ANEMIA Flashcards
Anemia definition
Decrease below normal of RBCs, hemoglobin, or hematocrit.
Normocytic, Normochromic Anemia
MCV and MCHC are both normal.
Normocytic, normochromic Conditions with normal or decreased Reticulocyte Count
Aplastic anemia, Kidney disease, Acute blood loss.
Normocytic, normochromic Conditions with increased Reticulocyte Count
(ENZYMES and Hemolytic anemias)
PNH, Paroxysmal Cold Hemoglobinuria, Sickle Cell Disease, Enzyme deficiencies: G6PD deficiency, PK deficiency, Other hemolytic anemias.
Rare, potentially deadly bone marrow failure syndrome
Aplastic anemia.
Aplastic anemia features
Pancytopenia (↓ RBCs, WBCs, platelets), Reticulocytopenia, Bone marrow hypocellularity, Depletion of hematopoietic stem cells.
Paroxysmal Cold Hemoglobinuria
Autoimmune hemolytic anemia with Donath Landsteiner antibody (autoanti-P).
Approximately 80 to 85% of aplastic anemia cases
Acquired Aplastic Anemia.
Acquired Aplastic Anemia categories
1) Idiopathic acquired aplastic anemia (no known cause), 2) Secondary acquired aplastic anemia (associated with identified causes like chemicals, viruses, and drugs).
Common causes of Secondary acquired aplastic anemia
Chemicals (e.g., insecticides, benzene), Viruses (e.g., Epstein-Barr virus), Drugs (e.g., chloramphenicol).
Drug most frequently implicated in acquired aplastic anemia
Chloramphenicol.
Approximately 15% to 20% of aplastic anemia cases
Inherited Aplastic Anemia.
Inherited Aplastic Anemia diseases
1) Dyskeratosis congenita, 2) Shwachman-Bodian-Diamond syndrome, 3) Fanconi Anemia (FA).
Most common inherited aplastic anemia, a chromosome instability disorder
Fanconi Anemia (FA).
Fanconi Anemia features
Aplastic anemia, cancer susceptibility, and physical abnormalities (e.g., skeletal abnormalities, skin pigmentation changes, short stature, abnormalities of the eyes, kidneys, and genitals).
Fanconi Anemia physical abnormalities
Skeletal abnormalities (thumb malformations, microcephaly, scoliosis), Skin pigmentation changes (hyperpigmentation, hypopigmentation, café-au-lait lesions), Short stature.
Fanconi Anemia vs Fanconi Syndrome
Fanconi Syndrome is a defect in proximal CT.
Paroxysmal Nocturnal Hemoglobinuria (PNH) A.K.A
Marchiafava-Micheli Syndrome.
Paroxysmal Nocturnal Hemoglobinuria (PNH) cause
Deficiency of complement regulatory proteins: DAF (decay-accelerating factor, CD55), MIRL (membrane inhibitor of reactive lysis, CD59).
Test for PNH
Ham’s Acidified Serum Test, Sugar Water Test (sucrose hemolysis test); Flow cytometry using FLAER (confirmatory for PNH).
FLAER in PNH
Fluorescein labelled proacrolysin variants.
Microcytic, Hypochromic Anemias
Small cells with increased central pallor (MCV and MCHC both LOW).
Microcytic anemia cause
Insufficient iron for normal erythropoiesis.
Microcytic anemia diagnosis
Abnormal iron studies.
Early microcytic anemia development
Reduced iron stores, no obvious anemia.
Associated conditions of microcytic hypochromic anemia (C T A I L S)
(Chronic blood loss, Thalassemia, Anemia of chronic inflammation, Iron deficiency anemia, Lead poisoning, Sideroblastic anemia).
Anemia of chronic inflammation (ACI) original name
Anemia of chronic disease (ACD).
Most common anemia among hospitalized patients
Anemia of chronic inflammation (ACI).
Conditions associated with ACI
Chronic infections (e.g., tuberculosis), Chronic inflammatory conditions (e.g., rheumatoid arthritis), Tumors.
Central feature of ACI
Sideropenia (↓ serum iron) despite abundant iron stores.
PBS in ACI
Usually normocytic, normochromic; advanced stages: microcytic, hypochromic.
Acute phase reactants (APRs) in ACI
Hepcidin, Ferritin, Lactoferrin.
Hepcidin function
Master regulatory hormone for systemic iron metabolism; inactivates ferroportin (iron transport from tissues to blood).
Sideroblastic anemia development
Prevented protoporphyrin production or the incorporation of iron into protoporphyrin.
Sideroblast definition
Nucleated RBC precursor with cytoplasmic iron granules.
Siderocyte definition
Anucleate RBC with iron granules.
Iron in sideroblastic anemia
Trapped in mitochondria, cannot be fully utilized in Hb synthesis.
Hallmark of sideroblastic anemia
Ring sideroblasts (mitochondria loaded with iron).
Peripheral blood picture in sideroblastic anemia
Dimorphic (normochromic and hypochromic RBCs).
Most common anemia
Iron deficiency anemia (IDA).
Possible causes of IDA
Blood loss (menstruating women), Nutritional deficiency (infants), ↑iron demand (pregnancy, lactation, adolescence), Malignancies of gastrointestinal tract, Hookworm infections.
Clinical features of IDA
Fatigue, weakness, irritability, headache, palpitations, loss of concentration, shortness of breath, brittle hair, pallor, koilonchia (spooning of fingernails), glossitis, angular cheilosis, pica (non-food cravings, especially ice).
TIBC (Total Iron Binding Capacity)
Indirectly measures transferrin concentration by its ability to bind iron.
Serum Ferritin Test
Reveals body’s tissue iron stores; good indicator of iron storage status; useful in diagnosing iron deficiency.
Used to measure serum ferritin
Radioimmunoassay.
Stage 1 of Iron Deficiency
Storage Iron Depletion.
Stage 1 Characteristics
Normal Hemoglobin, Serum Iron, and TIBC; Decreased Serum Ferritin.
Stage 2 of Iron Deficiency
Transport Iron Depletion.
Stage 2 Characteristics
Normal Hemoglobin, Decreased Serum Iron, Serum Ferritin; Increased TIBC.
Stage 3 of Iron Deficiency
Functional Iron Depletion (Frank Iron Deficiency Anemia)
Stage 3 Characteristics
Decreased Hemoglobin, Serum Iron, and Serum Ferritin; Increased TIBC
Serum Iron and Serum Ferritin: High; TIBC and FEP: Normal
Thalassemia
Serum Iron and TIBC: Low; Serum Ferritin and FEP: High
Anemia of Chronic Inflammation (ACI)
Serum Iron and Serum Ferritin: Low; TIBC and FEP: High
Iron Deficiency Anemia (IDA)
Normal to High Serum Iron (Adults); Normal to Low (Children); TIBC: Normal; Serum Ferritin: Normal; FEP: High
Lead Poisoning
Serum Iron and Serum Ferritin: High; TIBC: Normal; FEP: Mixed (High and Low)
Sideroblastic Anemia
MACROCYTIC
NORMOCHROMIC ANEMIAS Characterized by
Types of Megaloblastic Anemias
Vitamin B12 Deficiency, Folate Deficiency
Vitamin B12 Deficiency Causes
Inadequate intake, Increased need (e.g., pregnancy, lactation, growth), Competition (e.g., D. latum infection), Lack of Intrinsic Factor (e.g., gastrectomy, H. pylori infection, Pernicious Anemia)
Pernicious Anemia Features
Antibodies against Parietal Cells, Antibodies against Intrinsic Factor (IF)
Parietal Cells
Found in the stomach; produce HCl and Intrinsic Factor (IF)
Required factor for Vitamin B12 absorption
Intrinsic Factor
Folate Deficiency Causes
Inadequate intake, Increased need, Renal dialysis
Anemia associated with liver disease
chronic alcoholism
Megaloblastic Anemia neutrophils
Hypersegmented (> 6 segments)
Hypersegmented Neutrophils in Nonmegaloblastic Anemia
Absent
Normal Neutrophils
Have 3 to 5 nuclear lobes
Macrocyte Shape in Megaloblastic Anemia
Oval
Macrocyte Shape in Nonmegaloblastic Anemia
Round
Megaloblasts in Bone Marrow (Megaloblastic Anemia)
Present
Megaloblasts in Bone Marrow (Nonmegaloblastic Anemia)
Absent
Root Cause of Megaloblastic Anemia
Impaired DNA synthesis
Vitamin B12 is the cofactor for ____ in DNA Synthesis
Thymidine Triphosphate (TTP)
Vitamin B12 Alternative Name
Cobalamin
General term for any form of folic acid
Folate
Synthetic form of Vitamin B12 found in supplements
Cyanocobalamin
Naturally occurring form of Vitamin B12
obtainable from food or supplements
Symptoms in Folate or Vitamin B12 Deficiency
Fatigue, weakness, shortness of breath, glossitis, gastritis, nausea or constipation
Symptoms in Vitamin B12 Deficiency
Memory loss, numbness, tingling in toes and fingers, loss of balance, vibratory sense loss in lower limbs, Personality changes, psychosis
Vegan Diet and Type of Anemia
Prone to Vitamin B12 Deficiency Megaloblastic Anemia
Sources of Vitamin B12
Liver, meat, oysters, clams, fish, eggs, cheese, dairy products
Effect of Cooking on Vitamin B12
Not destroyed by cooking
Sources of Folate
Leafy green vegetables, dried beans, liver, beef, fortified cereals, broccoli, dairy, whole grains, oranges
Effect of Cooking on Folate
Folates are heat labile, overcooking can reduce nutritional value
Laboratory tests used to diagnose Vitamin B12 and Folate deficiency Screening tests
Complete blood count (Hemogram), Manual differential count, Absolute reticulocyte count, Serum total and indirect bilirubin, Serum lactate dehydrogenase
Laboratory findings in Vitamin B12 and Folate deficiency
Decreased Hb, Hct, RBCs, WBCs, PLTs; Increased MCH
Specific diagnostic tests for Vitamin B12 and Folate deficiency
Serum B12, serum folate, RBC folate, serum methylmalonic acid, serum/plasma homocysteine, holotranscobalamin assay
Other findings in megaloblastic anemia
Teardrop cells, nucleated RBCs, Howell-Jolly bodies, basophilic stippling, Cabot rings
Hypersegmented neutrophils
Pathognomonic for megaloblastic anemia
Vitamin B12 absorption and transport
Vitamin B12 binds to intrinsic factor (IF) in the stomach, then binds to transcobalamin in the enterocyte, forming holotranscobalamin (holoTC), the metabolically active form of Vitamin B12
Anemias caused by decreased RBC production
Aplastic anemia, Megaloblastic anemia, Iron deficiency anemia, Thalassemia, Anemia of chronic renal failure, Anemia of endocrine disorders, Anemia of chronic inflammation (ACI), Anemia associated with marrow infiltration, Sideroblastic anemia
Anemias caused by increased RBC destruction (intracorpuscular abnormalities)
Membrane defect: hereditary spherocytosis, hereditary elliptocytosis, pyropoikilocytosis; Enzyme deficiency: G-6-PD, pyruvate kinase, porphyria; Globin abnormality: hemoglobinopathies (Hb SS, CC, SC); Paroxysmal nocturnal hemoglobinuria
Anemias caused by increased RBC destruction (extracorpuscular abnormalities)
Mechanical: microangiopathic hemolytic anemia, etc.; Infection: malaria, Bartonella, Ehrlichia, Babesia; Chemical and physical agents: drugs, toxins, burns; Antibody-mediated: acquired hemolytic anemia due to warm-reacting antibodies
Anemia due to blood loss
Hemorrhage
