Test 3 (Units 11-15)

Question 1

Anemia-

Answer 1

decreased oxygen carrying capacity resulting in tissue hypoxia

Question 2

Symptoms of anemia:

Answer 2

• Fatigue and shortness of breath
  
  • Cravings
  • Pale, jaundice, spots on arms/legs
  • Severity depends on onset, cardiac output, severity of anemia
  • Enlarged spleen and liver

Question 3

Describe the normal life span of a red blood cell including the percentage recycled daily.

Answer 3

Lifespan: 120 days
Daily recycling 1% of RBCs
BM releases 1% of “retics”

Question 4

Discuss physiological adaptions found in patients with anemia.

Answer 4

EPO increased
Heart rate increased 
Respiratory rate increased
2,3 DPG increased
Too severe cardiac failure

Question 5

Ineffective erythropoiesis: Meaning, effects and examples

Answer 5

1) RBC progenitors defective
2) -Increased precursors in BM
- Decreased Hgb in peripheral blood
- Normal or decreased retics
3) -Megaloblastic anemia
- Thalassemias
- Sideroblastic anemia

Question 6

Insufficient erythropoiesis: Meaning, effects and examples

Answer 6

1) Insufficient amount being made
2) -Decreased precursors in BM
-Decreased RBC production
-Normal or decreased retics
3) -Iron deficiency
-EPO deficiency
-Loss of precursors due to:
Autoimmune processes
Infection
Infiltration from other cells
In BM

Question 7

Acute Blood Loss and Hemolysis: Meaning, effects and examples

Answer 7

1) Traumatic injury/premature hemolysis
2) -BM increased productions
- Increased retics, but maybe not right away
3) -RBC membrane defects
- Enzyme deficiencies
- Extrinsic

Question 8

List conditions resulting in premature hemolysis.

Answer 8

• RBC membrane defects
• Enzyme deficiencies
• Extrinsic: antibody, mechanical, infection

Question 9

List procedures and tests commonly performed for the detection and diagnosis of anemia.

Answer 9

CBC
Retic
Blood smear
Bone marrow

Also: 
	UA
	Stool analysis
	Renal and hepatic panels
	Iron studies
	B12
	Folate
	DAT (direct antiglobulin test)

Question 10

Discuss the importance of the reticulocyte count in the evaluation of anemia.

Answer 10

-Tests BM response
-hemolytic anemia: increased destruction once they make it out, increased retic
As bone marrow deals with loss
-Chronic blood loss: decreased or normal retic count

Question 11

Describe different algorithms used to classify anemias.

Answer 11

Classification based on MCV
On absolute retic count and MCV
On RDW

Question 12

Characterize the three groups of anemias categorized based on mean cell volume (MCV) and give one example of each.

Answer 12

Microcytic- Sideroblastic anemia
Normocytic- Anemia of renal disease
Macrocytic- Folate deficiency

Question 13

Recognize the importance of reviewing the peripheral blood film when assessing anemias and distinguish the important findings.

Answer 13

Check size, shapes and other possible abnormalities

Question 14

Define poikilocytosis.

Answer 14

Variation in shapes

Question 15

Diffuse basophilia: Composition, method of ID and importance

Answer 15

RNA remnants
Supravital stain-methylene blue
Normal finding but how many?

Question 16

Basophilic stippling: Composition, method of ID and importance

Answer 16

Precipitated RNA
Wright stain
Lead poisoning or thalassemia

Question 17

Howell-Jolly Body: Composition, method of ID and importance

Answer 17

Piece of DNA
Wright stain
Verify not a piece of dirt

Question 18

Ringed sideroblast: Composition, method of ID and importance

Answer 18

Iron
Prussian blue (in BM)
Sideroblastic anemia

Question 19

Pappenheimer bodies: Composition, method of ID and importance

Answer 19

Iron deposits	
Wright stain	
-After spleen removal
-Thalassemias
-Megaloblastic anemias

Question 20

Cabot ring: Composition, method of ID and importance

Answer 20

Remnant of mitotic spindle
Wright stain
Super rare, not reported

Question 21

Heinz bodies: Composition, method of ID and importance

Answer 21

Denatured hbg
Supravital stain
Thalassemias and drugs/chemicals

Question 22

4 causes of iron deficiency anemia

Answer 22

inadequate intake
increased need
impaired absorption
Chronic blood loss

Question 23

iron deficiency anemia: Inadequate intake etiology

Answer 23

Decreased intakeiron stores used up

Iron deficiencyID anemia

Question 24

iron deficiency anemia: increased need etiology

Answer 24

Increased need:
   -Periods of rapid growth like infancy,
   Childhood, adolescence 
   -Pregnancy
   -Nursing

Question 25

iron deficiency anemia: Impaired absorption

Answer 25

-Diet is adequate, absorption is not -Malabsorption: celiac disease -Loss of gastric acidity (can’t convert Ferric to ferrous): gastrectomy, Bariatric surgery, antacids

Question 26

iron deficiency anemia: pathophysiology

Answer 26

``` Stage 1: Hemoglobin N Serum Iron N TIBC N Ferritin Dec. Stage 2: Hemoglobin N Serum Iron Dec TIBC Inc Ferritin Dec. (Basically depleted) Stage 3: Hemoglobin Dec Serum Iron Dec TIBC Inc Ferritin Dec. ```

Question 27

iron deficiency anemia: Chronic blood loss

Answer 27

Chronic blood loss - Chronic hemorrhage or hemolysis - GI bleeds - heavy menstrual bleeding - Fibroid tumors - Loss through urinary tract

Question 28

Anemia of Chronic Inflammation: etiology

Answer 28

- Systemic diseases like chronic inflammatory disease or malignancies - Chronic blood loss IS NOT equal to anemia of chronic inflammation - Impaired ferrokinetics due to hepcidin - Body is inflamed so inc in hepcidin

Question 29

Anemia of Chronic Inflammation: pathophysiology

Answer 29

``` Serum Iron dec *TIBC dec Transferrin saturation N or dec Serum ferritin N or inc Bone marrow N or inc ```

Question 30

Sideroblastic Anemia: etiology

Answer 30

``` Acquired Primary Secondary-TB drugs, chloramphenicol, Alcohol, LEAD, chemotherapeutic agents Hereditary X linked Autosomal ```

Question 31

Sideroblastic Anemia: pathophysiology

Answer 31

``` Ringed sideroblasts in BM Lead poisoning leads to hypochromic, microcytic with basophilic stipling Serum iron inc TIBC N or dec Transferrin saturation inc Serum ferritin inc (N in lead poison) ZPP inc Bone marrow N or inc ```

Question 32

Iron Overload: etiology

Answer 32

Primary hereditary Hemochromatosis Secondary chronic anemia Problems with iron metabolismtoo much iron Free ironorgan damage

Question 33

Iron Overload: pathophysiology

Answer 33

Serum inc x2 *Transferrin saturation inc x2 Serum ferritin inc x2 Liver function tests-see if damage has occurred

Question 34

Describe the hemoglobin defect in thalassemias.

Answer 34

Quantitative defect- Structure ok, synthesis lowcompensation

Question 35

Name the chromosomes that contain the alpha globin gene and the beta globin gene clusters and the globin chains produced by each.

Answer 35

``` Chromosome 11 b d g e Beta cluster Chromosome 16 A z Alpha like genes ```

Question 36

Explain the pathophysiologic effects caused by the imbalance of globin chain synthesis in thalassemia.

Answer 36

``` Microcytic Hypochromic Hemolytic Unequal production Dec. in RBC production ```

Question 37

Thalassemia minor (one normal gene): clinical features

Answer 37

Asymptomatic to mild anemia | Cells smaller, basophilic stippling and target cells

Question 38

Thalassemia major: clinical features

Answer 38

``` Cooley’s anemia Severe Transfusion dependent Jaundice Bone changes (hair on end) Heinz bodies, basophilic stippling, Howell jolly body, elliptocyte, targets ```

Question 39

Thalassemia intermedia: clinical features

Answer 39

Moderate Few transfusion requirements Polychromatophilic

Question 40

a Thal minor: clinical features

Answer 40

Asymptomatic to mild Jaundice Hepatosplenomegaly

Question 41

Hemoglobin Bart: clinical features

Answer 41

g4 soluble enter circulationprecipitation removal by spleen High O2 affinity-can’t get off the “bus”

Question 42

Hemoglobin H: clinical features

Answer 42

``` b4 Fine, granular precipitate Mild to chronic hemolytic anemia Erythroid hyperplasia Enlarged spleen ```

Question 43

Hgb Hydrops Fetalis: clinical features

Answer 43

Incompatible with life No alpha chains Can be harmful to mother

Question 44

Alpha thalassemia: pathophysiology

Answer 44

Deletionsexcess g in fetuses and excess b in adults

Question 45

Beta thalassemia: pathophysiology

Answer 45

Excess a chains precipitatedamage surfaces Destruction of damaged RBCs Ineffective erythropoiesis Extravascular hemolysis Ineffective production and decreased destruction

Question 46

Describe the peripheral blood morphology associated with thalassemias.

Answer 46

``` H+H dec x2 RBC dec MCV dec x3 MCHC dec RDW inc ``` ``` Micro Hypo Poik- TARGET and elliptocytes Polychromasia-retics high Inclusions: basophil stippling , NRBCs TARGET CELLS MARKED MICROCYTOSIS MILD ERITHROCYTOSIS ```