Anemia Flashcards
normal WBC
4-12
normal WBC
4-12
normal Hbg
13.5-17
normal HCT
39-51
normal MCV
82-97
normal platelet
150-450
normal neutrophil %
45-70
normal lymphocyte %
20-40
normal monocyte %
2-9
normal eosinophil %
ANC
predisposes to rapidly fatal bacterial or fungal infection
anemia presents with
low RBC, low Hbg, low HCT
> 20% myeloblasts of uniform morphology indicates
leukemia
epo made in response to
low tissue oxygenation levels
epo is appropriately increased in cases of
anemia hypoxia CO poisoning Hgb variants methemoglobinemia high altitude
G-CSF (neupogen, neulasta)
for mobilization of stem cells
used post-chemotherapy or for autologous or allogenic donation
G-CSF (neupogen, neulasta)
for mobilization of stem cells
used post-chemotherapy or for autologous or allogenic donation
normal Hbg
13.5-17
normal HCT
39-51
normal MCV
82-97
normal platelet
150-450
normal neutrophil %
45-70
normal lymphocyte %
20-40
normal monocyte %
2-9
normal eosinophil %
ANC
predisposes to rapidly fatal bacterial or fungal infection
anemia presents with
low RBC, low Hbg, low HCT
> 20% myeloblasts of uniform morphology indicates
leukemia
too little hepcidin causes
iron overload
epo is appropriately increased in cases of
anemia hypoxia CO poisoning Hgb variants methemoglobinemia high altitude
epo is pathologically increased in
VHL syndrome
tumors of kidney, liver, cerebellum
G-CSF (neupogen, neulasta)
for mobilization of stem cells
used post-chemotherapy or for autologous or allogenic donation
microcytic anemia causes
iron deficiency
thalassemia
anemia of chronic disease
sideroblastic anemia
normocytic anemia causes
anemia of chronic disease iron deficiency toxins, drug malignancies kidney disease
macrocytic anemia causes
bone marrow failure myelodysplasia vitamin B12 deficiency folate deficiency elevated reticulocytes liver disease, thyroid disease, alcoholism
in extravascular hemolysis, what levels are elevated
LDH and retics
urine is dark in ___ hemolysis
intravascular
extravascular hemolysis can be amenable to
splenectomy
where is iron mostly absorbed
in the duodenum
where is iron balanced
in the liver
what does iron promote
free radical formation and bacterial growth
hepcidin is produced by
liver
function of hepcidin
controls iron absorption from the gut
too much hepcidin causes
anemia of chronic disease
too little hepcidin causes
iron overload
symptoms of anemia
fatigue pallor tachycardia increased plasma volume increased myocardial demand
iron deficiency in a man…
do a GI workup for blood loss and malabsorption
iron absorption is increased by
gastric acid, vitamin C
major limitation on life expectancy in thalassemia
iron overload
genetics of hemachromatosis
biallelic mutation of HFE gene
bronze diabetes
think hemachromatosis. Check iron livers (especially in patients with liver disease)
treatment of iron overload
phlebotomy if normal erythropoeisis
side effects of iron chelation
color vision, hearing abnormalities, effects on renal function
what is elevated in B12 deficiency
homocysteine (pro-thrombotic) and methylmalonic acid levels (neuro-toxicity)
folate deficiency may be responsible for
neural tube defects/spina bifida
where is B12 absorbed
terminal ileum
gastric symptoms of pernicious anemia
impaired mucosal proliferation
weight loss, diarrhea, malabsorption
gastric cancer
what to suspect in folate deficiency
alcoholism
pure red cell aplasia
autoimmune disease
just can’t make RBC’s
infectious cause of pure red cell aplasia
parvovirus B19
agranulocytosis often caused by
drugs- anti epileptics, phenylbutazone
inherited bone marrow failure syndromes
Fanconi’s anemia
Dyskeratosis congenita
Acquired bone marrow failure syndrome
aplastic anemia
PNH
MDS
HIV
treatment of aplastic anemia
quine anti-thymocyte globulin (ATG)
ATG immunosuppression enhanced by
cyclosporine
treatment of PNH
eculizumab: monoclonal antibody inactivating C5 complement protein
free Hb binds to
haptoglobin or hemopexin
how is unbound Hb excreted
in the urine
polychromatophilia
blue-gray staining due to RNA and Hb in young RBC’s
stomatocytosis
mouth-shaped central pallor
PNH caused by
loss of HPI proteins CD55 and 59- leads to increased sensitivity to lysis by complement
G6PD mutation
key enzyme of hexose monophosphate shunt
mutation in PK
necessary for energy production- rare
HbA
alpha2beta2 (>95%)
Fetal Hb
alpha2gamma2 (trace)
HbA2
alpha2delta2 (1-2%)
excess chains
damage to RBC membrane
how are damaged RBC’s removed
extramedullary hemolysis
Fe accumulation leads to
death of RBC’s in marrow (intramedullary hemolysis)
target cells
thalassemia
worst symptoms of beta thalassemia major
severe anemia
congestive heart failure
bone marrow expansion
iron overload
treatment of beta thalassemia
hypertransfusion Fe chelation splenectomy increased HbF production gene therapy bone marrow transplantation
hemoglobin H disease
absence of 3 functional alpha genes
cause of sickle cell anemia
single base pair mutation (glu->val)
altered solubility of desoxy HbS causes aggregation of molecules, decrease deformability
bite cells
G6PD deficiency
delayed hemolytic transfusion reaction caused by
exposure to blood with minor blood group incompatibility
