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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
Q

Variation in cell size

A

Anisocytosis

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26
Q

Small red cells with no central pallor

Correlates with increase in RDW

A

Spherocytes

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27
Q

Variation in cell shape

Suggests defect in maturation of red cell precursors

A

Poikilocytosis

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28
Q

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

A

Target cells

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29
Q

Red cells that are recently released from the bone marrow

Seen in polychromasia

A

Reticulocytes

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30
Q

Abnormally high number of immature red blood cells in circulation

A

Polychromasia

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31
Q

Used to see if the marrow is responding to the anemia

A

Corrected reticulocyte count (Retic %)

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32
Q

Determine whether anemia is hypoproliferative

A

RPI (reticulocyte production index)

33
Q

Normocytic, normochromic could be indivicative of hypoproliferative diseases which include

A

Marrow damage
Iron deficiency
Dec stimulation: inflammation, metabolic disease, renal disease

34
Q

Microcytic or macrocytic could be indicative of maturation disorder which include

A 
Cytoplasmic defects (iron def, thalassemia*, sideroblasmic anemia)
Nuclear defects (Folate, B12 def, drug toxicity, refractory anemia)
35
Q

RPI > 2.5 is indicative of

A

Hemolysis or hemorrhage

36
Q

Marrow infiltration or fibrosis

A

Myelopthsis

37
Q

Normocytic, normochromic red cells with inappropriately low reticulocyte response

A

Hypoproliferative anemias

38
Q

Hypoproliferative anemias: microcytic, hypochromic

A

IDA
Thalassemia*
Myelodysplastic syndrome (sideroblastic anemia)

39
Q

Hypoproliferative anemias: macrocytic anemia

A

Vitamin B12, folate deficiency
Drug toxicity
Myelodysplastic syndrome
Refractory anemia

40
Q

Hypoproliferative anemias: normocytic, normochromic anemia

A

Myelopthsis anemia
Anemia of inflammation
Anemia of chronic renal disease
Aplastic anemia

41
Q

Second most common cause of normocytic, normochromic anemia

Hyporesponsive to EPO

A

Anemia of inflammation

42
Q

Cause of aplastic anemia

A

Bone marrow failure disorder

43
Q

Proliferative anemia

A

Acute blood loss

Hemolysis

44
Q

Common clinical features of hemolysis

A

Jaundice

Tea-colored urine

45
Q

End-stage in a long process of iron loss

A

Iron deficiency anemia

46
Q

Three stages in iron loss

A

Negative iron balance
Iron deficient erythropoiesis
Iron deficiency anemia

47
Q

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

A

Negative iron balance

48
Q

When iron stores fall to 15-20% of total, hemoglobin synthesis becomes impaired
Appearance of microcytic and hypochromic reticulocytes

A

Iron deficient erythropoiesis

49
Q

When hemoglobin and hematocrit begin to fall

Iron stores are at around 10-15% of total

A

Iron deficiency anemia

50
Q

Iron is absorbed in the ____, which requires an acidic environment

A

Duodenum

51
Q

Two forms of iron

A

Heme iron

Nonheme iron

52
Q

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

A

Heme iron

53
Q

Comes from soil, usually found in plants

Has a lower rate of absorption

A

Nonheme iron

54
Q

Daily intake of iron from diet

A

10-20 mg

55
Q

Causes of iron deficiency anemia

A

Increased physiologic demand for iron
Increased iron loss
Decreased iron intake or absorption

56
Q

Fissuring of the angles of the mouth

A

Angular cheilitis

57
Q

Spooning of the nails

A

Koilonychia

58
Q

Unexplained craving for non-food item

A

Pica

59
Q

Treatment and management of iron deficiency anemia

A

Blood transfusion

Oral tablets

60
Q

250 mL of bag = ___ of iron

A

250 g

61
Q

One tablet of ferrous sulfate contains ___

A

65 mg of elemental iron

62
Q

Side effects of iron intake

A

Constipation
Hyperacidity
Secondary hemochromatosis

63
Q

Iron salts are deposited into tissues leading to liver damage and bronze discoloration of skin

A

Secondary hemochromatosis

64
Q

Iron should be give for ____ months in order to build enough stores of iron to prevent recurrence of anemia

A

6-12

65
Q

Inherited disorder of hemoglobin synthesis

A

Thalassemia

66
Q

Inability to synthesize alpha chains

A

a-thalassemia

67
Q

a-chains are located in chromosome ___

A

16 (4 genes)

68
Q

Inability to synthesize beta chains

A

b-thalassemia

69
Q

b-chains are located in chromosome ____

A

11 (2 genes)

70
Q

Deletion of all 4 alpha chains
Incompatible with life
Carries oxygen but does not distribute it to the tissues

A

Hydrops fetalis with hemoglobin Barts

71
Q

Marrow expansion leading to bulging skull and maxilla

A

Chipmunk facies

72
Q

Clinical features of thalassemia

A

Chipmunk facies
Splenomegaly
Sunburst appearance
Hydrops fetalis

73
Q

Diagnosis of thalassemia

A

Hemoglobin electrophoresis

74
Q

Able to sequester free flowing iron to prevent tissue damage

A

Iron chelators (deferaslrox)

75
Q

To increase progenitor cells for treating patients with thalassemia

A

Bone marrow transplant

76
Q

Decreased proliferation of all cell lines

Immune-mediated T-cell destruction of marrow precursor cells

A

Aplastic anemia

77
Q

Most common cause of aplastic anemia

A

Idiopathic

78
Q

Diagnosis of aplastic anemia

Done in the posterior superior iliac spine

A

Bone marrow aspirate

79
Q

Treatment of aplastic anemia

A 
Bone marrow transplant
Supportive treatment (WBC infusion, immunosuppressant e.g. clyclosporine, antithymocyte globulin)

Basic Pathology 2 (8 decks)

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