RBC Decreased Synthesis

Question 1

Important blood findings in Vit B12, Folate deficiency

Answer 1

Macrocytosis, Normochronic, anisocytosis
Low Retic Count
Large, hypersegmented PMNs
Large megakaryocytes

Question 2

Erythroid:Myeloid ratio in Vit B12, Folate deficiency

Answer 2

1:1

Question 3

Probably cause of Vit B12, Folate deficiency

Answer 3

Folic – Dietary insufficiency

B12 - malabsorption (pernicious anemia)

Question 4

Vit B12, Folate deficiency – which one has neuro probs

Answer 4

B12

Question 5

What might cause an increased B12 requirement?

Answer 5

Pregnancy, Hyperthyroid, Ca

Question 6

Where does B12 come from

Answer 6

animal products

get ya 2-3 gm/day

Question 7

Describe B12 handling

Answer 7

IF secreted in fundus parietal cells
Peptic digestion + rapid binders (cobalophilins)
IF+B12 in duodenum
Absorbed in ileum

Question 8

B12 is required for…

Answer 8

1. Homocysteins –> Methionine

2. Methylmalonyl coenzyme A –> Succinyl coenzyme A

Question 9

Problem with elevated methylmalonyl coenzyme A

Answer 9

Forms abnormal fatty acids that incorporate into lipids

Neurological complications

Question 10

How does pernicious anemia happen

Answer 10

Autoimmune destruction –> Chronic atrophic gastritis

Loss of Parietal cells

Question 11

Clinical findings of pernicious anemia?

Answer 11

• Atrophic glossitis (Glazed, beefy tongue)
• Chronic gastritis w/ fundic atrophy –> Intestinalization + Gastric Cancer
• CNS lesions (Subacute combined degeneration)
• Hemosiderosis of liver, spleen, BM

Question 12

What is a schilling test?

Answer 12

a test of ability to absorb radioactive cobalamin

Question 13

Causes of diminished folate

Answer 13

Diet, Diffuse interstitial disease/resection, anticonvulsant therapy, oral contraceptives

Question 14

Name three folate antagonists

Answer 14

Methotrexate
6-mercaptopurines
Cyclophosphamide

Question 15

Folate deficiency is most commonly seen in what populations?

Answer 15

alcoholics, indigent, elderly

Question 16

Metabolic processes that use folate

Answer 16

1. Purine synth
2. Methionine –> homocysteine
3. Synth of dTMP

Question 17

Unique test for folate deficiency

Answer 17

FIGlu in urine after histidine admin

Question 18

Most common nutritional disorder in the world

Answer 18

Iron deficiency anemia

Question 19

Most common causes of iron deficiency

Answer 19

In US – chronic blood loss (Colon Cancer)

In world – nutritional deficiency

Question 20

Why do infants get iron deficiency?

Answer 20

Low iron in breast milk

Cows milk has poor iron bioavailability

Question 21

Pathogenesis of iron deficiency

Answer 21

1. Iron reserves (ferritin and hemosiderin) are consumed to maintain hematopoesis
2. Eventually, serum iron, plasma ferritin, and transferrin sat drop. TIBC rises

Question 22

On peripheral smear, iron deficiency anemia shows

Answer 22

Microcytic, hypochromic

Question 23

Three clinical associations of anemia of chronic disease

Answer 23

Chronic microbial infections (osteomye., endocardi.)
Chronic Immune disorders (RA, regional enteritis)
Neoplasms (Hodgkin’s disease, carcinoma of lung/breast)

Question 24

Clinical features of anemia of chronic disease

Answer 24

Low iron, reduced TIBC, high ferritin

Question 25

____ may cause decreased utilization of iron by erythroid precursors in anemia of chronic disease

Answer 25

IL-1

Question 26

Describe hematocrit changes surrounding blood loss

Answer 26

Immediately after normal (equal loss of cells+Fluid) Then, fluid retention to compensate drops Hct Low Hct will trigger erythropoesis to return to normal

Question 27

Important physiological difference in external and internal hemorrhage

Answer 27

Internal hemorrhage will not cause loss of iron stores

Question 28

DJ and I. What is absorbed where?

Answer 28

D - Iron J - Folate I - B12

Question 29

anemia of chronic disease. maco, normo, or microcytic?

Answer 29

Micro or Normo

Question 30

Other work from chromatin clumping

Answer 30

Pkynosis

Question 31

What is achlorhydria (like in B12)

Answer 31

Lack of hydrochloric acid in gastric secretions

Question 32

How does she explain ferritin and hemosiderin

Answer 32

Ferritin -- Storage form of iron | Hemosiderin -- Garbage dump of iron (not really coming back)

Question 33

Predictable dose dependent causes of Aplastic Anemia

Answer 33

Benzene, Chloramphenicol, Alkylating Agents, Antimetabolites

Question 34

Idiosyncratic reactions that trigger Aplastic Anemia

Answer 34

Phenylbutazone, Chlorpromazine | Streptomycin, Carbamazepine (TEGRETOL)

Question 35

Non-drug related causes of Aplastic Anemia

Answer 35

Whole Body Radiation HIV, Hep C Inherited (Fanconi)

Question 36

Aplastic Anemia can transform into

Answer 36

Acute leukemia

Question 37

Pathology associated with Aplastic Anemia

Answer 37

Hypocellular marrow with increased fat cells, fibrous stroma | If multiple transfusions, can cause iron overload and hemosiderosis

Question 38

Other than Aplastic Anemia, what are the four important forms of marrow failure

Answer 38

1. Pure Red Cell Aplasia 2. Diffuse Liver Disease 3. Chronic Renal Failure -- EPO loss + uremic suppression 4. Chronic Infections (via IL-1)

Question 39

Difference btw primary and secondary polycythemia

Answer 39

1 -- Intrinsic stem cell abnormality | 2 -- RBC progenitors normal, but high EPO pushes production

Question 40

What is a polycythemia

Answer 40

RBC overproduction