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Anemia Flashcards

1
Q

Define Anemia

A

Insufficient red cell mass to adequately deliver oxygen to peripheral tissues

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2
Q

Anemia - influence of gender, age, etc demands

A

Females lower
High at birth, drops, then increase
pregnancy/menstration decrease HCT/HGB

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3
Q

Define Reticulocytes

A

Presence of mRNA in RBC first say in systemic circulations. Larger and darker - immature

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4
Q

Count and Absolute count RET

A

percent of RBC; a definite number of RBC

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5
Q

Reticulocyte index

A

way to measure RBC production by correcting RET count for concentration and stress reticulocytosis (1.5 - mild, 2.0 mod, 2.5 severe)
RI < 1 = anemia = decrease production of RBC
RI > 2 = loss of RBC, destruction/bleeding

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6
Q

MCV 80-100 =?

A

normocytic anemia

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7
Q

MCV >100

MCV < 80

A

macro and microcytic anemia

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8
Q

RET is normal –> consider which factors?

A

hemolysis or hemorrhagic causes

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9
Q

Iron more soluble at ____ pH

A

low

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10
Q

Distribution of Fe in hemoglobin, muscle, intracellular

A

65, 6, 25

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11
Q

Intracellular Fe storage by ____ and ____

A

ferritin and hemosiderin

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12
Q

Fe absorbed in __

A

duodenum

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13
Q

Iron transportation steps from duodenum across BL membrane

A

Fe3+ –> DCYTB to Fe2+ –> Enter cell DMT1 –> Fe stored in ferritin –> transported BL membrane –> ferrous exit via ferroportin –> Hephaestin oxidize to Fe3+ to plasma apotransferrin

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14
Q

Iron transportant from plasma to endocytosis

A

Fe3+ in plasma –> transferrin –> transferrin receptor on normoblast –> invagination –> endosome –> pH drops –> Fe released –> leaves DMT1 –> Fe in ferritin –> Transferrin/TR to cell surface

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15
Q

Transferrin is a _____ _______

A

plasma transporter

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16
Q

Ferritin is a _______ ______

A

intracellular Fe storage

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17
Q

Iron deficiency - stages 1, 2, 3 described as?

A

1: iron stores decreased (ferritin lvl)
2: iron deficient erythropoiesis - decrease in serium ion, increase iron binding capacity - decrease in percent sat
(Iron loading of normoblast impaired, no change in RBC)
3: Transferrin increase, serum iron low, sat low - microcytic/hypochromic; Red cell protoporhyrin increase

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18
Q

Causes of iron deficiency

A

Excessive losses - bleed, Failure to accumulate Fe, inability to gain Fe during growth

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19
Q

hepcidin - define and fcn

A

25 amino acid peptide - regulates iron absorption
binds to ferroportin + degradation = loss of Fe export out of epithelial cell –> response from (increased accumulation of Fe/infection/inflammation)

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20
Q

Koilonychia - define

A

bowing of nail

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21
Q

Achlorhydria - define

A

low production of gastric acids

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22
Q

Decreased RBC causes (by categories)

A 
iron deficiency
chronic infection/inflammation
malignant disease
renal insufficiency
endocrine disorder
lead intoxication
Mal nutrition
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23
Q

Hemoglobin synthesis

A

Heme + globin

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24
Q

Heme synthesis

A

Protoporphyrin synthesis + Fe

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25
Q

Lead effect on Hgb

A

Pb prevents synthesis of protoporphyrin + enzyme that ligates iron to proto

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26
Q

Chronic disease: TNF –> effect

A

Decrease iron, decrease EPO

27
Q

Chronic disease INF-B –> effect

A

Inhibits erythropoiesis

28
Q

TNF/INF B defect occurs during _____ and _____?

A

malignancies (neoplasm) and sepsis

29
Q

Chronic infection/inflammation affect which 2 factors

A

IL1 / INF Y

30
Q

IL1 effect on RBC

A

Decrease iron and EPO

31
Q

INF Y on RBC

A

inhibits proliferation of erythroid precursors

32
Q

Lead intoxication signs/symptoms

A

moderate anemia, decreased ret, microcytosis, basophilic stippling, increase zinc protoporphyrin

33
Q

Renal insufficiency signs/symptooms

A

Kidney<40% - normochromic, EPO deficiency

Treatment - give EPO

34
Q

Macrocytic anemia causes

A

Folate and B12 deficiency

35
Q

Folate absorbed in the _____

36
Q

B12 absorbed in the

A

Terminal ilieum

37
Q

B12 and folate –> macrocytic - why?

A

Folic acid –> methyltetrahdrofolate –> B12 –> Homocysteine = methionine
(pass on methyl group)
THF substrate for purine/pryimidine sythesis (DNA synthesis)
Deficienc = stops in S –> destruction

38
Q

B12 deficiency is caused by

A 
Mostly malabsorption (pernicious anemia - autoimmune destruction of IF producing gastric parietal cells)
Food - mostly with vegans
39
Q

Folate deficiency caused by

40
Q

B12/Folate deficiency blood/smear test:

A

Increase erythoid to myeloid ratio - hyperplasia
Megaloblastic anemia
Macrocytosis
RET decrease
Macro-ovalocytes/hyperseg neutro, poikilocytes
Neutropenia, thrombocytopenia, increase bilirubin, LDH (intramedullary destruction)

41
Q

B 12 and folate lab differences

A

B12 - neurological problems + MMA (methylmalonic acid)

42
Q

Onset rate of B12 and folate deficiency

A

B12 - months/year; folate - weeks

43
Q

B12 deficiency AKA ________ deficiency

44
Q

Treatment for B12 deficiency

A

IM/SQ B12 QD, QW –> HCT normal = maintance for life

45
Q

Folic deficiency

A

1 mg/day orally/parenterally (IV,SQ, IM)

46
Q

normochromic/normocytic anemia associated with

A

vitamin,mineral, protein/calorie malnutrition

47
Q

define hemolysis

A

decreased in red cell survival/increase turnover

48
Q

Intravascular hemolysis

A

destroyed in circulation

49
Q

Extravascular hemolysis

A

by RE system, enterohepatic cirrculation or excreted by kidney to urine

50
Q

Test for anemias

A

CBC, periphery smeas, RET/RI, bilirubin increase = hemolysis

51
Q

RBC membrane/cytoskeleton and hereditary spherocytosis

A

Spectrin, ankyrin, band3.1

52
Q

osmotic fragility test

A

Place cells in solution with different cocentration. At higher water concentration - cells will swell and lyse; spherocytes will lyse more easily

53
Q

Hereditary spherocytosis treatment

A

splenectomy

54
Q

G6PD deficiency and hemolysis anemia

A

G6PD gets rid of ROS by restoring GSSH –> GSH

55
Q

direct antiglobulin test DAT

A

IgG or C3d/C4d on RBC by adding coombs reagent –> agglutiniation

56
Q

Coombs reagents have Ab for ___, ___, ___

A

IgG, C3d, C4d

57
Q

IAT - indirect antiglobulin test

A

ABility to patient serum to bind IgG/complement - test normal RBC

58
Q

Autoimmune hemolytic anemia - define and DAT

A

antibody to red cell antigen - induces lyse/phagocytosis

DAT +

59
Q

Warm auto immune hemolytic anemia

A

Positive DAT, max at 37 - without antigen specificy

IgG binds RBC –> splenic macrophage -> antibody mediated pahgocytosis

60
Q

Cold autoimmune hemolytic anemia

A

positive DAT - max at 5, antigen specific for i or I

antibodies of IgG/IgM - binds in periphery -> activate complement –> in body punch holes

61
Q

C3 induced phagocytosis via complement receptor –> intra/extra vascular hemolysis

62
Q

Splenectomy: risk + benefit

A

Risk: Clearance of intravascular microbe - increas spesis mortality, developmenet of adaptive humoral response, origin of IgM agglutinins
Benefit - less hemolysis of red cell

63
Q

splenectomy - contraindicated and post op care

A

kids under 5
Give vaccine against H influ. S. Pneumonia, meingococcus
Give prophylactic antibotics 9penicillin) during childhood - prevents infection

Immunology (9 decks)

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