Anemia Flashcards
Microcytic anemia reasons
- defective heme
- defective globin
Normocytic anemia reasons
- underproduction
- overdestruction (intravascular and extravascular)
Macrocytic anemia reasons
- megaloblastic
- nonmegaloblastic
Defective heme anemias
- iron deficiency
- sideroblastic anemia
- anemia of chronic disease
Defective globin anemias
a and b thalassemia
Underproduction anemias
- parvovirus B19
- aplastic anemias
- myelophthistic anemia
Intravascular anemias
- paroxysmal nocturnal hemoglobinurea
- G6PD deficiency
- microangiopathic hemolytic anemia
- malaria
Extravascular anemias
- hereditary spherocytosis
- sickle cell anemia
- hemoglobin C
- immune hemolytic anemia
Megaloblastic anemias
- folate deficiency
- B12 deficiency
Non-megablastic anemias
- alcoholism
- liver disease
- drugs like 5-FU
Iron deficiency
- decreased serum iron, increased TIBC, decreased serum ferritin, decreased % saturation, increased RDW, increased FEP
- causes:
- vegetarian/ low iron diet (malnutrition)
- issues with duodenal absorption (ferroportin abnormalities)
- peptic ulcer disease
- menorrhagia
- gastrectomy - Plummer-Vinson Syndrome–> esophageal web
Sideroblastic anemia
- increased ferritin, decreased TIBC, increased serum iron, increased % saturation
- iron overload
- protoporphyrin deficiency (enzymes: ALAS+B6, ALAD, ferrochetelase)
- causes:
- congenital
- vitamin B6 deficient
- alcoholism
- lead poisoning (ALAD)
Anemia of chronic disease
- increased ferritin, decreased TIBC, decreased serum iron, decreased % saturation, increased FEP
- suppresses EPO production
- sequestered hepcidin
- treat with EPO or underlying autoimmunity
Alpha thalassemia
- 2 knockout–> cis is worse than trans deletion
- 3 knockout–> severe anemia (HbH)
- 4 knockout–> hydrops fetalis (Hemoglobin Barts)
Beta thalassemia
- B minor–> asymptomatic
- B major–> severe anemia
- ineffective erythropoiesis
- aplastic crisis with parvovirus
Parvovirus B19
- temporarily halts erythropoiesis
- supportive tx
Aplastic anemia
- damage to hematopoietic stem cells
- pancytopenia
- empty bone marrow
- tx: transfusion, EPO/ GM-CSF/ G-CSF, immunosuppresion, BM transplant
Myelophthistic anemia
- pathologic process that replaces bone marrow
- tumors and myelofibrosis - teardrop cells
- nucleated RBCs in periphery
Paroxysmal Nocturnal Hemoglobinurea
- acquired deficiency of GPI (no DAF or MIRL to fight off complement)
- affects myeloid stem cells
- hemoglobinemia
- hemoglobinurea
- hemosiderinurea
- thrombosis of hepatic v., portal v.
- can cause iron deficiency anemia and AML
- treat with eclizumab
G6PD deficiency
- reduced G6PD half-life, leads to oxidative stress
- bite cells and Heinz bodies
- hemoglobinuria and back pain
Malaria
- infection of RBCs and liver
- anaphylic mosquito
- cyclical fevers
Hereditary spherocytosis
- defect of spectrin and ankrin
- cytoskeleton binding proteins - consumed by spleen
- parvovirus can cause aplastic crisis
- treat with splenectomy–> Howell-Jolly bodies
Sickle cell anemia
- end up with >90% HbS
- precipitated by:
- hypoxemia
- dehydration
- acidosis - membrane damage
- autosplenectomy
- acute chest syndrome
- treat with hydroxyurea to increase HbF
Hemoglobin C
- mutation in beta chain Hb
- lysine substitution
- characteristic crystals
Immune Hemolytic Anemia
Warm agluttinin
- IgG mediated
- spherocytes produced
- tied to SLE, CLL, some drugs
- treat with steroids, IVIG, splenectomy
Cold agluttinin
- IgM mediated
- distal extremities in cold weather
- tied to mycoplasma and mono, Raynaud’s
Folate deficiency
- decreased serum folates, increased hemocysteine, normal MMA
- poor diet
- increased demand
- folate antagonists (methotrexate)
B12 deficiency
- decreased B12, increased homocysteine, increased MMA
- vegan diet
- pernicious anemia
- autoimmune destruction of parietal cells - pancreatic insuffiency
- Crohn’s disease
- ileum damage
