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Clinical Pathology > Anemia > Flashcards

Anemia Flashcards

1
Q

___ is a response in which tissue hypoxia produces increased levels of erythropoietin in the plasma. This stimulates the marrow stem cells to produce more RBCs

A

Normoblastic hyperplasia

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2
Q

The clinical expression of anemia results from _____

A

Tissue hypoxia

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3
Q

Clinically, anemia is defined as hemoglobin less than __g/dl for an adult female, and __g/dl for an adult male.

A

11, 13

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4
Q

The most important single test in the diagnoses of anemia?

A

Peripheral blood smear

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5
Q

The ___ has become the most important RBC index in the differential diagnoses of anemia

A

MCV (Mean Corpuscular Volume)

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6
Q

What are the three categories of anemia due to deficient erythropoiesis (the making of RBCs)?

A
  1. Hypochromic-microcytic anemia
  2. Normochromic-normocytic anemia
  3. Macrocytic anemia
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7
Q

Deficient or defective heme or globin synthesis produces a _____ RBC population (morphology)

A

Hypochromic-microcytic

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8
Q

A very important lab test for hypochromic-microcytic anemia?

A

Serum ferritin

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9
Q

___ is an iron storage glycoprotein closely correlated with total body iron stores.

A

Ferritin

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10
Q

Where is most iron absorbed by the body?

A

Duodenum and jejunum

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11
Q

Name a subgroup most likely to get iron deficiency anemia (IDA)?

A

Pregnant women (infants/toddlers next)

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12
Q

The most common cause of IDA?

A

Menorrhagia (heavy or prolonged menstruation)

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13
Q

An eating disorder in which a person eats things w/no nutritional value (dirt, paint chips, etc.)

A

Pica

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14
Q

A type of pica in which the person craves and likes chewing ice

A

Pagophagia

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15
Q

The name for a person getting “spoon nails”, usually due to iron deficiency anemia.

A

Koilonychia

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16
Q

Painful inflammation and cracking of the corners of the mouth - can be caused by IDA.

A

Cheilosis

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17
Q

RBC index that indicates average RBC size/volume

A

Mean corpuscular volume (MCV)

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18
Q

The first lab test to become decreased in IDA?

A

Serum ferritin

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19
Q

Cell found in persons w/G6PD deficiency?

A

Bite cell

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20
Q

Test for antibodies coating RBCs?

A

Coombs

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21
Q

Second most common anemia in the world?

A

Anemia of Chronic Disease (ACD)

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22
Q

Anemia with increased RBC count?

A

Thalassemia

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23
Q

Increased osmotic fragility of RBCs is called ____

A

Spherocytosis

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24
Q

Anemia with hypersegmented PMNs?

A

Megaloblastic/macrocytic

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25
Q

Measures effective bone marrow RBC production

A

Reticulocyte count

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26
Q

AKA beta thalassemia major

A

Cooleys

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27
Q

Autoantibody that reacts at cold temps

A

IgM

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28
Q

Causes normochromic, normocytic anemia

A

Hypothyroidism

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29
Q

Macrocytic anemia without neurological findings is due to?

A

Folic acid deficiency

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30
Q

Anemia with all lab parameters decreased?

A

Iron deficiency anemia (IDA)

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31
Q

Thalassemia with deficient synthesis of the beta globin chain

A

Beta Thalassemia

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32
Q

Anemia with koilonychia (spoon nails)

A

IDA

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33
Q

Eating fava beans causes this anemia

A

Glucose-6-Phosphate Dehydrogenase deficiency (G6PD)

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34
Q

Anemia with jaundice and spenomegaly

A

Hemolytic

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35
Q

Anemia with GI and neurological findings

A

B12 deficiency

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36
Q

Symptoms of anemia develop after 6 months of age

A

Sickle cell anemia

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37
Q

Craving for ice

A

Pagophagia

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38
Q

Cells found in microangiopathic anemia

A

Schistocytes

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39
Q

Reticulocyte count is >5%

A

Hemolysis

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40
Q

Most common cause of acquired sideroblastic anemia?

A

Alcoholism

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41
Q

Severe anemia, leukopenia, and thrombocytopenia

A

Aplastic

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42
Q

Cell type in blood of patients with thalassemia?

A

Target cells

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43
Q

A lack of gastric HCL is called ____ (a cause of IDA)

A

Achlorhydria

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44
Q

This anemia is due to inadequate or abnormal utilization of intracellular iron for Hb synthesis, despite adequate or increased amounts of iron in the mitochondria of developing RBC precursors. Can be congenital or acquired.

A

Sideroblastic anemia (iron utilization anemia)

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45
Q

What vitamin deficiency is associated with sideroblastic anemia?

A

Pyridoxine (B6)

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46
Q

What type of cells might be found in a peripheral smear of someone with SA?

A

Siderocytes

47
Q

Expected results for a patient with SA would be ____ serum iron, and ____ ferritin

A

Increased, increased

48
Q

Sideroblastic anemia would have a ___ reticulocyte count

A

Low

49
Q

A ____ is the best test to assess degree of iron overload

A

Liver biopsy

50
Q

In this anemia biologically aging RBC iron fails to be released by the reticulum cells for Hb synthesis by the erythron. Can be caused by infections, inflammatory disease (especially RA), and malignancy.

A

Anemia of Chronic Disease (ACD)= iron-reutilization anemia

51
Q

In ___ anemia, RDW is normal, while in the other two hypochromic, microcytic anemias it is elevated.

A

Anemia of Chronic Disease (ACD)

52
Q

What morphology of RBCs results from bone marrow failure and the resultant decreased RBC production.

A

Normochromic-normocytic

53
Q

In anemia of renal disease, the decreased ____ production results in inadequate humoral stimulus of RBC production.

A

Erythropoietin

54
Q

What type of cells might be found in a smear of anemia of renal disease?

A

Burr cells

55
Q

In anemia due to ____, metabolism is reduced causing the tissues to require less oxygen and erythropoietin levels to fall.

A

Hypothyroidism

56
Q

___ anemia is defined as pancytopenia and hypocellular bone marrow in the absence of abnormal cell infiltrate. 2 forms = congenital and acquired.

A

Aplastic

57
Q

Deficiency of ALL THREE cellular components of blood (RBCs, WBCs, and platelets)

A

Pancytopenia

58
Q

About __% of aplastic anemia cases are idiopathic

A

50%

59
Q

CBC findings would include normochromic, normocytic anemia, leukopenia, neutropenia <1,500/dl, marked thrombocytopenia, borderline high MCV (>104)

A

Aplastic anemia

60
Q

___ anemia is due to a carcinoma metastasizing to bone marrow from primary tumors, myelofibrosis, marble-bone disease of Albers-Schonberg, multiple myeloma, leukemia, Lymphoma, hodgkin’s.

A

Myelophthisic

61
Q

What RBC morphology is a result of defective DNA synthesis, however, RNA synthesis continues resulting in an increase in cytoplasmic mass and maturation?

A

Megaloblastic/Macrocytic

62
Q

What type of WBCs are a normal finding in megaloblastic anemias?

A

Hypersegmented PMN’s

63
Q

Absorption of vitamin B12 occurs in the terminal ____ with the aid of intrinsic factor (a glycoprotein secreted by the parietal cells in the fundus of the stomach).

A

Ileum

64
Q

Vitamin B12 attaches to a specific plasma protein, ______, and circulates in this form

A

Transcobalamin

65
Q

Vitamin B12 stores in the liver are normally sufficient to sustain physiologic needs for __-__ years!

A

3-5

66
Q

____ is necessary for adequate DNA synthesis through it’s role in folic acid metabolism. It is also involved in the synthesis of myelin.

A

Cyanocobalamin

67
Q

____ anemia may lead to a deficiency of intrinsic factor which can lead to Vitamin B12 deficiency anemia.

A

Pernicious

68
Q

Dietary deficiency of vitamin B12 happens often to those who are ____

A

Strict Vegans

69
Q

MCV would be >___ in B12 deficiency anemia

A

100

70
Q

A peripheral blood smear would show macro-ovalocytosis, anisocytosis, poikilocytosis, basophilic stippling of RBCs, Howell-Jolly bodies, hypersegmentation of granular leukocytes

A

Anemia due to B12 deficiency

71
Q

In B12 deficiency anemia, a chem panel would show ___ serum bilirubin, while a UA would show ___ bilirubin

A

Elevated, negative

72
Q

The ___ test measures the absorption of radioactive B12 with and without intrinsic factor

A

Schilling

73
Q

____ treatment (another B vitamin) without B12 in patients with pernicious anemia is contraindicated

A

Folic acid

74
Q

A patient who has B12 deficiency anemia has a 3-fold increase in the risk of developing ___ cancer

A

Stomach (gastric carcinoma)

75
Q

B12 injections will be needed how often for the rest of a patient’s life if they have B12 deficiency anemia?

A

Monthly (can be taught to give them to themselves)

76
Q

___ deficiency anemia may be indistinguishable from B12 deficiency anemia, except that neurological symptoms do NOT occur from this deficiency.

A

Folic acid

77
Q

In folic acid deficiency anemia, serum folic acid levels would be expected to be

A

Low (<5 ng/ml)

78
Q

___ anemia results when the bone marrow production can no longer keep up with the RBC destruction

A

Hemolytic

79
Q

Anemia with high lactate dehydrogenase values

A

Hemolytic

80
Q

An alpha-2 globulin that binds any free hemoglobin released into the blood from RBC destruction. The level of this would be decreased if tested because more is bound and undetectable.

A

Haptoglobin

81
Q

An autosomal dominant defect in the structure of the RBC membrane that allows sodium to leak into the cell at 2x the normal rate causing spherocytes which are sequestered and destroyed in the spleen

A

Hereditary spherocytosis

82
Q

Management for hereditary spherocytosis?

A

Splenectomy

83
Q

An X-linked genetic abnormality of a specific enzyme, occurring in about 10% of American black males, and to a lesser extent in persons of Mediterranean descent.

A

G6PD Deficiency

84
Q

___ is called sickle cell anemia, while ____ is called sickle cell trait which is normally asymptomatic w/no anemia. (Heterozygous, homozygous)

A

Homozygous, heterozygous

85
Q

Fetal mortality in a pregnant person with sickle cell anemia is __-__%

A

35-40%

86
Q

About 1/___ African Americans and 1/____ Hispanics have sickle cell anemia

A

500, 1,000

87
Q

Aka “Painful crisis” - the most common clinical sign of sickle cell anemia - pain results from tissue necrosis secondary to vascular occlusion and tissue hypoxia.

A

Vaso-occlusive crisis

88
Q

In sickle cell anemia there is NO Hb __, and 80-100% of Hb is Hb __

A

A, S

89
Q

Causes thickened cranial bones and malar eminences (bone hyperplasia)

A

Beta thalassemia major (Cooley’s anemia)

90
Q

This type of anemia will have elevated levels of Hb F (>50%), and reduced or absent Hb A

A

Beta thalassemia major

91
Q

Iron overload causes most of the morbidity and mortality in this anemia

A

Beta thalassemia major (Cooley’s)

92
Q

Beta thalassemia MAJOR is due to the ____ defective production rates of beta globin polypeptide chains, while beta thalassemia MINOR is due to the ____ (homozygous, heterozygous)

A

Homozygous, heterozygous

93
Q

In a special test where MCV/RBC count (Mentzer index), <13 means ___ is more likely, while >13 means ___ is more likely

A

Thalassemia, iron deficiency

94
Q

Schistocytes are formed from some kind of trauma in this anemia

A

Microangiopathic anemia (Traumatic hemolytic anemia)

95
Q

This type of anemia results when the mother’s antibodies attack the fetal RBCs. Reticulocytosis is >6%. Positive direct Coomb’s test (antibodies coating RBCs)

A

Isoimmune

96
Q

___ is an acquired anemia induced by binding of autoantibodies to RBC membrane antigens. 3 types: warm, cold, mixed

A

Autoimmune hemolytic anemia (AIHA)

97
Q

WARM AIHA has reacting ___ antibodies, while cold has reacting ___ antibodies

A

IgG, IgM

98
Q

Normal range for reticulocyte count?

A

0.5-1.5%

99
Q

A bone marrow examination confirms the diagnosis of SA. What type of cell would you expect to see?

A

Ringed sideroblasts

100
Q

In ACD, the transferrin saturation is >10%, meaning the serum transferrin levels are _____

A

Decreased (because the test is for FREE transferrin)

101
Q

In ACD, anemia of renal disease, anemia due to hypothyroidism, and myelophthisic anemia, what does the management/treatment consist of?

A

Treatment of the underlying disease

102
Q

The three etiologies of Vitamin B12 deficiency anemia?

A
  1. Deficiency of intrinsic factor
  2. Malabsorption syndromes
  3. Inadequate dietary intake
102
Q

What clinical finding of B12 deficiency might be found even in the absence of anemia?

A

Neuropathy (usually peripheral)

102
Q

In hereditary spherocytosis, MCHC should be ____

A

Elevated (hyperchromasia)

103
Q

A chronic hemoglobinopathy transmitted genetically. Marked by moderately severe chronic hemolytic anemia, periodic acute episodes of “painful crisis”, and increased susceptibility to intercurrent infections, especially Saccharomyces pneumoniae.

A

Sickle cell anemia

104
Q

Name the three types of “crises” in sickle cell anemia

A
  1. Vaso-occlusive (aka Painful crisis)
  2. Aplastic (suppression of RBC production by severe infection)
  3. Hyperhemolytic (accelerated hemolysis - could be due to acute bacterial infection)
105
Q

A good screening test for sickle cell anemia

A

Sickledex test

106
Q

____ RBCs are inflexible - their odd shape and cell rigidity cause increased blood viscosity, stasis, mechanical obstruction of small arterioles and capillaries, and ischemia. They are also fragile, leading to hemolysis.

A

Sickle

107
Q

Nucleated RBCs and Howell-Jolly bodies (RBCs with a small amount of DNA remaining in them) are often seen in a peripheral smear of _____ or ____ anemia’s

A

Sickle cell, thalassemia (B-T major)

108
Q

A group of inherited disorders that affect the synthesis of adult hemoglobin tetramer (Hb A). Inadequate hemoglobin and unbalanced accumulation of globin synthesis results in hypochromic, microcytic red cells, and hemolytic anemia.

A

Thalassemia

109
Q

Hemoglobin electrophoresis will show elevated Hb A2, decreased Hb A, and slightly increased Hb F. A few target cells will be present in the smear.

A

Beta thalassemia minor

110
Q

This type of anemia can be due to “march hemoglobinuria, karate, or bongo playing. Can also be due to prosthetic heart valves. Lab findings will show low MCV, and high RDW.

A

Microangiopathic anemia (traumatic hemolytic anemia)

111
Q

This excessive RBC destruction anemia can be due to malaria, bacterial toxins such as Clostridium perfringens, streptococci, or meningococci.

A

Hemolysis due to infectious agents

112
Q

What morphological type of RBCs would you see in Autoimmune Hemolytic anemia?

A

Normochromic, normocytic

Clinical Pathology (12 decks)

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