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Anemia Flashcards

0
Q

Anemia is a disorder characterized by a reduction in the amount of hemoglobin present in blood and a decrease in RBC count. The blood hemoglobin concentration is believed to be a better marker of the total cell mass than than which other test?

A

hematocrit

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1
Q

Diagnostic evaluation of anima starts with ______

A

Hemoglobin

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2
Q

Classification of Anemia Based on what 2 things?

A

RBC size and RDW

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3
Q

With a cell size of Microcytosis (MCV <80) which condition would show a normal RDW? An increased RDW?

A

Normal: Thalassemia minor
Increased: Iron deficiency anemia and G6PD deficiency

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4
Q

With a cell size of Nomocytosis which condition would show a normal RDW? An increased RDW?

A

Normal: Acute bleeding
Increased: Early or partially treated iron or vitamin deficiency and sickle cell disease

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5
Q

With a cell size of Macrocytosis (MCV >100) which condition would show a normal RDW? An increased RDW?

A

Normal: Aplastic anemia, myelodysplastic syndrome
Increased: Vitamin B12 or folate deficiency, alcohol, liver disease

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6
Q

Whenever anemia is suspected or discovered with a CBC, order a ______ __________ to check for cell abnormalities.

A

peripheral smear

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7
Q

Basophilic stippling representing aggregated ribosomes can be seen in which 3 conditions?

A
  • thalassemia syndromes
  • iron deficiency
  • lead poisoning
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8
Q

Howell-Jolly bodies are nuclear remnants seen in which 3 conditions?

A
  • asplenia
  • pernicious anemia
  • severe iron deficiency
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9
Q

Cabot’s ring bodies are nuclear remnants seen in which 3 conditions?

A
  • lead toxicity
  • pernicious anemia
  • hemolytic anemias
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10
Q

Heinz’s bodies are from denatured aggregated hemoglobin and can be seen in which 3 conditions?

A
  • thalassemia
  • asplenia
  • chronic liver disease
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11
Q

Which 2 tests detect Spherocytes? What do they indicate?

A
  1. Coombs DAT: indicates immune mediated hemolytic anemia (AIHA) 2. Osmotic fragility increased: indicates spherocytosis (HS)
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12
Q

When looking for Fragments, which test would be best, and what does it assess?

A

Disseminated Intravascular Coagulation (DIC) screen to assess: intravascular thrombus

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13
Q

With Sickle cells and target cells, which screen is used?

A

Hemoglobin electrophoresis

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14
Q

When screening for Nucleated RBC which exams would be used?

A
  1. Hemoglobin electrophoresis (HGBE)

2. Bone marrow examination

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15
Q

Microcytic hypochromic anemia is caused by which 3 main things and which 4 minor things:

A

Main:

  1. Iron deficiency anemia (IDA)
  2. Thalassemia
  3. Sideroblastic anemia

Minor:

  1. Anemia of chronic disease (some cases)
  2. Pyridoxine Responsive anemia
  3. Chronic blood loss
  4. Lead poisoning
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16
Q

Lack of iron or inability to use iron for heme production for Iron deficiency is a result of which 3 situations?

A
  1. Chronic Blood loss
  2. Dietary lack during high demand
  3. Poor absorption of food iron
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17
Q

Lack of iron or inability to use iron for heme production for poor iron mobilization from body stores results in what?

A

inflammatory states

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18
Q

Lack of iron or inability to use iron for heme production for Sideroblastic anemia is due to what?

A

Failure of iron incorporation into protoporphyrin ring leads to RBC iron precipitation called Basophilic stippling and causes polychromasia

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19
Q

Defective globin chain synthesis involves which 2 conditions?

A
  1.   Alpha-thalassemia

2.   Beta-thalassemia

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20
Q

What is the most common microcytic hypochromic anemia?

A

Iron deficiency anemia

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21
Q

In the GI tract, iron is chiefly absorbed from the _________

A

Duodenum

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22
Q

Dietary Iron absorption is facilitated by what?

A

gastric acid secretion

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23
Q

What has come to be recognized as the “gold” standard operation for treatment of morbid obesity? Exclusion of nearly all of the stomach & the entire duodenum predisposes these patients to develop vitamin/mineral deficiencies.

A

RYGB: Roux-en-Y Gastric Bypass

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24
Average western diet includes what daily intake of iron?  What is the % of absorption?
- 10-30 mg daily | - Absorption is 5-10% of intake
25
Total body iron is about ___ grams
4
26
Total iron absorption is approximately 1 or 2 mg a day, balanced by about the same daily loss, mostly through what 2 means?
- skin desquamation | - in the stool
27
Many common foods interfere with iron absorption, what are 3 examples?
- phytates in cereal & grains - vegetables (very high in soy) - casein in milk
28
___% of body total is incorporated into hemoglobin | ___% of body total is stored as ferritin
70% | 30%
29
What transports absorbed iron from intestine to bone marrow?
Transferrin
30
When assessing for IDA use iron indices, use which 4 laboratory parameters to make an accurate diagnosis?
1. serum iron level 2. total iron-binding capacity 3. percentage transferrin saturation 4. serum ferritin level
31
With IDA laboratory tests, which test is the measurment of the iron bound to transferrin?
Serum Iron
32
Severe stress decreases serum iron values by ___%
65
33
Which 6 conditions will increased serum iron values?
1. Hemosiderosis or hemochromatosis 2. Iron poisoning 3. Hemolytic anemia 4. Massive blood transfusions 5. Liver dz 6. Lead toxicity
34
Which 5 conditions will decreased serum iron values?
1.   Dietary deficiency 2. Chronic blood loss 3.   Malabsorption 4.   Pregnancy – late 5. Neoplasia
35
What are 4 interfering factors with iron measurements?
1. Recent blood transfusions 2. Recent ingestion of high iron meal or supplements 3. Hemolytic diseases 4. Drugs
38
What is the measurement of all proteins available for binding mobile iron?
Total iron binding capacity: TIBC
39
Which 4 conditions will have increased TIBC or transferrin?
1. Estrogen therapy 2. Pregnancy – late 3. Polycythemia vera 4. Iron def. Anemia
40
Which 6 conditions will have decreased TIBC or transferrin?
1.   Malnutrition 2. Hypoproteinemia 3. Inflammatory diseases 4. Cirrhosis 5. Hemolytic, pernicious 6. Sickle cell anemias
41
Most iron in circulation is bound to what? TIBC is an indirect measurement of this.
transferrin
42
Ferritin not included in TIBC, why?
only binds stored iron
45
What is the major iron-storage protein? Where is it primarily found?
Ferritin; in the liver
46
T/F: Ferritin is a good indicator of available iron stores in the body.
True
47
Ferritin is normally present in serum in concentrations directly related to iron storage. 1 ng/ml serum ferritin corresponds to about ___ mg of stored iron. Levels below 11 in women and 24 in men mg/dl = diagnostic for which condition?
8; IDA
48
Ferritin levels rise persistently in which 2 populations?
males and post-menopausal females
49
T/F: Severe protein depletion can decrease ferritin levels.
True
50
T/F: Normal levels of ferritin will exclude iron deficiency
FALSE!!! Normal levels does NOT exclude iron deficiency
51
Ferritin is factitiously __________ in patients with chronic disease states
elevated
52
Ferritin acts as acute phase reactant protein. It ___________ 1-2 days after onset of acute illness, peaking at __-__ days
increases; 3-5
53
What are 5 interfering factors for lab testing ferritin?
1. Recent blood transfusion, high iron intake 2. Hemolytic dz 3. Excess iron storage dz 4. Menstruation 5.   Recent administration of radionuclide if test is performed via RIA
54
What are 6 causes for increased ferritin levels?
1. Hemochromatosis, hemosiderosis 2. Megaloblastic anemia 3. Hemolytic anemia 4. Alcoholism 5. Inflammatory dz 6. Advanced cancers
55
What are 3 causes of decreased ferritin levels?
1. Iron deficiency anemia 2 Severe protein deficiency 3. Hemodialysis
56
What are the three stages of iron deficiency?
1. iron depletion (reduced stores) 2. early iron deficiency anemia (depleted stores, normal MCV, and red cell morphology) 3. advanced iron deficiency anemia
57
In IDA, PLT count may be ________ secondary to BM stimulation. Reticulocyte count will be _________.
increased; decreased
58
In IDA, PB smear will show __________ __________ RBC
microcytic hypochromic
59
Free erythrocyte protoporphyrin (FEP) a precursor to HgB is _________ in IDA but _________ in thalassemia.
increased; normal
60
According to the Mentzer Index: Ratio of MCV/RBC: | Ratio 13 indicates ______
Thalassemia; IDA
61
What is an inherited disorder of globin chain synthesis and can affect either alpha or beta chain production?  Homozygous is which form? Heterozygous?
Microcytic hypochromic anemias thalassemia Homozygous: major Heterozygous: minor
62
B-Thal Major smear exhibits which 4 types of cells?
1. microcytic hypochromic cells 2. basophillic stippling 3. target cells 4. NRBC's
63
Which microcytic hypochromic anemia has the following conditions? •  Serum iron increased •  TIBC decreased or normal •  % saturation increased •  Ferritin increased or normal •  Reticulocyte count increased •  Serum LDH may be increased with active hemolysis
Thalassemia
64
What is a carrier for FREE plasma HGB- levels tend to be reduced due to hemolysis?
Haptoglobin
65
Hp levels ___________ with increased RETIC and decreased RBC/Hbg/Hct --> points to which condition?
DECREASED; hemolytic anemia
66
What is happening when Hp levels DECREASE without signs of hemolytic anemia?
Liver is not making enough Hp
67
What is happening when Hp levels are normal with increased RETIC?
RBC destruction in the spleen/liver with no free Hgb released and no Hp consumed.
68
What is happening when Hp levels are normal with NORMAL RETIC?
Anemia present is not due to RBC breakdown as no Hp is being consumed
69
Thalassemia related Anemia Lab Evaluation Summary: 1. RBC size & Hgb content: 2. Abnormal shape RBCs: 3. Reticulocyte production response: 4. Clinical indicators:
1. microcytic 2. “thalassemia picture” if severe, normal if mild 3. increased 4. Congenital hx of anemia
70
Tests to DDx from IDA: 1. Thalassemia has ______ to ______ serum ferritin 2. TIBC ______ to _____ 3. Serum iron ______ to _______ 4. Hemoglobin eletrophoresis in ____________
1. normal to high 2. normal to low 3. normal to high 4. Thalassemia
71
What is required for synthesis of δ-ALA for heme production?
B6
72
Which microcytic hypochromic anemia deficiency is an acquired form more common and associated most frequently with isoniazid therapy for TB, hereditary form very rare?
pyridoxine (vitamin B6) deficiency
73
Which condition has the following characteristics? - Acquired or Hereditary (often due to B6 deficiency) - Ineffective RBC formation (two RBC populations, one normochromic & one hypochromic) - Diagnosed by BM biopsy, find “Rings” of Fe in RBC
Sideroblastic Anemia
74
Which condition has a defect in heme synthesis which leads to anemia when Pb levels are very high? Also, a significant lead intoxication will occur before micro-hypo anemia. Basophilic Stippling in RBCs & Retic Low
Lead Poisoning
75
The following are which types of -cytic/-chromic anemia? - Acute blood loss - Anemia of Chronic Disease (ACD) - Hemolytic Anemia from any cause - Hereditary spherocytosis - Aplastic Anemia - G6PD deficiency
Normocytic normochromic anemias
76
Which type of anemia has the following characteristics? •  Mild normo-normo (sometimes micro-hypo) anemia that persists more than 1-2 months. •  Characterized by low serum iron despite high iron stores (ferritin) •  Iron is being sequestered by the body so as to not damage the tissue during inflammatory processes. •  Mediated by cytokines and regulated by hepcidin •  Affects many aspects of RBC synthesis and lifespan
Anemia of chronic disease
77
What is the master regulator of iron homeostasis?
Hepsidin
78
Which type of anemia has the following characteristics? •  Cellular depletion with fatty replacement of marrow •  Pancytopenia - decreased production of all cell lines •  Increased serum iron - because there aren't enough RBCs to store the iron •  Patients given marrow transplants, but have to match HLA (human leukocyte locus A), usually with a family member
Aplastic anemia
79
T/F: The etiology of aplastic anemia is almost always by environmental, or chemical factors, is idiopathic but linked to benzene, radiation, infections, and Chloramphenicol.
True
80
Lab features of aplastic anemia include which 3 things?
1. normocytic normochromic anemia 2. decreased platelets 3. increased risk of infection
81
Lab tests for aplastic anemia include which 3 things?
1. reticulocyte count of zero 2. normocytic normochromic anemia 3. elevated serum iron
82
Aplastic anemia patients need to be kept alive by what means? What is their prognosis?
transfusions of WBCs and platelets | die within 4-5 years of onset
83
In Hemolytic Anemia: due to G6PD deficiency, decreased ATP production leads to which 2 detriments of the RBC?
1. decreased membrane flexibility | 2. increased oxidative damage
84
Which anemic condition has the following characteristics? •  Sex-linked genetic disorder, X chromosome •  More common in Kurdish Jews & Af.-American •  Selective advantage to malaria •  Females can manifest if defect on both XX
Hemolytic Anemia: due to G6PD deficiency
85
What is the most definitive test method for hemolytic anemia due to G6PD deficiency?
Assay of G6PD enzyme
86
Susceptible persons with Hemolytic Anemia: due to G6PD deficiency exhibit hemolysis under which 3 conditions?
1. oxidative stress – usually drugs: antimalarials, sulfa, nitrofurantoins, aspirin 2. certain foods - fava beans 3. high dose intravenous vitamin C
87
Spherocytosis has both hereditary and acquired forms. ___% or more RBC are affected if hereditary.
70%
88
Spherocytosis has an elevated retic (>9%) count in ____% of patients.
90%
89
The following are indicative of labs for which condition? - Normal to decreased MCV - Decreased Hgb - Normal to increased MCH - Increased MCHC - Hemolytic anemia pattern
Spherocytosis
90
Osmotic fragility test indicates the ability of the RBC to do what, and depends upon surface/volume ratio or shape?
take up water without bursting
91
When conducting the Osmotic fragility test: | RBCs in hypertonic solutions, cells ______; in hypotonic solutions, cells ________
shrink; swell
92
Full/thick cells like spherocytes have a/an _________ fragility; thin cells like target cells have a/an _______ fragility
increased; decreased

Lab Diagnosis (6 decks)

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