11 Intro to anemias

Question 0

Compensation in Anemia

Answer 0

• ^ Erythropoiesis
• ^ 2,3 DPG
• Blood shunting
• ^ CO
• ^ Pulmonary function

Question 1

Anema definition

Answer 1

decreased oxygen delivery to body secondary to decrease in amount of circulating healthy RBCs

Question 2

Anemia signs and symptoms

Answer 2

Weakness, malaise, fatigue- Tissue hypoxia
Marrow expansion/bony abnormalities- ^ RBC production
Pallor- Shunting
Tachycardia/ischemia- Increased CO demand
Dyspnea- Increased pulmonary demand

Question 3

Microcytic normochromic anemias

Answer 3

*Anemia of chronic disease (can be but is often normocytic and normochromic)

Question 4

Microcytic hypochromic anemias

Answer 4

• Iron deficiency

* Thalassemia

Question 5

Normochromic/normocytic anemia

Answer 5

Anemia of chronic disease
Anemia of renal failure
Marrow infiltration
Aplastic anemia
Bloodloss
Hemolysis

Question 6

Macrocytic anemias

Answer 6

(Megaloblastic)
B12 and Folate deficiency
Myelodisplastic syndromes
some drugs

(Non megaloblastic)
Retculocytosis
Hypothyroid
Liver DZ
Some drugs
Bloodloss
Hemolysis

Question 7

CBC

Answer 7

Hb
Hct( MCVxRBC)
RBC count
MCV
MCH (Hb/RBC)
MCHC (Hb/[RBCxMCV]) (measures hyper/hypochromicity)
RDW (red cell width distribution) Anisocytosis?

Question 8

Howell-Jolly Bodies

Answer 8

Large remaining nuclear fragments in splenectomy or megaloblastic anemias

Question 9

Pappenheimer bodies

Answer 9

Iron ggranules in splenectomy or iron overload

Question 10

Basophilic stippling

Answer 10

Problems with Hb snthesis seen in:

Thal, Myelodysplastic syndromes, lead poisoning

Question 11

Rouleaux

Answer 11

“Coin stacking” of RBCs from increased serum protein (decr. repulsive forces from RBC to RBC) IgG/Fibrinogen, MULTIPLE MYELOMA

Question 12

Agglutination

Answer 12

IgM RBC clumps- Seen in cold aglutinins

Question 13

Blood loss anemia

Answer 13

Acute:
Normal on CBC because whole blood is lost
Anemia on increased volume
Reticulocytes increase from day 2/3-day7/10

Chronic:
Initially normal
Then slight reticulocytosis
Eentual development of iron deficiency anemia

Question 14

RBC production

Answer 14

Originally in yolk sack, liver in fetus, BM after that

Regulated by kidney EPO

Question 15

Normoblastic maturation

Answer 15

Nucleated RBBCs obtain iron from plasma tranferrin

• Up to 16 reticulocytes created from pronormoblast
• Equal numbers normoblasts and reticulocytes in BM
• *As maturation occurs RNA goes down Hb goes up

Question 16

Reticulocyte

Answer 16

Slightly larger immature RBC

Residual RNA for creating Hb 1-2 days in marrow, goes away with maturation

Question 17

Reticulocyte count

Answer 17

Corrected= retic%X(patient HCT/45)

Absolute reticulocyte count is best

Question 18

Reasons for Decreased RBC production

Answer 18

Ineffective erythropoiesis (poor maturation)
Decreased RBC precursors(BM failure)
Anemia of chrronic disease(chronic inflammation)

Question 20

Decreased RBC progenitors (BM failure)

Answer 20

DECREASE IN ERYTHROID BM MASS

• decreased avaiability of progenitors to form erythroids
• decreased progenitor proliferation capacity

Features:
Normocytic, normochromic
little anisopoikilocytosis
Decreased Reticulocyte counts

Question 21

Decreased RBC precursor anemias

Answer 21

• Red cell aplasa or pan- aplasia (aplastic anemia)
• Congenital
  
  • Fanconi anemia- pan-aplasia
  • Dyskeratosis congenita- pan-aplasia
  • Diamond blackfan- pure red cell aplasia
• Acquired
  
  • Idiopathic
  • Drugs/toxins- i.e. Chemo
  • autoimmune
  • infectious
  • paraneoplastic
• Marrow replacement
  
  • Leukemia/lymphoma
  • mets
  • fibrosis
  • storage diseases
• Decreased EPO
  
  • Renal Failure

Question 22

Anemia of chronic disease

Answer 22

Inflammatory block on erythropoiesis

• IL-1
• TNF-alpha
• IFN gamma

Question 23

RBC basics

Answer 23

7.5-8.7u, 90fl normal size
Band 3, CH, Ankyrin, spectrin, Actin
Usually very deformable biconcave disc
120 day lifespan

Question 24

Hemolytic anemias

Answer 24

*Increased destruction causes increased production-
UP TO 8X NORMAL!!!
*Bone marrow attempts to compensate but if it cant, may have chronic low Hb
*Reticulocytosis common

Question 25

Extravascular hemolysis

Answer 25

Predominant in most hemolytic anemias-

• caused by nondeformable cells sheared in spleen/splenic cords
• Phagocytosed by cordal macrophages

Question 26

Hemolysis features

Answer 26

• Reticulocytosis
• increased indirect bilirubin(albumin bound from macs) from heme metabollism
• Decreased Haptoglobin
• Morphologic changes to RBCs
• Splenomegaly in chronic cases
• Bony abnormalities

Question 27

Ineffective erythropoiesis

Answer 27

DEFECTS IN MATURATION

• IronD - cytoplasmic maturation defect
• Megaloblastic anemia - Nuclear maturation defect
• MDS

Generally:
Anisopoikilocytosis
Dysmaturation of erythroids in BM
Decreased reticulocyte count without BM erythroid loss