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IHO week 3 > anemia > Flashcards

anemia Flashcards

1
Q

what are the 3 groups of anemia?

A
  1. weird size
  2. weird shape
  3. Normal size and shape
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2
Q

what does anisocytosis mean?

A

Abnormal size

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3
Q

What doe piokilocytosis mean?

A

abnormal shape

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4
Q

What are the 3 groups of weird size anemias?

A
  1. IDA
  2. Thalassemia
  3. Megaloblastic anemia
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5
Q

what are the things you need to know of IDA?

A
  1. most important cause is GI bleed
  2. Microcytic, Hypochromic anemia
  3. Increased anisocytosis and piokilocytosis
  4. Decreased reticulocytes and increased platelets
  5. abnormal iron studies
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6
Q

Where is iron absorbed in the gut?

A

Duodenum and proximal jejunum

  • after it crossed enterocytes it binds to transferrin in the blood
  • about 33% of transferrin molecules are bound to iron
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7
Q

What is the purpose of transferrin?

A

-chaperone protein that transporter iron in the blood and liver it to the liver and BM Macs for storage

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8
Q

What is hemoglobin made up of?

A 
Hgb= 4 heme+ 4 globin
-heme= fe+protoporphyrin
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9
Q

What is methemoglobin and what is its purpose?

A

heme cousin

- but finds Fe3+ (ferric) rather than Fe2+

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10
Q

What are 2 forms of iron storage?

A

Ferritin- quick in quick out
- long protein with multiple holding sites of Fe

Hemosiderin- more stable (harder to get in and out of RBC precursors and Macs)

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11
Q

What are the causes of IDA?

A
  1. Decreased iron intake (Bad diet or absorption)
  2. Increased iron loss (GI bleed, menses and slow bleeding over time)
  3. Increased Iron requirement (pregnancy or huge growth spurs)
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12
Q

What should you think when it comes to IDA dx?

A

Premenopausal women–> Menorrhagia

Everyone else–> Gi blood loss and rule our GI carcinoma in elderly

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13
Q

What are some symptoms of IDA?

A
  1. Weak, fatigue, and dyspnea
  2. pale conjunctiva and skin
  3. HA and lightheadedness
  4. angina with preexisting CAD
    - you can be asymptomatic
    - Pica- craving dirt, ice or windex
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14
Q

What is a common blood smear finding with IDA?

A
  • ovalocytes

- increased zone of central pallor

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15
Q

what are the BM findings in IDA?

A
  • erythroid hypoplasia
  • dyserythropoiesis
  • decreased iron stores
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16
Q

What are the common labs in IDA?

A
  1. Low ferritin
  2. increased TIBC
  3. Lowe serum iron
  4. Low % saturation
17
Q

How does one treat IDA?

A

Find out the cause!!!!

give oral iron (ferrous sulfate)

18
Q

What do you need to know about Megoloblastic anemia?

A
  • Defective DNA synthesis
  • Nuclear/cytoplasmic asynchrony
  • decreased B12 or folate or both
  • macrocytic anemia with oval macs and hypersegmented neuts (>5)
19
Q

What is the source of B12 and where do you absorb it?

A

comes from animal derived proteins

  • Binds to IF from parietal cells and gets absorbed in the ileum
  • onces in blood stream B12 binds to transcobalamin 2
  • takes years to present
20
Q

what are the cause of B12 deficient anemia?

A
  • Diet– rare (ton stored in liver
  • lack of IF (pernicious anemia destroyes pareital cells which make IF
  • Pancreatic damage (lack of proteases to break R-binder of of B12 in the duodenum
  • Illeal damage
  • Tapeworm (raw fish)
21
Q

What are signs and sx’s of B12 anemia?

A
  1. Atrophic glossitis (swelling of tongue called beefy tongue and papillae disappear)
  2. Macrocytosis RBC and hypersegmented neuts
  3. Subacute combined degeneration of spinal cord
  4. Increased methylmalonic acid
  5. increased serum homocysteine
  6. decreased serum vit b12
22
Q

What can increased homocysteine cause?

A

atherosclerosis and thrombosis

23
Q

What can decreased methionine cause?

A

Subacute combined degeneration

- both sensory and motor loss (DC/ML and lateral corticospinal tract respectively)

24
Q

What are the sources of folate and where is it absorbed?

A

Lots of sources but mainly from green vegetables and fruits

  • absorbed in jejunum and converted to methyl-FH4
  • transported freely to liver and red cells
25
Q

What are the causes of folate def?

A

Diet
alcohol abuse
jejunal damage
drugs

26
Q

What is the BM morphology of megaloblastic anemia?

A

Megaloblastic erythroblasts

Megaloblastic neuts

27
Q

What are the cause of macrocytic anemia that are not megaloblastic?

A

alcoholism
liver disease
Drugs like 5-FU

28
Q

what is the schilling test used for?

A

To detect deficiency in B12

  • the purpose is to see if the patient has Pernicious anemia
  • if no radioactive b12 in urine after given try with IF to see if its PA
29
Q

What re the weird shape anemias?

A

Hemolytic anemias like
HS, AIHA, sickle cell
G6pD deficiency and MAHA

30
Q

Sight of destruction of RBC’s?

A
  • increased serum bilirubin
  • increased LDH
  • decreased Haptoglobin
  • Hemoglobinemia/uria
31
Q

What is haptoglobin?

A

Scavenger of free hemoglobin in the blood

32
Q

What are some signs of increased RBC production?

A

Reticulocytosis

nucleated RBCs

33
Q

What is the direct antiglobulin test?

A

looks for ab on RBC surface

- + results means immune process

IHO week 3 (4 decks)

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