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09 Hematology > Anemia 1 > Flashcards

Anemia 1 Flashcards

1
Q

primary driver of red cells

A

erythropoietin

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2
Q

where is epo produced

A

kidneys

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3
Q

stimulants for epo production

A

decreased o2 tension

kidney, lung, heart problems

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4
Q

other things used in rbc production

A

iron, folate, b12

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5
Q

t/f anemia is a decrease in red cells

A

false, decrease in hemoglobin causing decreased oxygen carrying capacity of blood

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6
Q

who standard for anemia

A

< 13.0 g/dl in males

< 12.0 g/dl in females

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7
Q

first step in classification of anemia

A

get cbc and reticulocyte count

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8
Q

indexes in anemia

A

index < 2.5: red cell morphology, hypoproliferative

index >/= 2.5: hemolysis/hemorrhage

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9
Q

types of morphology pathologies

A

normocytic normochromic = marrow damage (aplasia, aplastic anemia), iron deficiency in early stages, decreased stimulation (kidney disease)

microcytic = cytoplasmic defects

macrocytic = nuclear defects

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10
Q

causes for hemolysis or hemorrhage

A

blood loss, intravascular hemolysis or destruction of red cells, membrane abnormality or hemoglobinopathy

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11
Q

causes for microcytic, hypochromic anemia (hypoproliferative anemia)

A 
iron deficiency anemia
thalassemia (not always)
myelodysplastic syndromes (sideroblastic anemia)
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12
Q

causes for macrocytic anemia (hypoproliferative anemia)

A 
vitamin b12, folate deficiency
drug toxicity
myelodysplastic syndrome (refractory anemia)
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13
Q

causes for normocytic, normochromic anemia

A

myelopthisis (marrow infiltration/fibrosis)
anemia of inflammation
anemia of chronic renal disease
aplastic anemia

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14
Q

causes of proliferative anemias

A

acute blood loss

hemolysis (toxin-induced, autoimmune, paroxysmal nocturnal hemoglobinuria)

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15
Q

most common form of anemia worldwide

A

iron deficiency anemia

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16
Q

who are at risk for iron deficiency anemia

A

pregnant women

growing children and teenage girls

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17
Q

normal values for checking iron deficiency

A

serum ferritin 60 mcg/l
transferrin saturation 35%
hemoglobin >120 g/l in females, >130 g/l in males

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18
Q

stage of iron depletion

A
  • depleted iron in ferritin, hemosiderin, or reticuloendothelial cells
  • decreased serum ferritin (<15 mcg/l)
  • normal hemoglobin
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19
Q

stage of iron deficient erythropoiesis

A
  • low serum ferritin (<15) and transferrin saturation (<15)

- normal hemoglobin (can still make rbc)

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20
Q

stage of iron deficiency anemia

A
  • no more stores, and no more in transport

- hemoglobin, transferrin, and ferritin are low

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21
Q

best test used to detect iron deficiency

A

serum ferritin

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22
Q

t/f the daily diet has 10-20mg of iron, and we absorb only 1-2 mg of iron

A

true

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23
Q

___ mg of iron is lost in a day because of desquamation of epithelium

A

1-2 mg

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24
Q

iron is obtained from _____ to make new red cells

A

old senescent red cells

25
Q

breakdown of iron use

A

75: erythropoiesis
10-20% in liver and heart via ferritin
5-15% others

26
Q

t/f iron has no physiologic excretion mechanism

A

true

27
Q

causes of iron deficiency

A

increased demand for iron
increased iron loss
decreased iron intake or absorption

28
Q

causes of increased demand for iron

A

rapid growth in infancy or adolescence
pregnancy
epo therapy

29
Q

causes for increased iron loss

A

chronic blood loss (females: gyne conditions, males: occult bleeding)
menses
acute blood loss
blood donation
phlebotomy as treatment for polycythemia vera

30
Q

common cause of iron deficiency in males and post-menopausal females

A

gi bleed unless proven otherwise (common ulcer or bleeding mass)

31
Q

needed diagnostic test for elderly patients with blood loss

A

gastroesophagealduodenoscopy

or colonoscopy

32
Q

___ are also at risk for iron deficiency

A

patients who regularly donate blood

33
Q

causes for decreased iron intake or absorption

A

inadequate diet
malabsorption from disease (sprue, crohn’s disease)
malabsorption from surgery (gastrectomy and bariatric surgery)
acute or chronic inflammation

34
Q

wounds at the angle of the mouth

A

angular cheilitis

35
Q

spooning of the nails

A

koilonychia

36
Q

eating disorder where patient craves for unusual things

A

pica

37
Q

common lab pattern in iron deficiency anemia

A

low serum ferritin (<20)
low serum iron
elevated tibc (>400)

38
Q

gold standard for iron deficiency anemia diagnosis

A

demonstrating that bone marrow no longer has iron

- bone marrow exams are not required for all patients

39
Q

t/f serum iron is initially low in negative iron balance and decreases as disease progresses

A

false, initially normal in negative iron balance

40
Q

t/f total iron binding capacity is low in iron deficiency anemia

A

false, it’s elevated because transferrin still has a large capacity for iron to be transported

41
Q

best treatment for very symptomatic patients of iron deficiency anemia

A

transfusion to immediately correct the symptoms

42
Q

iron deficiency anemia treatment with patients without or with bearable symptoms

A

tablets of ferrous sulfate, ferrous gluconate, or ferrous fumarate
at least 300 mg of elemental iron per day
best taken without food and with something acidic, once a day

43
Q

side effects of iron tablets

A

bloatedness, abdominal pain, nausea, vomiting, constipation, black tarry stools

44
Q

iron deficiency anemia treatment for patients with ckd or unbearable side effects

A 
iv iron (iron dextran/sucrose/ carboxylase)
- adverse effects: anaphylaxis, tattoo
45
Q

dietary advise for patients with iron deficiency anemia

A

intake of food rich in iron (red meat, liver, vegetables, limit intake of tea)

46
Q

composition of hemoglobin

A

2 alpha subunits, 2 beta subunits

47
Q

consequences of malformed hemoglobin

A

inefficient in transporting oxygen -> hold on to oxygen -> negatively affects tissue perfusion

48
Q

alpha vs beta thalassemia

A 
alpha = dont make enough adult hemoglobin with a chains
beta = dont make enough adult hemoglobin with b chains
49
Q

product when only producing a and gamma chains

A

hgbf

50
Q

what happens to pure a chains

A

precipitation –> destruction of rbc precursors or hemolysis causing splenomegaly

51
Q

effects of anemia (thalassemia)

A
  • more epo produced
  • bone marrow produces more blood
  • marrow expansion
  • bone deformity, increased metabolic rate, wasting, gout, folate deficiency
52
Q

effects of transfusions

A

iron overload = endocrine deficiencies, cirrhosis, cardiac failure, death

53
Q

clinical manifestations of thalassemia

A 
frontal bossing
chipmunk facies
hydrops fetalis (stillborn with hg barts, bloated)
splenomegaly
hair on end appearance on xray
54
Q

required to diagnose thalassemia

A

hemoglobin electrophoresis

55
Q

treatments for thalassemia

A

rbc transfusion
iron chelating agents
bone marrow transplant (best)
other advice

56
Q

indication and problem with rbc transfusion

A

indication: symptomatic
problem: iron overload

57
Q

t/f 1 L of blood = 1 g of Fe

A

false, 1 mL blood = 1 g of Fe

58
Q

example of iron chelating agent

A

deferasirox

binds to excess iron

59
Q

best treatment for thalassemia major

A

bone marrow transplant: hematopoietic stem cell transplant

allogenic stem cell transplant for thalassemia major

09 Hematology (9 decks)

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