2. Iron deficient anemia: iron metabolism, etiology, pathogenesis, clinical manifestation, diagnosis, treatment.

Question 1

describe erythropoeisis of blood cell?

Answer 1

BFU-E – CFU-E –proerythroblast - erythroblast (blood) - reticulocyte (blood)

BFU-E = requires growth factors and SCF

CFU-E = depend on epo

Question 2

what are the components needed for normal erythropoesis ?

Answer 2

iron , vitb12 , folic acid
insulin -gf 1
steroids

erythron - machineary for red cell production
normal renal production od - epo
functioning erythroid marrow
adquate supply of substrates for hemoglobin

Question 3

what is the average hematocrit in males and females an why the difference ?

Answer 3

male = 46 
femal = 42 

greater androgens stiulating rbc

Question 4

what are the clinical affectes of anemia

Answer 4

acute anemia from blood loss
30 percent blood volume = hypotension and tachycardia , fainting , RAPIDLY BOUNDING PULSE
more than 40 percent = hypovolumic shock
= angina pectoris
intravascular hemolysisi - acute back pain

chronic anemia is symptomatic until uncompensatry = 70-80g/l

= shortness of breath 
= systolic heart murmur in pulmonic area 
intermitten claudicaton and chronic leg ulcers 
= tachycardia 
= bouding pulse 
= pallour 
= early greying 
= loss of hair 
= thinning of skin 
= fissures at angle of mouth 
= nails brittle , concave 
= glossitis 

= headache , tinnitus , drowsiness , restlessness

Question 5

what are the compensatory phsiologcal mechnaism seen in chronic anemia

Answer 5

2,3 bisphophnate shift to the right facilitating o2 uloading

shunting of blood away fromorgans ric in supply

increased cardiac output

Question 6

how does different colour tell us abut the type ofanemia

Answer 6

pale = chronic anemia

lemon yellow = pernicious

mild scerla and cutanoeus icterus = hemolytic

pallor with petechia and echchymosis = bone marrow failure

Question 7

in which syndrome can we see IRON DEF anemia as a part ?

Answer 7

plummer vinson syndrome = with dysphagia
glossitis
inflammtion of corner of mouth
esophgeal webs

Question 8

lab evalutaion of anemia

Answer 8

mcv
80-100 fl = normocytic
less than 80 = microcytic
more than 100 macrocytic

peripheral blood smear -
iron def anemia - large area of central pallor

hemoglobin c = target cells - rbc has central red spot

helmet cells / schistocytes - fragmnted rbc = microangiopathic hemolytic anemia

sickle cell

hypersegmnetd neutrophils = pernicious anemia

change in size = anisocytosis
shape = poikilocytosis

Question 9

examination of bone marrow is needed in anemia what can we see ?

Answer 9

Hypoplasia

Myelofibrosis

Red cell aplasia

Examination of iron in bone marrow macrophages is considered the definitive way to demonstrate decreased iron stores
prussian blue staining

Sideroblastic anemia (ringed sideroblasts)

Megaloblastic anemias

, thalassemias,

sideroblastic anemias (confused with hemolytic anemia, but reduced reticulocytes = ringed sideroblast )

Question 10

what causes microcytic anemia ?

Answer 10

iron def anemia :

chronic inflammation - MOST OF THE TIME NORMOCYTIC AND NORMOCHORMIC

globulin disorder
apha and beta thalasemmia

hemoglobin c and e sydromes

sideroblastic ANEMIA

myeloproliferative disorder

alcohol

bood loss

increased iron utilisation = pregnancy , infancy , polycethmia vera

malbaosprtion = celiac disease , atrophic

Question 11

what are indices findings in iron def anemia ?

Answer 11

hypochromic , microcytic

Question 12

why do we have to check fo the reticulocyte response

Answer 12

high increase in retciulocyte prodction index = blood loss or hemolysis

low retcuocytes = marrow production defect