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02 Heme Lymph > 11 Intro to anemias > Flashcards

11 Intro to anemias Flashcards

0
Q

Compensation in Anemia

A
  • ^ Erythropoiesis
  • ^ 2,3 DPG
  • Blood shunting
  • ^ CO
  • ^ Pulmonary function
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1
Q

Anema definition

A

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

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2
Q

Anemia signs and symptoms

A

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

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3
Q

Microcytic normochromic anemias

A

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

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4
Q

Microcytic hypochromic anemias

A
  • Iron deficiency

* Thalassemia

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5
Q

Normochromic/normocytic anemia

A 
Anemia of chronic disease
Anemia of renal failure
Marrow infiltration
Aplastic anemia
Bloodloss
Hemolysis
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6
Q

Macrocytic anemias

A

(Megaloblastic)
B12 and Folate deficiency
Myelodisplastic syndromes
some drugs

(Non megaloblastic)
Retculocytosis
Hypothyroid
Liver DZ
Some drugs
Bloodloss
Hemolysis
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7
Q

CBC

A

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

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8
Q

Howell-Jolly Bodies

A

Large remaining nuclear fragments in splenectomy or megaloblastic anemias

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9
Q

Pappenheimer bodies

A

Iron ggranules in splenectomy or iron overload

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10
Q

Basophilic stippling

A

Problems with Hb snthesis seen in:

Thal, Myelodysplastic syndromes, lead poisoning

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11
Q

Rouleaux

A

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

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12
Q

Agglutination

A

IgM RBC clumps- Seen in cold aglutinins

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13
Q

Blood loss anemia

A

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

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14
Q

RBC production

A

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

Regulated by kidney EPO

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15
Q

Normoblastic maturation

A

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
16
Q

Reticulocyte

A

Slightly larger immature RBC

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

17
Q

Reticulocyte count

A

Corrected= retic%X(patient HCT/45)

Absolute reticulocyte count is best

18
Q

Reasons for Decreased RBC production

A

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

20
Q

Decreased RBC progenitors (BM failure)

A

DECREASE IN ERYTHROID BM MASS

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

Features:
Normocytic, normochromic
little anisopoikilocytosis
Decreased Reticulocyte counts

21
Q

Decreased RBC precursor anemias

A
  • 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
22
Q

Anemia of chronic disease

A

Inflammatory block on erythropoiesis

  • IL-1
  • TNF-alpha
  • IFN gamma
23
Q

RBC basics

A

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

24
Q

Hemolytic anemias

A

*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

25
Q

Extravascular hemolysis

A

Predominant in most hemolytic anemias-

  • caused by nondeformable cells sheared in spleen/splenic cords
  • Phagocytosed by cordal macrophages
26
Q

Hemolysis features

A
  • Reticulocytosis
  • increased indirect bilirubin(albumin bound from macs) from heme metabollism
  • Decreased Haptoglobin
  • Morphologic changes to RBCs
  • Splenomegaly in chronic cases
  • Bony abnormalities
27
Q

Ineffective erythropoiesis

A

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

02 Heme Lymph (16 decks)

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