause of congenital sideroblastic anemia

Answer 36

defect in ALAS (rate limiting that catalyzes succinyl Coa to ALA enzyme)

Question 37

What is the most common cause of acquired sideroblastic anemia

Answer 37

- alcoholism (mitochondrial poison, don't make protoporhyrin) - lead poisoning - denatures ALAD and ferochelatase - Vitamin B6 (ALAS won't function properly,)

Question 38

What denatures and what happens if you have a defect in ALAD or ferrochetalase

Answer 38

ALAD - decrease protoporphyrin and it will get trapped in the mito ferrochetelease - won't make heme

Question 39

What will the ferritin levels be in sideroblastic levels

Answer 39

high stores of iron in bone marrow macrophages and high levels of serum iron - store all the iron from all the dead erythroid precursors