Acquired Hemolytic Anemia, Blood Loss, Metabolic and Nutritional Causes of Anemia (Angelina L. Mirasol, MD) Flashcards
Electrophoresis pattern in patient with hemoglobin H disease:
a. A1 increased, A2 increased
b. A1 decreased, A2 increased
c. A1 increased, A2 decreased
d. A1 decreased, A2 decreased
D. A1 decreased, A2 decreased
T/F: In terms of treatment, Iron deficiency is a more serious condition than iron overload.
False
T/F: Iron supplementation is a necessity in hemoglobin H patients.
False
T/F: Blood transfusion is a strong recommendation for treatment of hemoglobin H disease.
True
T/F: Conducting a peripheral blood smear is a necessity for the diagnosis of hemoglobin h disease as CBC results will suffice.
True
In severe iron deficiency anemia with symptoms of high output failure, which is the best blood product for transfusion?
a. packed RBC
b. fresh whole blood
c. whole blood
d. heparinized whole blood
A. packed RBC
The most common single cause of iron deficiency in women is
a. poor intake of iron
b. obesity
c. poor release of iron by the reticulo-endothelial system
d. menstrual blood loss
D. menstrual blood loss
Parenteral iron is given if (2012, 2014)
a. rapid increase in hemoglobin (HB) is desired
b. malabsorption syndrome exists
c. the patient requests for it
d. rapid utilization of iron by the body
B. malabsorption syndrome exists
Infants should be given iron supplements as early as 2 months of age because
a. they are easily prone to colic
b. human and cow’s milk are poor sources of iron
c. they bleed easily
d. they have poor iron absorption
B. human and cow’s milk are poor sources of iron
Iron Deficiency Anemia produces this type of anemia
a. hypochromic, macrocytic
b. normochromic, macrocytic
c. hypochromic, microcytic
d. normochromic, microcytic
C. hypochromic, microcytic
Regulatory hormone for erythropoiesis
Erythropoietin (EPO)
Normal levels of EPO
10 - 25 U/L
Average life span of adult RBC
100 - 120 days (3 - 4 months)
Normal daily rate of RBC replacement
0.8 - 1.0% (2.5 M)
Machinery for RBC production
Erythron
Enumerate the critical elements for erythropoiesis
EPO
Iron Availability (+B12 & Folic Acid)
Proliferative Capacity of Bone Marrow
Effective Maturation of Red Cell Precursors
Responsible for destroying abnormal RBCs
Reticuloendothelial System (RES)
Sites of RBC production
Children < 5 y/o - marrow in all bones
Adults - marrow of spine, ribs and pelvis
Where are bone marrow samples taken from?
Sternum & Tibia (Biopsy)
Posterior Superior Iliac Spines of Pelvis (Aspiration)
Normal RBC levels according to WHO
Male: 130 - 170 g/L
Female: 120 - 170 g/L
RBC level range for mild anemia
80 - 120 g/L
Most common symptom of anemia
Weakness and fatigue
Present in 25 - 30% of people with iron deficiency and possibly due to dopamine abnormalities in the brain
Restless Leg Syndrome (RLS)
RBC level range for severe anemia
< 80 g/L
Cause and duration of acute anemia
Cause: blood loss
Duration: several hours to a few days only
Note: Body has no time to compensate.
It is safe to lose up to how much of your blood volume?
15%
Ranges of proportion of volume loss in the different classes of hypovolemic shock
Class I - 40%
T/F: There is increased peripheral resistance in chronic anemia because blood is more viscous.
False
Decreased peripheral resistance because blood is less viscous
T/F: In chronic anemia, it is symptomatic because the body has time to compensate
False
Asymptomatic
Compensatory mechanisms for chronic anemia
Tachycardia
Increased DPG
Increased O2 delivery
Laboratory tests for anemia
Complete Blood Count (CBC)
Reticulocyte Index/Count
Iron Supply Studies
Marrow Examination
Define: Reticulocyte
Immature RBC
What should be done prior to a marrow iron stain?
Bone marrow aspiration
Disorders with decreased serum EPO
Renal disease
Endocrine deficiencies (Hypopituitarism, hypothyroidism, hypocorticoidism and hypogonadism)
Starvation
Chronic disease anemia
Disorders with marrow unresponsiveness to EPO
Nutritional deficiency
Sideroblastic anemias
Pure red cell aplasia (e.g. Fanconi’s Anemia)
Typical RBC deformities
Burr cells
Acanthocytes
What is the EPO treatment of choice for disorders with impaired erythropoiesis?
3000 units subcutaneous 3x/day (up to as much as 10k units)
T/F: Anemia of chronic diseases is caused by inadequate delivery of iron to marrow despite normal or increased iron stores.
True
Three stages leading from iron deficiency to anemia
Stage 1 - Negative Iron Balance
Stage 2 - Iron-deficient Erythropoiesis
Stage 3 - Iron Deficiency Anemia
Enumerate the stages of pregnancy and the iron blood level cut-offs for IDA
1st Trimester - <11.0
Iron used in heme is transported from GIT to RES to red cell precursors by what?
Transferrin
Describe: Polycythemia Vera
Panhyperplastic, malignant, neoplastic marrow disorder
Uncontrolled RBC production
Which part of the GIT is iron absorbed?
Proximal small intestines
T/F: Total Iron Binding Capacity (TIBC) is decreased in Iron Deficiency Anemia
False
It is increased!
T/F: RBCs may be normocytic and normochromic in Sideroblastic Anemia.
True
Differentiate ferritin levels in IDA, Thalassemia and Sideroblastic Anemia
IDA - low
Thalassemia & Sideroblastic Anemia - normal
Shelf life of PRBC depending on anticoagulant
Acid-Citrate-Dextrose (ACD) - 21 days
Citrate-Phosphate-Dextrose-Adenine (CPDA) - 28 days
Saline-Adenine-Glucose-Mannitol (SAGM) - 42 days
Describe the ineffective erythropoiesis in megaloblastic anemia
Cellularity increased but production is decreased since cells tend to be destroyed in the bone marrow.
Major causes of Megaloblastic Anemia
Vit. B12 (cobalamin) deficiency (Type I)
Folic acid deficiency (Type II)
Major storage site of cobalamin
Liver
Minimum daily folic acid requirement
50 micrograms
Major absorptive site of folic acid
Proximal jejunum
Minimum daily Vitamin B12 requirement
1 - 2.5 micrograms
Major absorptive site of cobalamin
Ileum
Common causes of Megaloblastic Anemia in the temperate zone
Folate deficiency - alcoholics
Cobalamin deficiency - pernicious anemia or achlorhydria
Common cause of Megaloblastic Anemia near the equator
Tropical sprue (malabsorption due to villi flattening)
Common cause of Megaloblastic Anemia in Scandinavian countries
Diphyllobotrium latum
Laboratory findings that diagnose Megaloblastic Anemia
Hypersegmentation in blood smear
Improvement of urine Vit B12 with IM and oral doses in Schilling’s test
Cause of pernicious anemia
Absence of intrinsic factor (IF)
Individuals predisposed to developing pernicious anemia
Northern Europeans & African Americans
Elderly
Patients with immunologic diseases
Major concern of patients with pernicious anemia and Vit. B12 deficiency anemia
Folic acid supplements can mask presence of diseases but not cure them
T/F: Autoimmune Hemolytic Anemia is linked to a higher incidence of lymphoproliferative disorders.
True
Characterized by polychromatophilic blood smear and elevated reticulocyte count
Autoimmune Hemolytic Anemia
Describe the haptoglobin and bilirubin levels in Autoimmune Hemolytic Anemia patients
Haptoglobin is low.
Bilirubin is high.
Diagnostic test for Autoimmune Hemolytic Anemia
Direct Coombs’ Test
T/F: Mainly intravascular Autoimmune Hemolytic Anemias are detected.
False
Extravascular
