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Hematology > Anemia > Flashcards

Anemia Flashcards

1
Q

ANEMIA can be a result of:

A

An absolute failure of the bone marrow to replace those erythrocytes that are normally destroyed after 120 days

Premature destruction (such as seen in hemolysis)

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2
Q

Types of anemia

A 
ANEMIA OF:
BONE MARROW FAILURE
SYSTEMIC DISORDERS
ABNORMAL NUCLEAR DEVELOPMENT
ABNORMAL IRON METABOLISM
ABNORMAL GLOBIN DEVELOPMENT
INCREASED ERYTHROCYTE DESTRUCTION
BLOOD LOSS
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3
Q

ANEMIA OF BONE MARROW FAILURE

A

APLASTIC ANEMIA

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4
Q

There is peripheral blood pancytopenia (that is, a decrease in ALL formed elements of the blood)
Bone marrow is severely hypolastic or aplastic

A

APLASTIC ANEMIA

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5
Q

underdevelopment or incomplete development of a tissue or organ

A

HYPOPLASIA

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6
Q

failure of a tissue or organ to develop

A

APLASIA

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7
Q

The name can be misleading as it implies that the anemia is the main problem; however, the most serious complications arise from _____ brought about by ____ and ___ from ______

A

severe infections - leukopenia

bleeding from thrombocytopenia

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8
Q

DIAGNOSTIC CRITERIA FOR SEVERE APLASTIC ANEMIA

BONE MARROW
Cellularity__ of normal or __ of normal cellularity with __ hematopoietic cells

Plus any two of the following:
Granulocytes
Platelets
Anemia with

A
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9
Q

-
-

Seen maximally at the age of ____

A

There are no immature myeloid cells in the peripheral blood

There is an aplastic or hypoplastic marrow (that is one replaced by fat)

Lack of splenomegaly

-

6-50 years

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10
Q

2-5X more frequent in the Far East (i.e. Japan, China, Korea) than North America or Europe

A

aplastic anemia

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11
Q

Rare, inherited form of aplastic anemia

Autosomal recessive

A

FANCONI ANEMIA

Congenital Aplastic Anemia

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12
Q

FANCONI ANEMIA
Congenital Aplastic Anemia

Seen coupled with:
8

A 
Microcephaly
Brown skin pigmentation
Short stature
Malformation of the thumb
Internal strabismus (cross eyes)
Renal malformations
Genital hypoplasia
Mental retardation
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13
Q

A rare condition that involves either an idiopathic or an immune mechanism

Some patients may have an Ig inhibitor of erythroid precursors or erythropoietin inhibitor

May be due to a benign disease, drugs, chemicals, infections, or hemolytic anemia-aplastic crisis

A

ACQUIRED PURE RED CELL APLASIA

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14
Q

Some patients may have an Ig inhibitor of erythroid precursors or erythropoietin inhibitor

A

ACQUIRED PURE RED CELL APLASIA

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15
Q

May be due to a benign disease, drugs, chemicals, infections, or hemolytic anemia-aplastic crisis

A

ACQUIRED PURE RED CELL APLASIA

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16
Q
  • Congenital Hypoplastic anemia or PRCA
  • A rare congenital disorder defined as a normochromic-normocytic anemia with normal leukocyte and platelet count and a marked decrease in marrow normoblasts
  • First described in 1938
  • Etiology is unknown, however one in vitro study shows the the colony-forming units-erythroid (CFU-E) were insensitive to erythropoietin stimulation
A

DIAMOND BLACKFAN ANEMIA

Congenital Pure Red Cell Aplasia

17
Q

DIAMOND BLACKFAN ANEMIA
Congenital Pure Red Cell Aplasia

  • _______ or PRCA
  • A rare congenital disorder defined as a __________ with normal ____ and _____ and a marked decrease in marrow ______
  • First described in ____
  • Etiology is unknown, however one in vitro study shows the the colony-forming units-erythroid (CFU-E) were insensitive to _______
A

Congenital Hypoplastic anemia

normochromic-normocytic anemia
leukocyte and platelet count
normoblasts

1938

erythropoietin stimulation

18
Q

A common finding in 94% of patients with carcinoma

The degree of anemia correlates with the degree of ____ burden

Sometimes used interchangeably with _______________

A

MYELOPHTHISIC ANEMIA

tumor
leukoerythroblastic reaction

19
Q

NOTE:
The _________ is the presence of circulating nucleated rbc (NRBC) and immature leukocytes in the peripheral blood; THIS REACTION IS NOT ASSOCIATED WITH ANEMIA.

A

MYELOPHTHISIC ANEMIA

LEUKOERYTHROBLASTIC REACTION

20
Q

Aplastic anemias which have a number of identified causative factors and agents.

Radiation
Seen in long term, low dose irradiation where radiation may damage the stem cells
High dose radiation associated with acute exposure (radiotherapy, radioactive isotope administration, or work in unsafe power plants)
Immune Mechanisms
Caused either directly by lymphocytes or by some humoral factors

A

SECONDARY APLASTIC ANEMIAS

21
Q

SECONDARY APLASTIC ANEMIAS

Drugs and Chemicals
________is the classic drug associated with marrow aplasia

Others include 5

Chemicals include: 3

A

Chloramphenicol

benzene and 
benzene derivatives, 
hydantoins, 
sulfonamides, and 
gold preparations

Chlordane,
Chlorophenothane (DDT) and
gamma benzene hexachloride (Lindane)

22
Q

Radiation
Seen in long term, low dose irradiation where radiation may damage the stem cells

High dose radiation associated with acute exposure (radiotherapy, radioactive isotope administration, or work in unsafe power plants)

–
Caused either directly by lymphocytes or by some humoral factors

A

SECONDARY APLASTIC ANEMIAS

Immune Mechanisms

23
Q 
Laboratory Findings
Peripheral Blood:
-
-
-
-
-
-
Bone Marrow:
- 
- 
- 
- 
- 
-
A

Pancytopenia
Normocytic-Normochromic type of anemia with slight macrocytosis
Normal red cell morphology
Reticulocyte Count is decreased
Reticulocyte Production Index is severely decreased
NO IMMATURE CELLS in the peripheral blood

Hypoplastic or aplastic
Increased fat replacement
Decreased hematopoietic cells
Principal cells present are lymphocytes and plasma cells
No increased number of immature cells
Patchy areas of cellularity
24
Q

used to evaluate patients with suspected PNH (______) or suspected congential dyserythropoietic anemia

Diagnosis of PNH shows that the suspected patient’s red cells have a high sensitivity to complement mediated hemolysis.

A

Ham Acid Serum Test

Paroxysmal Noctural Hemoglobinuria

25
Q

Positive test result shows lysis of Red cells in acidified serum samples with patients cell (not with normal cells).

A

Ham Acid Serum Test

26
Q

Lab Findings

Special Hematology Tests:
4

Chemistry:
3

A

Hemoglobin F (HbF) – elevated
Kleihauer-Betke Acid elution test for HbF– uneven distribution in red cells
Leukocyte alkaline phosphatase (LAP) – increased
Ham acid-serum test (confirmatory test for PNH) – maybe positive

Serum iron – Elevated
Plasma Iron Clearance – Delayed
Cytogenetics:
Marrow chromosomes – normal (when abnormalities are found, think of MYELODYSPLASTIC SYNDROME)

27
Q

Treatment

Bone marrow transplantation

Patients should receive prior treatment with _____ to reduce the risk of rejection

Blood transfusions

Immunosuppressive therapy (antithymocyte globulin [ATG] or antilymphocyte globulin [ALG])

Androgens (that stimulate erythropoiesis and to a lesser degree, granulopoiesis and platelets)

A

cyclophosphamide

28
Q

Failure of sustained marrow engraftment (i.e. rejection)

Development of graft versus host disease (GVHD)

Defined as an immune reaction trigerred by an incompatibility between the donor and recipient HLA antigens

Is mediated by donor lymphocytes acting against the host tissues

Appears anywhere between ___ after grafting which attacks the skin, liver, and the gut

Responsible for __ of mortality

A

Day 10 to 70

12%

29
Q

Transplant Complications
Can be prevented by:

___ (though 25-30% of patients receiving this drug still develop GVHD)

____, which is a newer drug effective in the treatment of GVHD, particularly after kidney transplantation

Treated by ____, sometimes in combination with azathioprine

A

Methotrexate
Cyclosporin A (CyA)
prednisone

30
Q

Prognosis
Patients who undergo bone marrow transplantation have a more favorable prognosis and survival rate than those from whom no donor can be found, especially after 6 months after diagnosis.

A

Patients who undergo bone marrow transplantation have a more favorable prognosis and survival rate than those from whom no donor can be found, especially after 6 months after diagnosis.

31
Q

Anemias of Systemic Disorders

REMEMBER:
____________!

A

Hormones play a BIG ROLE in hematopoiesis

32
Q

ANEMIA OF CHRONIC RENAL FAILURE

A ___ that can be severe, almost invariably occurs in patients with chronic renal failure (CRF)

Related to the etiology of renal disease:
-Failure of renal excretory function with resultatnt -accumulation of waste products
Failure of renal production and release of erythropoietin

Uremia is always often present

A

hypoproliferative anemia

33
Q

Uremia is always often present

A

ANEMIA OF CHRONIC RENAL FAILURE

34
Q

A hypoproliferative anemia that can be severe, almost invariably occurs in patients with chronic renal failure (CRF)

A

ANEMIA OF CHRONIC RENAL FAILURE

35
Q

Related to the body’s low oxygenation

A

ANEMIA OF ENDOCRINE DISORDERS

HYPOTHYROIDISM

36
Q

Anemia occurs because the pituitary gland influences the functions of the thyroid (through TSH), gonads Through FSH and LH), and adrenals (through ACTH)

The anemia is caused by ____ and a resultant ___ in stimulation of ______ production

Anemia is _____, with N/N red cell morphology

_____ stimulates the release of erythropoietin as well as ____ and ____

A

HYPOPITUITARISM

reduced metabolic demands
decrease
erythropoietin production

mild to moderate

Vasopressin
growth hormone
prolactin

37
Q

Most often related to iron deficiency or folate deficiency

A

Anemia of Pregnancy

38
Q

Anemia occurs due to deranged cortisol secretion that have multiple effects on blood cells, most markedly with circulating eosinophils and lymphocytes.

_____ – hypocortisolism
_____ – hypercortisolism

A

ANEMIA OF ENDOCRINE DISORDERS

ADRENAL ABNORMALITIES
Addison’s disease
Cushing’s disease

39
Q

Is characterized by retarded growth and secondary sexual development
REMEMBER: ____

A

ANEMIA OF ENDOCRINE DISORDERS

HYPOGONADISM
Testosterone is an androgen

Hematology (5 decks)

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