Anemia 1: Acute Blood Loss, Decreased Production, Decreased Hematopoiesis, & Polycythemia

Question 1

Describe the morphology (size and color) of acute blood loss anemia.

Answer 1

Normocytic and normochromic

Question 2

Describe the morphology (size and color) and pathophysiologic classification of iron-deficiency anemia vs. anemia of chronic disease.

Answer 2

Iron deficiency: microcytic and hypochromic
Chronic disease: normocytic to microcytic and normochromic
Both: from decreased production of RBC precursors

Question 3

Describe the reticulocyte count, serum iron, serum ferritin, serum transferrin, and TIBC (total iron binding capacity) of iron-deficiency anemia.

Answer 3

No reticulocytosis, low serum iron and ferritin, high serum transferrin and TIBC

Question 4

Describe the reticulocyte count, serum iron, serum ferritin, serum transferrin, and TIBC (total iron binding capacity) of anemia of chronic disease.

Answer 4

No reticulocytosis, low serum iron and ferritin, low serum transferrin and TIBC

Question 5

What is the pathophysiologic classification of aplastic anemia and pure red cell aplasia? How are they different?

Answer 5

Both caused by decreased production of precursors; aplastic anemia features pancytopenia (WBC, RBC, platelets) while PRCA features only RBC suppression

Question 6

Describe the EPO and reticulocyte count in aplastic anemia and pure red cell aplasia.

Answer 6

Same for both: high EPO, no reticulocytosis

Question 7

Name a common viral cause associated with both aplastic anemia and pure red cell aplasia.

Answer 7

Parvovirus B19

Question 8

What genetic syndrome is associated with aplastic anemia? With pure red cell aplasia?

Answer 8

Fanconi anemia; Diamond-Blackfan syndrome

Question 9

What is the pathophysiologic classification of anemia of renal disease? It is characterized by a decrease in what molecule?

Answer 9

Decreased production of RBC precursors; decreased EPO

Question 10

What is the pathophysiologic classification of myelophthisic anemia? With what process is it associated?

Answer 10

Decreased production of RBC precursors; bone marrow infiltration

Question 11

What is the pathophysiologic classification of anemia of lead poisoning?

Answer 11

Decreased production of RBC precursors

Question 12

What is the pathophysiologic classification of megaloblastic anemia? It is associated with low levels of what two molecules?

Answer 12

Ineffective hematopoiesis (due to intramedullary cell death); B12 and folate

Question 13

What anemia is associated with antibodies against gastric parietal cells?

Answer 13

Pernicious anemia

Question 14

What molecule transports Vitamin B12 in the blood? Deficiency is usually from lack of what molecule?

Answer 14

Transcobalamin; intrinsic factor

Question 15

What test measures B12 absorption using radioisotopes?

Answer 15

Shilling test

Question 16

Megaloblastic anemia is characterized by what 2 kinds of abnormal cells?

Answer 16

Large, nucleated RBC precursors (megaloblasts) and neutrophils with hypersegmented nuclei

Question 17

What is the pathophysiologic classification of thalassemia?

Answer 17

Ineffective hematopoiesis (due to intramedullary cell death)

Question 18

Give another name for and describe the morphology (size and color) of homozygous β-thalassemia.

Answer 18

Cooley anemia; microcytic and hypochromic

Question 19

Describe the morphology (size and color) and major presenting symptoms of heterozygous β-thalassemia.

Answer 19

Microcytic and hypochromic; usually asymptomatic

Question 20

Names for α-thalassemia with 1 or 2 genes affected; what is their morphology (size and color)?

Answer 20

Silent carrier α-thalassemia and α-thalassemia trait; microcytic and hypochromic

Question 21

Normal hemoglobin is mostly Hb A with some Hb A2 and Hb F. Give the subunits of these 3 hemoglobins.

Answer 21

Hb A: α2β2
Hb A2: α2δ2
Hb F: α2γ2

Question 22

What 2 abnormal hemoglobin types can form Heinz bodies? Give their subunits.

Answer 22

Hb H: β4

Hb Bart: γ4

Question 23

What 2 hemoglobin types are increased in β-thalassemia? Which one has a higher affinity for O2?

Answer 23

Hb A2 and Hb F; Hb F has higher affinity (leads to decreased release in tissue)

Question 24

Compare the typical genetic mutations in α- and β-thalassemia.

Answer 24

α-thalassemia: gene deletions

β-thalassemia: point mutations

Question 25

Name for α-thalassemia with 3 gene deletions; what 2 hemoglobin types and what one precipitation are seen?

Answer 25

Hemoglobin H disease; Hb H, Hb Bart’s, and Heinz bodies

Question 26

Give another name for homozygous α-thalassemia. How many genes are affected, and what hemoglobin dominates in the short-lived fetus, causing increased risk for obstetric complications like eclampsia and postpartum bleeding?

Answer 26

α hydrops fetalis; all 4 α genes are missing; Hb Bart is seen

Question 27

What is another name for Gaisbock syndrome, and what is its cause?

Answer 27

Relative polycythemia, caused by dehydration

Question 28

Is polycythemia vera relative or absolute, primary or secondary, and EPO-dependent or independent?

Answer 28

Absolute, primary, EPO-independent

Question 29

What kind of polycythemia can occur in response to chronic lung disease, cigarette smoking, high altitudes, a R-to-L heart shunt, and Hb with increased O2 affinity? Is it EPO-dependent or independent?

Answer 29

Secondary polycythemia, EPO-dependent

Question 30

Which polycythemia is considered a primary myelodysplastic syndrome?

Answer 30

Primary polycythemia / polycythemia vera