ANEMIA Flashcards
What type of anemia?
SICKLE CELL DISEASE
Normo Normo with increased reticulocytes
All aplastic anemia generally exhibit Normo-Normo type, except for ______ which may have a ______ type of anemia
Fanconi Anemia = macrocytic
Renal disease is what type of anemia
Normo Normo with normal or low reticulocytes
Inherited aplastic anemia makes up _____% of all aplastic anemia cases
15-20%
ACQUIRED APLASTIC ANEMIA is majority (80-85%)
_______Drug most frequently associated in ______ aplastic anemia
Chloramphenicol - acquired
Confirmatory test to detect PNH. This is also known as what disease?
Flow cytometry
Aka MARCHIAFAVA-MICHELI syndrome
Apart from fanconi anemia, what are 2 other associated conditions for inherited type of aplastic anemia
- Scwachman-Bodian-Diamond syndrome
2. Dyskeratosis congenita
DAF is also known as
CD 55
Deficiency in complement regulatory proteins is present in what condition? What are these CRP’s?
Paroxysmal nocturnal hemoglobinuria (PNH)
Deficient in DAF/CD-55 and MIRL/CD-59
CD-59 is also known as
MIRL- Membrane Inhibitor of Reactive lysis
3 general mechanisms of anemia
- Hemorrhage
- Hemolysis
- Low production of RBC
What is the first consideration when a patient has anemia?
Hemorrhage
Common site of significant bleeding occurs in the ______
Gastrointestinal tract
List the diseases associated with MICROCYTIC, HYPOCHROMIC anemia
TAILS
Thaassemia; Anemia of chronic inflammation; IDA; Lead poison; sideroblastic anemia
Tests for PNH
- Ham’s acidified serum
- Sugar water (sucrose hemolysis) test
- Flow cytometry
Physical abnormalities and cancer susceptibility may be associated with fanconi anemia. List those physical abnormalities
- Skeletal - thumb malformation, microcephaly, scoliosis
- Skin - hyper/hypopigmentation, cafe au lait
- Short stature
- Abnormality - eye, kidney, genital
MICROCYTIC anemia may result from insufficiency of _______ = insufficient erythropoeisis
Iron = abnormal iron studies
Acute leukemia results in ______ erythropoeisis
Insufficient
Renal disease results in _____ erythropoeisis
Insufficient
Early development of MICROCYTIC anemia shows ________; no obvious anemia developed
Low iron stores
Most common anemia
IDA
The most common pica is called _______; craving for _____
Pagophagia; ICE
Most common anemia seen in hospitalized patients
ACI
A cause for IDA is high demand for iron commonly seen among:
Pregnancy, adolescence, lactation
The difference between sideroblast and siderocyte. Since commonly they have iron granules
SideroBLAST = nucleated
This type of anemia occurs when there is low serum iron, yet very high iron stores
ACI = sideropenia
Acute phase reactants associated with ACI
- Lactoferrin
- Ferritin
- Hepcidin
What type of anemia does ACI usually present, given the case is not so advanced
Normo-normo
Only when advanced state = MICROCYTIC, hypochromic
Hallmark of the anemia that occurs when protoporphyrin production or incorporation of iron into it is prevented
Sideroblastic anemia = RINGED SIDEROBLAST
In this anemia, iron becomes trapped in the mitochondria
Sideroblastic anemia (micro,hypo)
Possible cause of IDA
- Menstruation (blood loss)
- High iron demand
- Nutritional deficiency
- GIT malignancy
- Hookworm
Differentiation of MICROCYTIC, hypochromic anemias:
Give the iron study results (Serum iron, ferritin, TIBC) in ACI
Serum iron = low
Ferritin = high
TIBC = low
Serum iron = low
Ferritin = low
TIBC = high
This is most likely what condition?
IDA
Which 2 conditions have similar iron studies:
Serum iron = high
Ferritin = high
TIBC = normal
Sideroblastic anemia and thalassemia
Although for FEP: sideroblastic anemia has mixed result, unlike thalassemia is normal ; other conditions is high
Serum iron result in adults ____ in kids _____ with LEAD POISONING
Adults = normal to high
Child = normal to low
What is the TIBC and ferritin result in patients with lead poisoning, both child and adult?
TIBC = normal
Ferritin = normal
Note: iron is not affected in lead poisoning, only FEP result is high
The most sensitive test for IDA
FERRITIN
Note: only IDA has a truly low iron store
The first depletion when there is iron deficiency is low _____
Low iron stores (ferritin) = stage 1 IDA
In frank IDA, which component is already affected?
Hemoglobin = functional iron depletion
In stage 2 IDA, which is affected?
Iron in transit (serum iron becomes low = TIBC will increase )
Stage 1 IDA is also known as _____ depletion
Storage iron depletion
Lack of intrinsic factor may be due to what conditions (3)
- Gastrectomy - no stomach to produce IF
- H. Pylori infection - destroys parietal cell
- Pernicious anemia - antibodies to parietal cell & IF
Renal dialysis may cause deficiency of ___
Folate
What is pathognomonic for megaloblastic type of macrocytic, Normochromic anemia
Hypersegmented neutrophils
Tapeworm infection (D. Latum) may cause what type of anemia?
Macrocytic, Normochromic anemia (vit b12 deficiency due to competition and intestinal obstruction)
Give 3 conditions associated with presence of big RBC (non-megaloblastic)And this increase in cell size is due to ____
Liver disease - high cholesterol in rbc membrane (can’t clear out; no HDL)
Chronic alcoholism - directly affects BM, HSC differentiation
Bone marrow failure
Macrocytosis in non-megaloblastic anemia is due to presence of immature cells (big) and not due to impaired nuclear differentiation
Shape of macrocytes present in non-megaloblastic anemia
Round
Oval in MEGALOBLASTIC
Which among vit b12 and folate does its nutritional value decrease if food is overcooked
Heat label = folate
Ex: leafy veggies, liver, orange, beans, beef, fortified cereals, dairy
______ may result if pregnant woman is deficient in folate
Neural tube defects (fetal nervous system) = spina bifida
Which among VitB12 or folate is most frequent? And why is it infrequent in the other or who may be affected in such cases
Folate deficiency is more common
VitB12 may occur in STRICT VEGETARIANS
Difference in the blood picture between deficiency in folate and vitamin b12
None. Indistinguishable
Which component is important in DNA synthesis?
TTP - Thymidine triphosphate
A synthetic form of vitamin b12 found in supplements
CYANOCOBALAMIN
What replaces TTP when it is not formed due to deficiency in folate and/or VitB12?
Deoxyuridine triphosphate
Why is vitamin b12 important in the successful synthesis of DNA?
Functions to transfer the methyl group (from methyl THF/ Folic acid) to produce TTP
3 consequences if DEOXYURIDINE TRIPHOSPHATE replaces TTP
- Nuclear fragments
- Cell destruction
- Impaired cell division
Neurological and neuropsychiatric symptoms are seen in ______
Vitamin b12 deficiency
CBC picture both for folate and VitB12 deficiency
LOW = RBC, Hct, Hb, WBC, PLT HIGH = MCV, MCH
Total and B1 in folate and vit b12 deficiency is ______
HIGH
Also high: serum LACTATE DEHYDOGENASE
What cells and other characteristics found in folate/VitB12 deficiency during MANUAL DIFFERENTIAL COUNT
- Anisocytosis
- Poikilocytosis = oval macrocytes
- RBC inclusion
- Hypersegmented neutrophils
Total and indirect biliribin (serum) is a _______ type of test for folate/ vit b12 deficiency
SCREENING
Metabolically active form of Vit.B12 is called ____
HoloTc - holotranscobalamin (VitB12+transcobalamin complex)
____% of VitB12 is bound to transcobalamin 2
10-30%
Note: 75% bound to Transcobalamin 1, 3
Minimum number of lobes to be classified as a Hypersegmented neutrophil. This is pathognomonic for?
6 lobes; megaloblastic anemia
In folate deficiency, holoTc is _____ (high/low)
LOW - folate is not associated with holoTc (VitB12-transcobalamin complex)
Serum homocysteine is HIGH in _____
Both folate and VitB12 deficiency
Note: its presence is due to either no source of methyl group since no folate OR no cofactor to stimulate the conversion of homocysteine to methionine
What are other possible PBS findings in megaloblastic anemia
Teardrop cell
Basophilic stippling
Cabot ring
NRBC
Howell jolly body
