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Hem part 2 > 121014 hypoproliferative anemias cases > Flashcards

121014 hypoproliferative anemias cases Flashcards

1
Q

anemia associated with pica

A

iron deficiency anemia

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2
Q

hypersegmented nucleus

A

means impaired DNA synthesis

points to macrocytic anemia (most commonly due to folate or vitamin B12 deficiency)

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3
Q

build up of methylmalonic acid

A

due to decreased vit B12

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4
Q

homocysteine

A

accepts methyl group from vit B12 to produce methionine

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5
Q

normal methylmalonic acid is seen in

A

folate deficiency

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6
Q

macrocytic RBCs

A

folate deficiency

vitB12 deficiency

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7
Q

what do you see in blood smear of megaloblastic anemia?

A

oval shaped, higher MCV RBCs
tear drop cells
anisocytosis
poikilocytosis

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8
Q

megaloblastic anemia with neurologic defects

A

vitB12 deficiency

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9
Q

what is the most common cause of vit B12 deficiency

A

pernicious anemia (autoimmune destruciton of PARIETAL CELLS, resulting in intrinsic factor deficiency

P for parietal

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10
Q

is dietary deficiency of vitB12 common?

A

no, it’s rare except in vegans

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11
Q

ex of impaired proliferation/differentiation of stem cell anemias

A

aplastic anemia

pure red cell aplasia

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12
Q

ex of impaired proliferation/matruation of erythroid precursors (ineffective erythropoiesis) causing anemia

A 
megaloblastic anemia
anemia of renal failure
anemia of chronic disease
anemia of liver disorders
myelodysplastic syndromes
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13
Q

ex of defective hemoglobin synthesis causing anemia

A 
iron deficiency anemia (heme)
sideroblastic anemia (heme)
thalassemias (globin)
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14
Q

ex of marrow replacement/infiltration causing anemia

A

hematopoietic tumors
metastatic tumors
granulomatous inflammation

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15
Q

lab features for hypoproliferative anemias

A

anemia

low reticulocyte count

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16
Q

in hypoproliferative anemia, when do you see hypercellular bone marrow?

A

marrow infiltration

ineffective erythropoeisis

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17
Q

differential diagnosis of PANcytopenia

A

stem cell disorders-aplastic anemia, PNH

ineffective hematopoiesis-MDS, megaloblastic anemia

marrow infiltration-leukemia/lymphoma, metastatic carcinoma, myelofibrosis

splenic sequestration-massive splenomegaly

drugs/treatments-immunosuppressants, chemo and radiation, etc

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18
Q

common path for folate and S-adenosylmethionine pathways

A

methionine synthetase-requires methyl tetrahydrofolate and vit B12

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19
Q

how is folate turned into tetrahydrofolate?

A

catalyzed by dihydrofolate reductase. turned first into dihydrofolate. catalyzed again by dihydrofolate reductase. turned into tetrahydrofolate.

these two steps are INHIBITED by methotrexate

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20
Q

vitamin B9

A

folate

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21
Q

tetrahydrofolate is needed in the body for what rxn?

A

conversion of dUMP to dTMP by thymidylate synthetase

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22
Q

megaloblastic anemia can be caused by

A

dihydrofolate reductase deficiency/methotrexate
thymidylate synthetase deficiency/5-FU
folate deficiency
vit B12 deficiency

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23
Q

fxn of folate pathway

A

purine synthesis
conversion of dUMP to dTMP
synthesis of methionine for SAM pathway

24
Q

megaloblastic anemia

A

inhibited DNA synthesis

25
Q

morphologic changes of megaloblastic anemia

A

peripheral blood:
hypersegmented neutrophils
macrocytic anemia with oval macrocytes
anisopoikilocytosis

bone marrow (NOT NEEDED FOR DIAGNOSIS):
hypercellularity
giant bands (band neutrophils)
nuclear to cytoplasmic dyssynchrony in erythroids, granulocytes

26
Q

what does parietal cells do?

A

secrete intrinsic factor and acid

27
Q

trace the path of vitB12 after ingestion

A

vitB12 is bound to food
when reaches the stomach, is released from food due to the acid and pepsin

instomach, binds mostly to R protein but some of it binds to IF

in duodenum, R protein is degraded releasing vitB12. vitB12 binds to IF.

in ileum, IF-vitB12 complex binds to receptor and vitB12 is transferred to transcobalamin in blood

28
Q

causes of vitB12 deficiency

A

impaired absorption (intrinsic factor deficiency, ileal resection, pancreatic insufficiency)

increased requirement (pregnancy)

decreased intake (vegans)

tapeworm (diphyllobothrium latum)

29
Q

what can cause demyelination?

A

vit B12 deficiency

30
Q

what is required for diagnosis of pernicious anemia?

A

autoantibodies against IF

31
Q

what can clue you in to vitB12 deficiency?

A

low vitB12 levels in lab
low reticulocyte count
autoantibodies to IF or parietal cells (if it’s pernicious anemia)
elevated methylmalonic acid (absent in folate deficiency)

32
Q

causes of folate deficiency

A

decreased intake (alcoholism, poverty)

increased requirements (growth, pregnancy, states of high cell turnover in hemolytic anemias and leukemias)

defective absorption (jejunal resection or malabsorption)

folic acid antagonists

33
Q

source of folate?

A

green veggies

34
Q

neural tube birth defect

A

folate deficiency

35
Q

most common cause of microcytic, hypochromic anemia?

A

blood loss–for younger female think menstrual cycle. for elderly think GI

36
Q

severe anemia

A

under 7g/dL

very few things can cause severe anemia. possible causes are:
acute blood loss (trauma, massive bleed)
nutritional deficiency (iron, folate, vitB12, combined)

37
Q

differential for microcytic, hypochromic anemia

A

most common in US: iron deficiency
thalassemia
anemia of chronic disease

38
Q

hemosiderin

A

breakdown of ferritin

39
Q

most common worldwide nutritional disorder

A

iron deficiency

infants, children, women most susceptible

40
Q

causes of iron deficiency

A 
dietary lack (milk fed infants)
impaired absorption (duodenum)
increased requirement
chronic blood loss (most important case in US)
41
Q

GI source of chronic blood loss in pt older than 50

A

GI malignancy unless proven otherwise

42
Q

ferroportin transporter is regulated by

A

hepcidin

43
Q

iron in blood is carried with

A

transferrin

44
Q

how does iron enter blood stream in duodenum

A

through ferroportin transporter

45
Q

diagnosing iron deficiency anemia

A

microcytic hypochromic anemia

iron studies:
serum ferritin
serum iron
total iron binding capacity
% iron saturation
reference values specific to sex (like Hb and heamtocrit)
46
Q

most sensitive assay for iron deficiency anemia

A

serum ferritin

47
Q

ferritin is a

A

acute phase reactant

48
Q

serum iron’s utility for iron deficiency anemia

A

least informative b/c many metabolic variations affect level

49
Q

TIBC

A

surrogate for transferrin concentration, reflecting the iron that can be bound by protein

qualitatively the opposite of serum ferritin levels

50
Q

% iron saturation

A

percent of transferrin bound with iron

51
Q

ringed sideroblasts

A

erythroid precursor cells that have mitochondria loaded with iron

52
Q

in anemia of chronic disease, what happesn to marrow storage iron value?

A

increased

53
Q

mechanism for anemia of chronic disease

A

block in transport of iron from macrophages into erythroid precursors. this block is mediated by hepcidin (acute phase reactant)

54
Q

diagnosis of anemia of chronic disease

A 
mild normocytic (80%) or microcytic (in 20%) anemia
without significant anisopoikilocytosis
IRON STUDIES is important (increased ferritin)
55
Q

myelophthisic anemia

A

anemia secondary to marrow infiltration by metastatic carcinoma

56
Q

leukoerythroblastic rxn

A

immature erythrocytes and granulocytes are thrown out of the bone marrow

Hem part 2 (11 decks)

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