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Patho 2 > 3 - Anemia > Flashcards

3 - Anemia Flashcards

1
Q

When talking about anemias, “cytic” refers to ____ and “chromic” refers to _____

A

cell size

hemoglobin content

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2
Q

Microcytic-hypochromic anemias are caused by:

A

disorders of hemoglobin synthesis (usually iron deficiency)

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3
Q

macrocytic anemias are usually caused by:

A

abnormal maturation in the bon marrow

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4
Q

Why do some patients with anemia become febrile?

A

release of leukocyte pyrogens from ischemic tissues

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5
Q

Describe the CBC of a post-hemorrhagic patient (minor hemorrhage) after 24 hours

A

decreased hematocrit as plasma is replaced by fluid and electrolytes from tissues/interstitium

rapid elevation of circulating neutrophils and platelets

increase in immature circulating RBCs

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6
Q

Megaloblastic (macrocytic) anemias are the result of _____

A

diminished erythropoiesis due to impaired DNA synthesis

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7
Q

What are the two causes of megaloblastic anemia?

A

Folate Deficiency

Vitamin B12 Deficiency

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8
Q

Why do megaloblastic anemias cause large RBCs?

A

They have a very difficult time making DNA, but no problem making RNA

This means the nucleus doesn’t mature at the same rate as the rest of the cell

When the cell reaches a size that would usually spark cell division, the nucleus isn’t mature enough to do so

So it keeps growing until the nucleus matures, resulting in a larger cell

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9
Q

Why do megaloblastic cells lead to anemia?

A

The large cells get killed off much more quickly in the circulation

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10
Q

Individuals with pernicious anemia commonly have autoantibodies against:

A

gastric H-K ATPase

the major protein constituent of parietal cells

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11
Q

What are the hallmark s/s of megaloblastic anemia?

A

classic anemia (weakness, fatigue, weight loss)

Also beefy red tongue “atrophic glossitis”

Sallow skin (pallor and icterus)

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12
Q

Why is folate deficiency caused by malabsorption a vicious cycle?

A

Malabsorption from impaired mucosa causes Folate deficiency, which is integral to intestinal mucosal proliferation

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13
Q

Microcytic-hypochromic anemias are characterized by blood cells that are:

A

abnormally small with abnormally low amounts of Hgb

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14
Q

What percentage of ingested iron is absorbed?

A

10-15%

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15
Q

Who is at highest risk for Iron Deficiency Anemia (IDA)?

A

Black females living in urban poverty

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16
Q

A blood loss of _____ ml/day is required to cause IDA

A

only 2-4 ml

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17
Q

What are the most common causes of IDA in developed nations?

A

Pregnancy

Chronic blood loss

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18
Q

Exposure to ____ and ____ can cause IDA. Why?

A

Pb and Cd

Increased competition for absorption

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19
Q

In addition to the s/s of anemia, individuals with IDA may also manifest:

A

gastritis

neuromuscular changes

irritability

headache

numbness/tingling/parasthesia

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20
Q

How can you differentiate IDA from anemia of chronic disease?

A

by comparing the ratio of serum transferrin receptors to ferritin levels

If the ratio is high, that means the body is upregulating receptors due to a lack of ferritin

If it’s unchanged, there is enough iron in the body

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21
Q

Describe the morphology of anemia of chronic disease

A

begins as normocytic/normochromic, but will eventually become microcytic/hypochromic

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22
Q

What causes Anemia of Chronic Disease?

A
  1. decreased erythrocyte lifespan
  2. suppressed production of erythropoietin
  3. ineffective bone marrow response to erythropoietin
  4. altered iron metabolism and iron sequestration within macrophages
23
Q

Aplastic anemia would cause a reduction in which cell type?

A

All of them: pancytopenia

24
Q

What percentage of aplastic anemias or idiopathic?

A

75%

Caused by autoimmune disease

25
Q

What is Pure Red Cell Aplasia?

A

Form of aplastic anemia where only erythrocytes are affected

26
Q

What is Fanconi anemia?

A

aplastic anemia caused by a defect in bone marrow DNA repair genes

27
Q

Which cells appear to be the culprit in aplastic anemia?

A

Cytotoxic T cells

28
Q

Where do extravascular and intravascular hemolysis occur?

Which is more common?

A

Extra: within lymphoid phagocytes

Intra: in the blood

Extra is more common

29
Q

Name two congenital hemolytic anemias caused by defective RBC membranes

A

Hereditary spherocytosis

paroxysmal nocturnal hemoglobinuria

30
Q

Which hemolytic anemia results from altered enzymatic pathways?

A

G-6-PD deficiency

31
Q

What are the three types of autoimmune hemolytic anemias?

A
  1. Warm reactive antibody type
  2. Cold agglutinin type
  3. Cold hemolysis type

Based on the optimal temperature at which the antibody binds to erythrocytes

32
Q

What causes Warm autoimmune hemolytic anemia?

A

IgG binds to erythrocytes at body temperature

The erythrocytes then bind to monocytes and macrophages and are phagocytized

33
Q

What causes cold agglutinin hemolytic anemia?

A

IgM antibodies bind to erythrocytes at cold temperatures

usually manifests during the recovery phase from a major illness like mono

severe but self-limiting

When these people are out in the cold, IgM binds to erythrocytes in finger/toes/ears etc and causes acrocyanosis or gangrene

IgM falls off again once the body rewarms

34
Q

What causes cold hemolysin hemolytic anemia?

A

exposure to cold initiates acute and severe intravascular hemolysis that results in hemoglobinuria

Mediated by IgG

35
Q

What are characteristics of drugs that cause hemolytic anemia?

A

Called the hapten model:

Usually LMW

functions as a hapten

binds to proteins on the surface of erythrocytes

36
Q

More than 90% of hapten model hemolytic anemias are due to which drug?

A

cephalosporins

37
Q

What are the three models of Drug-induced hemolytic anemia?

Give an example of each

A
  1. Hapten (Penicillin)
  2. Immune complex formation (quinidine)
  3. Autoimmune (Alpha methyldopa)
38
Q

What is the most common cause of aplastic crisis?

A

human parvovirus B19

39
Q

What is the first and second line treatment for hemolytic anemias?

A

First: corticosteroids

Second: splenectomy and administration of rituximab

40
Q

What is rituximab?

A

monoclonal antibody directed against the CD20 antigen

specifically depletes or suppresses B cells throughout the body

41
Q

Why is folate often given to people with a hemolytic anemia?

A

to prevent secondary megaloblastic anemia due to increased folate demand

42
Q

List the Chronic Myeloproliferative Disorders

A

Polycythemia Vera

Essential thrombocytosis

chronic idiopathic myelofibrosis

chronic myeloid leukemia

chronic neutrophilic leukemia

chronic eosinophilic leukemia

43
Q

All chronic myeloproliferative disorders result from:

A

abnormal regulation of the multipotent hematopoietic stem cells

44
Q

What are the major characteristics shared by all chronic myeloproliferative disorders?

A
  1. involvement of a hematopoietic stem cell
  2. overproduction of one thing
  3. Dominance of one progenitor cells
  4. marrow hypercellularity or fibrosis
  5. cytogenic abnormalities
  6. predisposition to thrombus and hemorrhage
  7. spontaneous transformation to acute leukemia
45
Q

What causes polycythemia vera

A

chronic, neoplastic, nonmalignant

clonal proliferation of RBCs in the bone marrow independent of erythropoietin

46
Q

More than 95% of people with PV have a mutation in which gene?

A

Janus Kinase 2 Gene

it’s a cytoplasmic tyrosine kinase

Gets rid of the self-regulatory function of JAK2, meaning the erythropoietin receptor is pretty much always active regardless of the presence of erythropoietin

47
Q

Almost every individual with polycythemia presents with:

A

splenomegaly and abdominal pain

48
Q

Does polycythemia increase the risk of bleeding or clotting?

A

Mild to moderate: clotting

extreme: bleeding

49
Q

What are two vascular complications associated with polycythemia?

A

thromboangiitis obliterans

Raynaud phenomenon

50
Q

What skin symptom is caused by polycythemia?

A

aquagenic pruritis

51
Q

Hereditary hemochromatosis causes deposition of iron in which tissues?

A

increased GI iron absorption leads to

tissue iron deposition (liver, pancreas, heart, joints, endocrine glands)

52
Q

Individuals with HH should avoid foods containing:

A

iron

Vitamin C

raw shellfish

53
Q

What are the clinical manifestations of HH?

A

fatigue, malaise, abdominal pain, arthralgias

hepatomegaly, bronzed skin, cardiac dysfunction

Patho 2 (24 decks)

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