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Basic Pathology 2 > 18 Approach to Patients with Anemia > Flashcards

18 Approach to Patients with Anemia Flashcards

1
Q

Process by which the formed elements of blood are produced

A

Hematopoiesis

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2
Q

Two main hematopoietic lineages

A

Common myeloid progenitor

Common lymphoid progenitor

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3
Q

Main regulatory hormone of red cell production which is produced in the kidney

A

EPO

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4
Q

Stimulus for EPO production

A

Low atmospheric oxygen level
Tissue hypoxia
Living in high altitudes
Cardiovascular failure

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5
Q

Decrease in hemoglobin

Often recognized with lab test after px present with s/s

A

Anemia

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6
Q

Diagnostic values for anemia

A

M: <13.0 g/dL
F: <12.0 g/dL

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7
Q

Diagnostic approach to anemia

A 
S/s
Lab tests
History
PE
Peripheral blood smear
Retics count
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8
Q

First and important step in diagnostic

A

History

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9
Q

History includes

A 
Nutritional status
Easy fatigability
Family history
Drug intake
Presence of chronic disease
Inflammatory diseases
Menstruation and pregnancy history
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10
Q

At-risk population

A

Children
Adolescents
Pregnant
Elderly

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11
Q

S/s to check in PE

A

Pallor
Pale conjuctiva
Systolic flow murmur
Palmar creases lighter in color than the surrounding tissue

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12
Q

Oxygen-carrying capacity

A

Hemoglobin

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13
Q

Percentage of RBCs in relation to the entire volume of blood

A

Hematocrit

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14
Q

Indicative of cell size

Measured in femtoliters

A

Mean corpuscular volume

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15
Q

MCV diagnostic values for anemia

A

<80 fL - microcytosis

>100 fL - macrocytosis

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16
Q

Amount of Hb in a particular red cell

Measured in pg

A

Mean corpuscular hemoglobin/mea

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17
Q

Amount of Hb in a certain volume

Increased in hereditary spherocytosis

A

Mean corpuscular hemoglobin concentration

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18
Q

Measure of variance of the red cells in a particular blood sample
Increased in hemolysis, thalassemia, post-blood transfusion

A

RBC distribution width

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19
Q

Increases when bone marrow is trying to recover

A

Monocytes

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20
Q

PBS result for IDA

A

Microcytic, hyprochromic anemia

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21
Q

PBS result for megaloblastic anemia

A

Macrocytic, normochromic anemia

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22
Q

Possible causes of megaloblastic anemia

A

B12 and folate deficiencies

D. latum infection

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23
Q

What causes folate deficiency

A

Low vegetables intake
Malabsorption
Gastric bypass

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24
Q

Provides important information about defects in the red cell production
Used as a complement to the red cell indices indicated in the CBC

A

PBS

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25
Variation in cell size
Anisocytosis
26
Small red cells with no central pallor | Correlates with increase in RDW
Spherocytes
27
Variation in cell shape | Suggests defect in maturation of red cell precursors
Poikilocytosis
28
Have bull's-eye appearance and are seen in thalassemia and in liver disease Membrane is pulled towards the center as it tries to preserve its volume
Target cells
29
Red cells that are recently released from the bone marrow | Seen in polychromasia
Reticulocytes
30
Abnormally high number of immature red blood cells in circulation
Polychromasia
31
Used to see if the marrow is responding to the anemia
Corrected reticulocyte count (Retic %)
32
Determine whether anemia is hypoproliferative
RPI (reticulocyte production index)
33
Normocytic, normochromic could be indivicative of hypoproliferative diseases which include
Marrow damage Iron deficiency Dec stimulation: inflammation, metabolic disease, renal disease
34
Microcytic or macrocytic could be indicative of maturation disorder which include
``` Cytoplasmic defects (iron def, thalassemia*, sideroblasmic anemia) Nuclear defects (Folate, B12 def, drug toxicity, refractory anemia) ```
35
RPI > 2.5 is indicative of
Hemolysis or hemorrhage
36
Marrow infiltration or fibrosis
Myelopthsis
37
Normocytic, normochromic red cells with inappropriately low reticulocyte response
Hypoproliferative anemias
38
Hypoproliferative anemias: microcytic, hypochromic
IDA Thalassemia* Myelodysplastic syndrome (sideroblastic anemia)
39
Hypoproliferative anemias: macrocytic anemia
Vitamin B12, folate deficiency Drug toxicity Myelodysplastic syndrome Refractory anemia
40
Hypoproliferative anemias: normocytic, normochromic anemia
Myelopthsis anemia Anemia of inflammation Anemia of chronic renal disease Aplastic anemia
41
Second most common cause of normocytic, normochromic anemia | Hyporesponsive to EPO
Anemia of inflammation
42
Cause of aplastic anemia
Bone marrow failure disorder
43
Proliferative anemia
Acute blood loss | Hemolysis
44
Common clinical features of hemolysis
Jaundice | Tea-colored urine
45
End-stage in a long process of iron loss
Iron deficiency anemia
46
Three stages in iron loss
Negative iron balance Iron deficient erythropoiesis Iron deficiency anemia
47
Body's demand of iron exceeds the body's ability to absorb iron from diet Iron deficit must be made up mobilizing iron stores Red cell morphology and indices are still normal
Negative iron balance
48
When iron stores fall to 15-20% of total, hemoglobin synthesis becomes impaired Appearance of microcytic and hypochromic reticulocytes
Iron deficient erythropoiesis
49
When hemoglobin and hematocrit begin to fall | Iron stores are at around 10-15% of total
Iron deficiency anemia
50
Iron is absorbed in the ____, which requires an acidic environment
Duodenum
51
Two forms of iron
Heme iron | Nonheme iron
52
Comes from the hemoglobin and myoglobin in meat Transported to the heme transporter inside the mucosal cell where eventually it will be bound with proferritin to become ferritin
Heme iron
53
Comes from soil, usually found in plants | Has a lower rate of absorption
Nonheme iron
54
Daily intake of iron from diet
10-20 mg
55
Causes of iron deficiency anemia
Increased physiologic demand for iron Increased iron loss Decreased iron intake or absorption
56
Fissuring of the angles of the mouth
Angular cheilitis
57
Spooning of the nails
Koilonychia
58
Unexplained craving for non-food item
Pica
59
Treatment and management of iron deficiency anemia
Blood transfusion | Oral tablets
60
250 mL of bag = ___ of iron
250 g
61
One tablet of ferrous sulfate contains ___
65 mg of elemental iron
62
Side effects of iron intake
Constipation Hyperacidity Secondary hemochromatosis
63
Iron salts are deposited into tissues leading to liver damage and bronze discoloration of skin
Secondary hemochromatosis
64
Iron should be give for ____ months in order to build enough stores of iron to prevent recurrence of anemia
6-12
65
Inherited disorder of hemoglobin synthesis
Thalassemia
66
Inability to synthesize alpha chains
a-thalassemia
67
a-chains are located in chromosome ___
16 (4 genes)
68
Inability to synthesize beta chains
b-thalassemia
69
b-chains are located in chromosome ____
11 (2 genes)
70
Deletion of all 4 alpha chains Incompatible with life Carries oxygen but does not distribute it to the tissues
Hydrops fetalis with hemoglobin Barts
71
Marrow expansion leading to bulging skull and maxilla
Chipmunk facies
72
Clinical features of thalassemia
Chipmunk facies Splenomegaly Sunburst appearance Hydrops fetalis
73
Diagnosis of thalassemia
Hemoglobin electrophoresis
74
Able to sequester free flowing iron to prevent tissue damage
Iron chelators (deferaslrox)
75
To increase progenitor cells for treating patients with thalassemia
Bone marrow transplant
76
Decreased proliferation of all cell lines | Immune-mediated T-cell destruction of marrow precursor cells
Aplastic anemia
77
Most common cause of aplastic anemia
Idiopathic
78
Diagnosis of aplastic anemia | Done in the posterior superior iliac spine
Bone marrow aspirate
79
Treatment of aplastic anemia
``` Bone marrow transplant Supportive treatment (WBC infusion, immunosuppressant e.g. clyclosporine, antithymocyte globulin) ```

Basic Pathology 2 (8 decks)

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