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xS1B5 - Pathology > S1B5 - Intro to Anemia > Flashcards

S1B5 - Intro to Anemia Flashcards

(54 cards)

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1
Q

What is the goal of treatment in iron deficiency anemia?

A

In general, the goal of treatment for iron deficiency anemia is to alleviate the underlying cause (i.e. menorrhagia, colorectal cancer, parasitic infection, etc.)

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2
Q

What is koilonychia? What is pica?

A

Notable signs and symptoms associated with iron deficiency anemia include some of the following:

  • Koilonychia (thin nails which have lost their convexity, i.e. “spoon nails” – the opposite of nail clubbing)
  • Alopecia (hair loss)
  • Intestinal malabsorption
  • Pica (consumption of non-foodstuffs such as clay or food ingredients such as flour)
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3
Q

Write the equation for corrected absolute reticulocyte count.

A

The corrected absolute reticulocyte count is a method of correcting for reticulocyte maturation time (RMT). The equation used to derive this value is: absolute reticulocyte count x (hematocrit/45)

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4
Q

Total iron-binding capacity is an indirect measure of what serum protein?

A

Iron studies can be useful in the diagnosis of a variety of inflammatory, hemolytic, and neoplastic conditions (among other things). Important measures include the following:

  • Serum ferritin
  • Serum iron
  • Serum total iron-binding capacity (TIBC – indirect measure of serum transferrin)
  • Iron saturation
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5
Q

What are the two most common causes of iron deficiency in adult females under the age of 50?

A

Breast-fed infants are at increased risk of developing dietary iron deficiency, owing to a low iron content in human breast milk. In adults under age 50, risk factors for the development of iron deficiency differ based on gender:

  • In males, peptic ulcer disease is an important risk factor
  • In females, menorrhagia or pregnancy are important risk factors
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6
Q

Describe the serum ferritin and TIBC in iron deficiency anemia.

A

Iron study findings in iron deficiency anemia are as follows:

  • Serum ferritin: DECREASED
  • Serum iron: Usually decreased
  • TIBC: INCREASED
  • Transferrin (%) saturation: DECREASED
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7
Q

Are thalassemias qualitative or quantitative defects of hemoglobin?

A

Thalassemias are quantitative defects of hemoglobin, rather than the qualitative defects of sickle cell disease or hemoglobin C, with decreased hemoglobin production.

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8
Q

What are the main causes of microcytic anemia?

A

Microcytic anemia causes

  • Disorders of metabolism
    • Iron deficiency
    • Chronic disease (may also be normocytic)
    • Neoplasia
  • Disorders of heme synthesis
    • Sideroblastic anemia
    • Hereditary (X-linked or autosomal)
    • Acquired, idiopathic (myelodysplasia)
    • Acquired, toxic (lead, drugs, alcohol)
  • Disorders of globin synthesis
    • Thalassemias
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9
Q

Which component of the CBC is used to determine if an anemia is due to underproduction of red cells by the bone marrow?

A

The corrected reticulocyte count is used to determine if the underlying cause of anemia is due to underproduction of red cells by the bone marrow (hypoproliferation), internal destruction of red cells (hemolysis), or bleeding (hemorrhage).

The reference range is typically 0.5-1.5%.

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10
Q

What is the equation for calculating transferrin saturation?

A

Transferrin saturation is calculated by: (serum iron ÷ TIBC*) × 100

  • * Total iron-binding capacity (TIBC)
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11
Q

What does a serum iron study really measure?

A

Serum iron studies technically measure the amount of iron bound to transferrin, since there is virtually no free (unbound) iron in the bloodstream.

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12
Q

What do the red cell indices from a complete blood count (MCV, MCHC, RDW, etc.) help determine?

A

The following are the most useful indices on a complete blood count (CBC) that assist physicians in determining the underlying cause of a given case of anemia:

  • Mean corpuscular volume (MCV)
  • Mean corpuscular hemoglobin (MCH – weight of hemoglobin in the average red cell - not used as much as the MCHC)
  • Mean corpuscular hemoglobin concentration (MCHC)
  • Red cell distribution width (RDW)
  • Corrected reticulocyte count
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13
Q

Which component of the CBC is used to differentiate between hypochromic and normochromic anemias?

A

Mean corpuscular hemoglobin concentration (MCHC) is used to classify anemias based on hemoglobin concentration (hypochromic and normochromic).

The reference range is typically 32-36 g/dL.

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14
Q

What are the major causes of normocytic, nonhemolytic anemia?

A

Normocytic nonhemolytic anemia causes:

  • Anemia of chronic diseas
  • Aplastic anemia
  • Chronic kidney disease
  • Iron deficiency (early)
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15
Q

Do patients with iron deficient anemia first present with normocytic or microcytic anemia?

A

Patients with iron deficient anemia first present with normocytic anemia, which can progress to a microcytic anemia.

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16
Q

Ferrous sulfate (FeSO4) and vitamin C may be used in the treatment of which form of anemia?

A

Supplements for iron deficiency anemia include some of the following:

  • Supplemental ferrous sulfate (FeSO4)
  • Vitamin C
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17
Q

Delayed achilles tendon reflex is suggestive of what cause?

A

Delayed achilles tendon reflex: hypothyroidism

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18
Q

Petechiae is suggestive of what cause?

A

Petechiae: thrombocytopenia and marrow replacement/failure

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19
Q

What are the major causes of non-megaloblastic macrocytic anemia?

A

Non-megaloblastic anemia

  • Liver disease
  • Alcoholism
  • Reticulocytosis
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20
Q

Which component of the CBC is used to differentiate between microcytic, normocytic, and macrocytic anemias?

A

Mean corpuscular volume (MCV) is used to classify anemias based on red cell size (microcytic, normocytic, and macrocytic).

The reference range is typically 80-100 µm3 or 80-100 fL.

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21
Q

Which major type of anemia is treated (mostly) by addressing the underlying inflammatory disorder or disease?

A

Treatment for the anemia of chronic disease generally involves curing or ameliorating the underlying disorder.

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22
Q

Massive splenomegaly is suggestive of what cause?

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A

Massive splenomegaly: chronic myeloid leukemia, myelofibrosis

23
Q

Skin ulcers are suggestive of what cause?

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A

Skin ulcers: sickle cell disease

24
Q

What is a heterogeneous group of inherited disorders characterized by reduced globin chain synthesis?

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A

Thalassemias: heterogeneous group of inherited disorders characterized by reduced globin chain synthesis.

25
What is the most common cause of iron deficiency anemia in affluent countries?
Iron deficiency anemia is a hypochromic microcytic anemia. It is the most common type of anemia worldwide. In affluent countries, the most common cause of iron deficiency is **overt or occult blood loss**.
26
What are the general signs/symptoms of anemia?
General * Pallor * Fatigue * Syncope * Dyspnea * Tachycardia * Palpitations * Heart murmurs * Congestive heart failure * Postural hypotension
27
What are the major causes of megaloblastic macrocytic anemia?
Megaloblastic anemia causes * **Folate deficiency** * **B12 deficiency** * **Orotic aciduria**
28
Which acute phase protein is thought to play a major role in the pathogenesis of the anemia of chronic disease?
The pathogenesis of the anemia of chronic disease is multifaceted, but it is thought that **hepcidin**-induced alterations in iron metabolism play a major role. **Hepcidin** is an acute phase protein and the primary regulator of iron absorption.
29
Which form of iron does transferrin bind: ferrous (Fe2+) or ferric (Fe3+)?
Dietary iron is both intestinally reabsorbed and delivered to the blood in the ferrous (Fe2+) state. Once ferrous iron enters the bloodstream, it is rapidly oxidized back to **ferric (Fe3+) iron** and bound by the carrier protein, transferrin.
30
Smooth tongue with glossitis is suggestive of what cause?
Smooth tongue, with glossitis: * pernicious anemia * severe iron deficiency
31
Describe the MCV, MCHC, and reticulocyte count in iron deficiency anemia.
Laboratory/blood film examination findings in iron deficiency anemia are as follows: * **MCV: DECREASED** * **MCHC: DECREASED** * RDW: INCREASED * **Reticulocyte count: Usually normal**
32
Splenomegaly is suggestive of what cause?
Splenomegaly: hematolymphoid malignancy, infectious mononucleosis
33
In elderly patients, how does the most common etiology of iron deficiency differ between those in developed countries versus those in third-world countries?
In the elderly, risk factors for the development of iron deficiency differ based on location: * In the developed world, **colorectal polyps or colorectal carcinoma** are important risk factors * In third world countries, **hookworm infection (Ancylostoma duodenale and Necator americanus)** is an important risk factor
34
What is the percent composition of normal hemoglobin types (HbA, HbA2, and HbF) in a healthy adult?
Hemoglobin electrophoresis can be used to diagnose specific hemoglobinopathies or thalassemias. A normal hemoglobin electrophoresis study would yield the following: * Approximately **97% HbA (α2β2)** * Approximately **2% HbA2 (α2δ2)** * Approximately **1% HbF (α2γ2)**
35
Which lab study would yield information about the presence of abnormal hemoglobin forms such as HbH and HbS?
Some abnormal variants of hemoglobin which can be detected on **hemoglobin electrophoresis** include: * HbS (sickle Hb) * HbH (ß4) * Hb Bart (γ4)
36
Hepatosplenomegaly with ascites is suggestive of what cause?
Hepatosplenomegaly with ascites: liver disease
37
What are the major causes of intrinsic hemolytic anemia?
Intrinsic hemolytic anemia causes * **Hereditary spherocytosis** * **RBC enzyme deficiency** * **Hemoglobin C defect** * **Paroxysmal nocturnal hemoglobuliuria** * **Sickle cell anemia**
38
Which component of the CBC is used to determine anisocytosis?
**Red cell distribution width (RDW)** is used to determine anisocytosis (degree of size variation between red cells). *The reference range is typically 12-13.5%.*
39
Is anemia a diagnosis?
Anemia is not a diagnosis in and of itself, but a sign of underlying disease.
40
Lymphadenopathy is suggestive of what cause?
Lymphadenopathy: hematolymphoid malignancy or infection
41
What are the indicating CBC findings of anemia of chronic disease?
Morphology in peripheral blood, CBC findings: * Microcytic hypochromic anemia OR normocytic normochromic anemia with normal RDW * Low reticulocyte count
42
In the pathogenesis of the anemia of chronic disease, what factors are responsible for producing the anemia?
Anemia is caused by the following factors: * **Reduced transfer of iron to developing erythroid precursors** (due to hepcidin-induced inhibition of ferroportin) * **Inappropriately low levels of erythropoietin and reduced efficiency of erythropoiesis** (due to suppression by inflammatory cytokines such as TNF-α and IL-1β)
43
What are the major causes of extrinsic hemolytic anemia?
Extrinsic hemolytic anemia causes * **Autoimmune** * **Microangiopathic** * **Macroangiopathic** * **Infections**
44
How long after the onset of chrinic disease does anemia of chronic disease appear?
Appears 1-2 months after onset of chronic disease.
45
Scleral icterus is suggestive of what cause?
Scleral icterus: hemolysis
46
What disorder of the esophagus presents with iron deficiency anemia?
**Plummer-Vinson syndrome** is a disorder of the esophagus that presents with cervical esophageal web, atrophic glossitis, dysphagia, macroglossia, and iron deficiency anemia.
47
Write the equation for reticulocyte production index.
The reticulocyte production index (RPI) is a method of correcting for the degree of anemia as well as the RMT. The equation to derive this value is: **reticulocyte % × (Hct ÷ 45) × (1 ÷ RMT)** *A normal value is typically less than 3%.*
48
What are the indicating findings for beta thalassemia major in peripheral blood morphology?
Peripheral blood morphology of beta thalassemia * Marked anisocytosis * Marked poikilocytosis * Many nucleated RBCs * Polychromasia * Severe microcytic hypochromic anemia
49
What group of disorders is characterized by an abnormally low circulating red cell mass?
The **anemias** are a group of disorders characterized by an abnormally low circulating red cell mass as measured by a reduction in hematocrit (Hct) and hemoglobin concentration (Hgb).
50
Subacute combined degeneration of the spinal cord is suggestive of what cause?
Subacute combined degeneration of the spinal cord: pernicious anemia
51
What is the most common form of anemia in hospitalized patients?
The **anemia of chronic disease** is an anemia of variable severity that is usually normochromic normocytic (it is a hypochromic microcytic anemia in only 25% of cases). *It is the most common form of anemia in hospitalized patients.*
52
Koilionychia is suggestive of what cause?
Koilonychia: iron deficiency
53
What is the best laboratory test to assess total body iron stores?
Ferritin is an intracellular iron-binding protein synthesized by macrophages and hepatocytes. The amount of ferritin in the serum is highly correlated to iron stores under steady-state conditions. Therefore, **serum ferritin is the best test to assess total iron body stores.**
54
What kind of anemia is second only to iron deficiency in incidence?
**Anemia of chronic disease** is second only to iron deficiency in incidence.

xS1B5 - Pathology (3 decks)

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