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POS 1: HEMATO > 6. Anemias Carenciales > Flashcards

6. Anemias Carenciales Flashcards

1
Q

What are the two types of anemias carenciales?

A

Anemia ferropénica and anemia megaloblástica

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2
Q

What is the typical morphology of anemia ferropénica?

A

Microcítica

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3
Q

What is the typical morphology of anemia megaloblástica?

A

Macrocítica

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4
Q

What are the physiological causes of anemia ferropénica?

A

Increased demand during infancy, pregnancy, rapid growth, heavy menstruation, blood donation

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5
Q

What are the environmental causes of anemia ferropénica?

A

Insufficient dietary iron, malnutrition

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6
Q

What are the pathological causes of anemia ferropénica?

A

Decreased absorption, chronic blood loss

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7
Q

Where is iron absorbed in the body?

A

Duodenum

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8
Q

What diseases can cause decreased absorption leading to anemia ferropénica?

A

Diseases affecting proximal sections of the small intestine

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9
Q

What is a common cause of chronic blood loss that can lead to anemia ferropénica?

A

Diseases of the digestive tract such as ulcerative colitis or colorectal cancer

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10
Q

What are some genitourinary causes of chronic blood loss?

A

Excessive menstruation

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11
Q

What pharmacological causes can lead to anemia ferropénica?

A

NSAIDs, proton pump inhibitors, glucocorticoids

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12
Q

What genetic condition can cause refractory anemia ferropénica?

A

Presence of a mutation

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13
Q

What happens to HIF levels in response to low iron in the blood?

A

HIF increases

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14
Q

What are the two effects of HIF2-alpha during iron deficiency?

A
  • Stimulates erythropoiesis via increased EPO
  • Activates DMT1 to absorb iron
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15
Q

What happens to hepcidin levels during iron deficiency?

A

Hepcidin decreases

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16
Q

What is the consequence of decreased hepcidin?

A
  • Increased iron absorption in the intestine
  • Easier release of iron from ferritin stores
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17
Q

What is transferrin’s role in iron transport?

A

Transferrin captures Fe2+ to transport it to tissues requiring iron

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18
Q

What is a manifestation of latent iron deficiency?

A

Altered lab results showing decreased ferritin and increased transferrin

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19
Q

What would a biopsy of the bone marrow show in latent iron deficiency?

A

Decreased iron stores in the marrow

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20
Q

¿Qué síntomas se presentan en la ferropenia sin anemia?

A

Astenia, coiloniquia, glositis, fragilidad capilar, estomatitis angular, síndrome de Paterson-Brown-Kelly

El síndrome de Paterson-Brown-Kelly puede causar disfagia debido a membranas esofágicas.

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21
Q

¿Cuáles son los principales hallazgos en la analítica de ferropenia sin anemia?

A

Disminución de ferritina, aumento de transferrina, disminución de sideremia

La sideremia se refiere a los niveles de hierro en sangre.

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22
Q

¿Qué se observa en un frotis de sangre periférica en caso de anemia ferropénica?

A

Eritrocitos microcíticos e hipocrómicos

Los eritrocitos hipocrómicos tienen un centro más pálido de lo normal.

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23
Q

¿Qué se observa en una biopsia de médula ósea en anemia ferropénica?

A

Disminución de los depósitos de hierro medulares

Los depósitos de hierro se tiñen de azul en la muestra.

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24
Q

Completa la frase: La progresión normal de la ferropenia es de ferropenia latente a _______ y luego a anemia ferropénica.

A

ferropenia sin anemia

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25
Q

¿Qué alteraciones de laboratorio se presentan en la anemia ferropénica?

A

Microcitosis, hipocromía, hiposideremia, aumento de transferrina, disminución de saturación de transferrina, disminución de ferritina

El VCM (volumen corpuscular medio) bajo indica microcitosis.

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26
Q

¿Qué es la coiloniquia?

A

Deformidad de las uñas en forma de cuchara

Puede ser un signo de deficiencia de hierro.

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27
Q

¿Qué es el síndrome de Plummer-Vinson?

A

Condición caracterizada por disfagia y membranas esofágicas

También se le conoce como síndrome de Paterson-Brown-Kelly.

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28
Q

¿Qué síntomas generales se encuentran en anemia ferropénica?

A

Palidez, astenia

La astenia se refiere a una sensación de debilidad o falta de energía.

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29
Q

¿Qué indica una disminución de la ferritina en el contexto de anemia ferropénica?

A

Reservas de hierro bajas

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30
Q

Verdadero o falso: La hiposideremia indica niveles altos de hierro en sangre.

A

Falso

La hiposideremia se refiere a niveles bajos de hierro sérico.

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31
Q

¿Qué es la anemia ferropénica?

A

Es una de las anemias microcíticas hipocrómicas más comunes.

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32
Q

¿Cuál es el principal problema en la anemia inflamatoria?

A

¡Que aumenta la hepcidina!

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33
Q

¿Qué efecto tiene el aumento de hepcidina en la anemia inflamatoria?

A

Provoca que el hierro no se absorba a sangre circulante y que no se libere adecuadamente de los depósitos.

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34
Q

¿Qué condiciones pueden causar anemia inflamatoria?

A

Infecciones crónicas, conectivopatías, neoplasias y enfermedades reumatológicas.

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35
Q

¿Qué sucede con el hierro en el sistema reticuloendotelial durante la anemia inflamatoria?

A

Se secuestra hierro y se frena/disminuye su absorción intestinal.

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36
Q

¿Cómo afecta la enfermedad renal crónica a la hepcidina?

A

Acompaña a una disminución del aclaramiento de la hepcidina.

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37
Q

Características de las anemias inflamatorias

A

Son levemente hipocrómicas y habitualmente aumentan los depósitos en el SRE.

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38
Q

¿Qué puede ocurrir si el estímulo inflamatorio en anemias inflamatorias es prolongado?

A

Los depósitos de hierro se acaban agotando.

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39
Q

¿Qué es la capacidad total de fijación de hierro (CTFiFe)?

A

Es un reactante de fase aguda NEGATIVO y disminuye en contexto inflamatorio.

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40
Q

¿Qué son las anemias sideroblásticas?

A

Anemias en las que falta el grupo heme para la formación de hemoglobina.

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41
Q

Causas de las anemias sideroblásticas

A

No se produce suficiente grupo heme y defecto en el uso de hierro por normoblastos.

42
Q

¿Qué son los ‘sideroblastos en anillos’?

A

Precursores eritrocitarios con acumulación de hierro alrededor del núcleo.

43
Q

¿Qué se observa en la médula ósea en anemias sideroblásticas?

A

Una serie roja hipercelular y diseritropoyesis.

44
Q

¿Por qué hay diseritropoyesis en las anemias sideroblásticas?

A

Porque no se logran ensamblar los distintos componentes.

45
Q

¿Qué indica una médula ósea hiperactiva en anemias sideroblásticas?

A

Los precursores no logran madurar, pero hay alta celularidad.

46
Q

What condition results from a lack of erythrocyte production?

A

Anemia hipocrómica y sobrecarga férrica

This condition occurs because iron is present but cannot be incorporated into the heme group.

47
Q

What increases as a consequence of iron overload?

A

Depósitos de ferritina hipersideremia y aumento de la ferritina

These are markers indicating iron overload.

48
Q

What are sideroblasts in ring?

A

Células anormales que indican sobrecarga de hierro

Sideroblastos en anillo son un hallazgo en ciertos tipos de anemias.

49
Q

What is thalassemia?

A

Trastorno hereditario que ocurre cuando el cuerpo no produce suficiente hemoglobina

Existen dos tipos: alfa y beta, dependiendo de la cadena de hemoglobina afectada.

50
Q

What are the two types of thalassemias?

A

Alfa y beta

La clasificación se basa en el gen mutado que afecta las cadenas alfa o beta de la hemoglobina.

51
Q

What are the sideremia levels in ferropénica anemia?

A

Baja

Se caracteriza por producción de transferrina aumentada y niveles bajos de ferritina.

52
Q

What is the transferrin saturation in sideroblastic anemia?

A

Muy saturada

Esto ocurre junto con niveles altos de sideremia y ferritina.

53
Q

What is the ferritin level in chronic disease-related anemia?

A

Normal-alta

Acompañada de sideremia baja y transferrina normal.

54
Q

True or False: In thalassemia, the sideremia level is normal-alta.

A

True

La talasemia muestra una capacidad de fijación de hierro normal.

55
Q

What are the key markers in ferropénica anemia?

A

Sideremia baja, producción de transferrina aumentada, ferritina baja

Indican reservas bajas de hierro.

56
Q

Fill in the blank: In sideroblástica anemia, there is a decrease in the total _______ capacity.

A

fijación de hierro

Esto se relaciona con la sobrecarga de hierro en el cuerpo.

57
Q

What are the characteristics of sideroblastic anemia?

A

Sideremia alta, transferrina muy saturada, ferritina alta

Indica un problema significativo de sobrecarga de hierro.

58
Q

What is the relationship between transferrin and ferritin levels in thalassemia?

A

Transferrina muy saturada y niveles altos de ferritina

Esto es para manejar la carga de hierro en el organismo.

59
Q

¿Dónde se absorbe la Vitamina B12?

A

En el ileon terminal

60
Q

¿Cuál es la principal fuente de Vitamina B12?

A

Alimentos de origen animal

61
Q

¿Qué problemas estomacales pueden causar déficit de Vitamina B12?

A

Anemia perniciosa, falta de producción de factor intrínseco, gastrectomía, bypass gástrico

62
Q

¿Qué es el factor intrínseco?

A

Proteína necesaria para la unión y absorción de la Vitamina B12

63
Q

¿Qué ocurre si hay un pH alcalinizado en el estómago?

A

Las proteínas de unión a la Vitamina B12 no se disocian

64
Q

¿Qué problemas pancreáticos pueden afectar la absorción de Vitamina B12?

A

Enzimas pancreáticas no separan la haptocorrina de la Vitamina B12

65
Q

¿Qué puede causar un déficit de ácido fólico?

A

Dieta insuficiente, malabsorción, aumento de requerimientos, fármacos antagonistas

66
Q

¿Dónde se reabsorbe el ácido fólico?

A

En el tramo proximal del intestino delgado (duodeno, yeyuno)

67
Q

¿Cuál es la relación entre el déficit de Vitamina B12 y el ácido fólico?

A

Ambos son importantes para la síntesis de DNA

68
Q

¿Cuáles son las consecuencias clínicas del déficit de Vitamina B12?

A

Asincronía entre la maduración nuclear y citoplasmática

69
Q

¿Cuánto tiempo tarda el déficit de B12 en producir anemia?

A

Tarda un tiempo, en comparación con el ácido fólico

70
Q

¿Qué puede causar un déficit de absorción de B12 a nivel del ileon terminal?

A

Resección del íleon terminal, enfermedad de Crohn, mutaciones en el transportador

71
Q

¿Qué condiciones pueden incrementar los requerimientos de ácido fólico?

A

Embarazo, hemólisis

72
Q

¿Qué tipo de medicamentos son antagonistas del ácido fólico?

A

Metotrexato, anticonvulsivantes, cotrimoxazol

73
Q

¿Qué es la haptocorrina?

A

Proteína que se une a la Vitamina B12 a nivel gástrico

74
Q

Verdadero o falso: La Vitamina B12 es importante para la síntesis de lípidos.

A

Verdadero

75
Q

¿Qué requiere la pepsina para funcionar correctamente?

A

Un pH específico

76
Q

¿Qué sucede en caso de pancreatitis crónica respecto a la Vitamina B12?

A

Puede provocar anemia megaloblástica

77
Q

Fill in the blank: La _______ es necesaria para que la Vitamina B12 se una y pueda ser absorbida.

A

factor intrínseco

78
Q

What is a consequence of vitamin B12 deficiency related to lipid synthesis?

A

Decrease in myelin synthesis and neurological symptoms

Vitamin B12 is crucial for lipid synthesis, and its deficiency affects myelin production, leading to neurological manifestations.

79
Q

Which neurological structures are primarily affected in vitamin B12 deficiency?

A

Posterior columns of the spinal cord, peripheral nerves, cranial nerves, and white matter

These areas are critical for sensory and motor functions, and their impairment leads to various neurological symptoms.

80
Q

What are some neurological manifestations of vitamin B12 deficiency?

A

Paresthesia, psychiatric manifestations, peripheral neurological involvement

These symptoms arise due to the impact of vitamin B12 deficiency on the nervous system.

81
Q

What is diseritropoyesis in the context of bone marrow?

A

Hypercellularity with asynchrony between nucleus and cytoplasm maturation

This condition indicates abnormal erythropoiesis, often seen in vitamin B12 deficiency.

82
Q

What are megaloblasts?

A

Large nucleated precursors of erythrocytes with non-condensed chromatin

Megaloblasts are characteristic of megaloblastic anemias, including those caused by vitamin B12 deficiency.

83
Q

What hematological findings are associated with peripheral blood in vitamin B12 deficiency?

A

Pancytopenia, macrocytic erythrocytes, anisocytosis, hypersegmented neutrophils

These findings indicate a reduction in all three blood cell lines, typical of macrocytic anemia.

84
Q

What is the clinical finding of folic acid deficiency in contrast to vitamin B12 deficiency?

A

No neurological alterations

Folic acid deficiency leads to similar hematological findings but does not affect lipid synthesis, hence no neurological symptoms.

85
Q

What is the significance of hypersegmented neutrophils in megaloblastic anemia?

A

Indicates macrocytic anemia and vitamin B12 or folate deficiency

Hypersegmentation of neutrophils is a classic finding in megaloblastic anemias.

86
Q

What are some laboratory findings in megaloblastic anemia?

A

Elevated bilirubin, high LDH, low haptoglobin

These findings indicate hemolysis and ineffective erythropoiesis associated with megaloblastic anemia.

87
Q

Fill in the blank: In megaloblastic anemia, we see _______ and hypersegmentation of neutrophils.

A

macrocitosis

88
Q

What are metamielocitos gigantes?

A

Giant metamyelocytes found in the context of megaloblastic anemia

These cells are indicative of abnormal myeloid development associated with vitamin deficiencies.

89
Q

What are the typical manifestations seen in vitamin B12 deficiency?

A

Palidez, glositis, queilosis angular

These are key clinical signs associated with vitamin B12 deficiency.

90
Q

What neurological condition is commonly associated with vitamin B12 deficiency?

A

Afectación de los cordones laterales y posteriores

This refers to the impact on specific neural pathways due to B12 deficiency.

91
Q

What is a major consequence of vitamin B12 deficiency related to myelin?

A

Alteración del metabolismo de la mielina

Myelin is crucial for proper nerve function, and its impairment can lead to neurological issues.

92
Q

What spinal condition can arise from vitamin B12 and folate deficiency during pregnancy?

A

Espina bífida

This condition is a type of neural tube defect that can occur with insufficient vitamin levels.

93
Q

What type of anemia is associated with vitamin B12 deficiency?

A

Anemia macrocítica

This type of anemia is characterized by larger than normal red blood cells.

94
Q

What hematological finding indicates a vitamin B12 deficiency?

A

Hipersegmentación de neutrófilos

This refers to neutrophils having more segments than normal, which can indicate a deficiency.

95
Q

What laboratory findings are related to hemolysis in B12 deficiency?

A

Aumento de bilirrubina no conjugada y descenso de la haptoglobina

These changes occur due to intramedullary destruction of red blood cells.

96
Q

What is a common metabolic change in vitamin B12 deficiency?

A

Aumento de la homocisteína

Elevated homocysteine levels are often seen in vitamin B12 deficiency and can be a risk factor for cardiovascular diseases.

97
Q

What is one of the most frequent causes of vitamin B12 deficiency?

A

Anemia perniciosa

This autoimmune condition affects the absorption of vitamin B12 due to the lack of intrinsic factor.

98
Q

What can be studied to investigate anemia perniciosa?

A

Presencia de anticuerpos frente a factor intrínseco o frente a células parietales

Testing for these antibodies helps confirm the diagnosis of pernicious anemia.

99
Q

What is another significant cause of vitamin B12 deficiency?

A

Infección bacteriana

Bacterial overgrowth can interfere with vitamin B12 absorption, leading to deficiency.

100
Q

Fill in the blank: During pregnancy, vitamin B12 and folate deficiencies can lead to _______.

A

alteraciones del tubo neural

This highlights the importance of adequate vitamin intake during pregnancy.

POS 1: HEMATO (10 decks)

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