Anemia

Question 1

• Definition of anemia?
• Surrugate measures?
• Ranges vary based on?
• Normal retic count?
• Normal absolute retic count?
• Retic index? Eq?
• Iron: Tough to get rid of when? Consumed in what form? (2) Where? What cells? Which goes into body? What helps? Transporter to blood? Transporter to liver/macrophages? Storage molecule? Normal saturation %? Decrease absporption? Hepcidin? Binds where?

Answer 1

• Insufficient RBC mass
• Hb, HCT, RBC count
• Age, gender, altitude
• 04.-1.7%
• 50k
• Corrects for stress: RI = Retic count * (Pt. HGB/ Normal HGB) * (1/stress factor)
• Absorbed in blood stream; Heme form animals, non heme plants; Duodenum; enterocytes; Fe2+; acididity of stomach; ferroportin; transferrin; ferritin; 33%; phytates and oxalates; liver protein made to block ferroportin when Fe is high

Question 2

• Iron Deficiency: Common? Systemic symptoms? (3) Causes? (3) Stages? (3) Treatment?
• Causes of overaccumulation of iron? (3) effects? (2) Treatment?
• Ways to decrease RBC production? (3)
• Neoplasm/sepsis lead to inceased? (2)
• Chronic infection lead to increased? (2)
• Effect of: TNF? INFB? IL1? INFgamma?

Answer 2

• Most common anemia; decr. muscle performance, immune dysfunction, tongue atrophy
  1.) Decrease Ferritin stores, increased absorption
  2.) Decrease serum iron; increased iron binding; increased free protophoryn; decreased iron sat.
  3.) Increased transferrin; decreased sat., micro
• Oral/IV iron;
• Increased in diet; increased absorption via hemochromatosis; transfusions; arrythmias and organ damage; chelation
• Low iron; low EPO; Low erythroid prolif.
• TNF; INFB
• IL1; INFgamma
• TNF = Decrease iron stores; decrease EPO prod
  INFB = Decrease Erythropoises
  IL1 = Decrease iron and EPO
  INFgamma = Decrease erythropoieses

Question 3

• Effect of lead poisoning?
• Renal failure?
• Sideroblastic anemia?
• B12/Folate Deficiency?
• Folate: What foods? Absorbed where? Stored where?
• B12: Stored how long? Progression of disease? What foods? Absorped where? What helps with this? Stored where?

Answer 3

• Decreased protoporphoryn
• Decreased EPO
• Impaired Proto production
• Important for synthesis of methionine and homocysteine; cells arrested in S phase
• Cereals, bread, fruit/veggies; Jejunum; liver
• 6 months; slow; not in plants; eggs, meat and milk; intrinsic factor; liver

Question 4

• Microcytic anemia: Cause? How can this happen? (3) Ex? (4)
  1. ) Iron Deficiency (Microcytic Anemia):
• What can lead to this?
  2. ) Chronic Disease:
• Role of hepcidin in this? (2) Difference in CBC from iron deficiency? (2)
  3. ) Sideroblastic Anemia:
• Mechanism? Leads to what in mitochondria? Cell type? Serum Fe/ saturation? Causes? (3)
  4. ) Thallessemia:
• Mechanism? Types of cells? (2) What type of Hb is high?

Answer 4

• Low Hb production: Low globin, iron, protophoryn, Fe def., CD, Sideroblastic Anemia, thallessemia
• Blood loss, malabsorption, gastrectomy
• Locks Fe in macrophages and decreases EPO, high ferritin and low TIBC
• Low proto. synthesis; build up of iron, sideroblastic ring; high for both; Lead poisoning, B6 deficiency, isozanid
• Low globin production; TArget and nucleated RBCs, HbA2

Question 5

• Macrocytic anemia: Cause? (2) Mechanism? Affects what else? Classic cell type?
  1. ) Folate Deficiency: Comes from? Absorbed where? Body storage? Classic serum finding?
  2. ) B12 Deficiency: Comes from? absorbed where? Help from? Common? Why? Common cause? Other causes? Can also have what problem? Blood has high? (2)

Answer 5

• B12/Folate deficiency; THF-M –> B12-M –> Homocysteine + methyl = methionine; Folate and B12 are DNA precursors; other rapidly dividing cells; hypersegmented neutrophils
• Veggies/fruits; jejunum; minimal; increased homocysteine
• Animal products; Ileum; IF; No; Liver has high stores; Prenicious disease –> destruction of parietal cells which lowers IF; pancreatits, crohns, vegans, degeneration of spinal cord; homocysteine and MMA

Question 6

• Normocytic anemia: Due to? (2) Retic count? How could it be falsely elevated?
• Extravascular hemolysis: RBC’s destroyed by? Broken down to? (3) Proto =? Then goes to? Then? Clinical findings? (4) 3 types?
• Intravascular hemolysis: Destroyed where? Hb then bound to? Overwhelmed can lead to? Clinical findings? (3) 2 types?

Answer 6

• peripheral destruction or underproduction; high; % RBC’s are dropping and it is measured as a %
• Macros, spleen, lymph, liver; Globin/heme/ proto; unconjugated billi; liver via albumin bound; conjugated and excretion as bile; splenomegaly; jaundice; gall stones; marrow hyperplasia; HS, Sickle, HbC
• In blood vessels; Haptoglobin;increased methemoglobin; hemoglobinemia, hemoglobinuria, decreased haptoglobin; G6PD and immune hemolytic anemia

Question 7

• Extravascular Anemia:
  1.) HS: Hereditary? Shape causes what? Caused by? Ex? (3) MCHC? Increased risk of? (2) Diagnosed how? Treatment? Often find what type of cells? Which is?
  2.) Sickle Cell: Type of cells? (3) Haptoglobin? Spleen? Increased risk of?
  3.) HbC: Cells seen?
• Emden Meyerhoff: Glucose to?
• Rapport-Leubering: Produces what to stabilize deoxy Hb?
  Hexose Monophosphatase produces what to decrease ox stress?

Answer 7

• AD/AR; Spleen to break it down; faulty anchoring proteins; Spectrin, ankyrin, band 3.1; High; B19 parovirus, aplastic crisis; Hypotonic solution test; splenectomy; HJ bodies; fragmented nucleus
• Sickle, HJ, Target Cells; down; Autospenectomy; encapsulated organisms
• HbC crystals
• Lactate
• 2-3 diphosphoglycerate
• Glutationine

Question 8

• Intravascular Anemia:
  1. ) G6PD deficiency: Hereditary? Defective what? Which does what? Also effects this? (3) Ppt Hb leads to what cells? (2)
  2. ) Extravascular warm immune: Where in body? What Abs? Tpyes of RBC’s?
  3. ) Intravascular cold? Where in body? Type of Ab? Test for this?
• Underproduction caused by? (4)

Answer 8

• X linked; glutathionine; oxidative stress; flava beans, drugs, infection; Heinz bodies –> Bite cells
• Warm parts; IgG; spherocytes
• Peripheral; IgM; Coombs
• Renal failure, marco/microcytosis, neoplasia, damage to precursors