Week 08.Hematology Flashcards by Michelle Herman

Causes of iron deficiency anemia

Inadequate dietary intake
Inadequate absorption
Excessive blood loss

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Define CHEILITIS

Chronic or acute inflammation of the lips

Erythema, join us, scaling, fissuring, edema, itching, burning

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Of what type of anemia can CHEILITIS be a sign?

Iron deficiency anemia

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Iron deficiency anemia is what type of anemia

Microcytic, sometimes hypochromic

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What lab value is reviewed to determine if an anemia is microcytic or macrocytic

MCV: mean corpuscular volume

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Briefly summarize the cause of thalassemia minor

Mutation in the genes encoding for alpha or beta chains of hemoglobin

Hemoglobin synthesis and red cell modulation are impaired

Excess of either alpha or beta chains of hemoglobin accumulate

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What is HEPCIDIN?

An acute phase reactant that impairs iron absorption and utilization

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Name causes of anemia of chronic disease

Results from reduced erythropoietin production

And

Reduced iron availability due to a rise in hepcidin

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Name four types of microcytic anemias

Iron deficiency anemia
Thalassemia minor
Anemia of chronic disease
Sideroblastic anemia

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Name some types/causes of macrocytic anemia

Vitamin B12 deficiency
Folate deficiency
Anemia due to liver disease
Myelodysplastic syndromes

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Name some causes of B12 deficiency anemia

Malabsorption of B12

Dietary deficiency of B12

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Name some causes of B12 malabsorption

Pernicious anemia
Gastrectomy
Disease of the ileum (Crohn’s disease, celiac disease, resection)

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What drug, used in diabetes management, can cause B12 deficiency?

Metformin (chronic use)

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A patient asks you to explain pernicious anemia. What do you say?

It is an autoimmune condition

Autoantibodies attack parietal cells and intrinsic factor

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Besides metformin, what other drugs can block absorption of B12?

Prolonged use of PPIs

Other acid-blocking drugs

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What kind of dietary habits puts patients more at risk for B12 deficiency?

Strict vegetarian or vegan diets

Severely restricting meat and dairy products

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The body can store a lot of B12. How long can the body stores last?

Up to three years

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Name a major neurological risk of B12 deficiency

Demyelination
Axonal degeneration
Irreversible neuronal death

Nerve damage can occur in the absence of anemia, and often precedes it

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Signs and symptoms of B12 deficiency anemia

Anorexia
Diarrhea
Sore tongue from atrophic glossitis
Numbness and tingling associated with peripheral neuropathy
Disorder gay
Spasticity
Upturned toes
Memory loss
Depression
Irritability
Dementia

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How long can body stores a folate last?

Three months

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Name some causes of folate deficiency

Alcohol abuse (classic cause)

Increased demand due to:
Pregnancy
Hemolysis
Malignancy
Severe psoriasis

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Name some folate antagonists That can cause decreased uptake of folate

Methotrexate
Trimethoprim
Triamterene

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Name some drugs that can cause malabsorption of folate

Phenytoin
Other anticonvulsants
Methotrexate
Trimethoprim
Triamterene

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Folate deficiency and B12 deficiency can look similar; what is a major differentiating factor between the two?

Folate deficiency does not cause neurological deficits

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Folate deficiency can increase the risk for arterial and venous thrombosis; why?

Folate deficiency causes hyperhomocystinemia

What is a myelodysplastic syndrome?

Myeloid stem cell disorder classified as a hematologic malignancy

Myelodysplastic syndromes can turn into what disease?

Acute myeloid leukemia

In anemia of chronic disease, why is some iron trapped?

Macrophages trap it, making it unavailable for erythropoiesis

What kind of anemia is anemia of chronic disease? What can it look like instead?

Normocytic normochromic | But it can be microcytic hypochromic, and mimicking iron deficiency anemia

What lab values are reduced in anemia of chronic disease?

Serum iron | Iron binding capacity

Why do hemolytic anemia is cause splenomegaly?

The spleen enlarges from the trapping of damaged red cells

Name symptoms of acute hemolysis

Sudden fever, chills, headache, back and abdominal pain | Hemoglobinuria

Hemoglobin breakdown results in what byproduct that depends on the liver?

The liver conjugates excess BILIRUBIN. If hemoglobin breakdown is too excessive the LIVER can’t keep up. Serum level of unconjugated bilirubin climbs; Patient looks jaundiced

Sickle cell trait is often asymptomatic. What abnormality can be seen in patients with sickle cell trait?

Hematuria due to circling in the hypertonic renal medulla

Hemoglobin electrophoresis reveals a predominant of what in sickle cell disease?

Hemoglobin S

With sickle cell trait, hemoglobin electrophoresis reveals what percent of hemoglobin to be hemoglobin S?

Less than 50%

What lab can confirm the diagnosis of sickle cell disease or sickle cell trait?

Hemoglobin electrophoresis

What can G6PD deficiency cause?

Hemolysis after exposure to oxidant compounds including sulfonamides an antimalarials, as well as infection

What common viral infection can cause hemolytic anemia?

Epstein-bar virus

In chronic kidney disease, crossing what GFR threshold commonly results in Anemia?

Falling below 60 mL/min

In what way are the red blood cells affected in chronic renal failure

Reduction in production and survival of red cells

What endocrine condition is associated with a number of anemic states?

Hypothyroidism

How should anemias be classified?

``` With a peripheral blood smear to determine: Normochromic-normocytic Hypochromic Microcytic Macrocytic ```

MCV is what in microcytic anemia?

MCV <80 fL

Normocytic anemia, the MCV falls between what?

MCV: 80-100fL

Macrocytic anemia is classified by MCV of what?

MCV > 100 fL

What is RDW?

Coefficient of variation of red cell volume

Test of choice for screening and diagnosis of iron deficiency anemia?

Serum ferritin

What is serum ferritin

Storage protein for iron

Definitive test for iron deficiency anemia

Bone marrow iron stores. This is invasive and painful, so serum ferritin is done instead. Ferritin is the storage protein for iron and correlates best with marrow iron stores

Differentiate anemia of chronic disease from iron deficiency anemia as far as lab work is concerned

Anemia of chronic disease: low iron level, low TIBC I am deficiency anemia: low iron level, increased TIBC

If the cause of iron deficiency is not evident, what work up needs to be done?

Woke up for G.I. blood loss

Why does someone with pernicious anemia need gastric endoscopy?

Increased risk for gastric cancer and carcinoid tumors

CBC with smear shows an increased MCV; what do you think?

Hemorrhage and hemolysis both stimulate marrow production of immature red cells; this raises MCV. Need to consider bleeding and work up for hemolysis

In microcytic anemia, what test should be ordered first? And what is this looking for?

Serum ferritin, looking for iron deficiency anemia

In microcytic anemia, after ruling out iron deficiency anemia, what needs to be assessed next?

Assess for thalassemia Examine the peripheral smear Look for target cells, tear drops, increased red cell count, reduced MCHC

In microcytic anemia, once iron deficiency and thalassemia have been ruled out, what test should be ordered? What do these tests discern?

Transferrin saturation Ferritin These help differentiate anemia of chronic disease from sideroblastic anemia

Differentiate anemia of chronic disease from sideroblastic anemia via lab work

Microcytic anemia Anemia of chronic disease: transferrin saturation is low, ferritin is increased Sideroblastic anemia: transferrin saturation and ferritin are both elevated, consider bone marrow aspirate to check for ringed sideroblasts

In macrocytic anemia, what should be considered first?

Vitamin B12 deficiency | Folate deficiency

In addition to serum levels of vitaminB12 and folate, what other labs can be added to enhance diagnostic sensitivity?

Serum homocystine level | Methylmalonate level

If vitamin B12 deficiency is detected, what needs to be done?

Rule out pernicious anemia Test for H. pylori infection Upper G.I. if evidence of atrophic gastritis

If the reticulocyte count is high, and there is no hemorrhage, what needs to be considered?

Check for hemolysis

If the reticulocyte count is high, but there is no hemorrhage or hemolysis, what needs to be considered?

Hepatic dysfunction | Thyroid dysfunction

What antibiotics can prolonged bleeding time?

High parenteral doses of beta-lactams

Major risks of thrombocytosis

Bleeding and thrombosis

Differentiate primary from secondary thrombocytosis; what causes secondary thrombocytosis

Secondary occurs in the context of some other inflammatory disease, infection, or malignancy

Week 08.Hematology Flashcards

(66 cards)