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
2
Q
The clinical expression of anemia results from _____
A
Tissue hypoxia
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
4
Q
The most important single test in the diagnoses of anemia?
A
Peripheral blood smear
5
Q
The ___ has become the most important RBC index in the differential diagnoses of anemia
A
MCV (Mean Corpuscular Volume)
6
Q
What are the three categories of anemia due to deficient erythropoiesis (the making of RBCs)?
A
- Hypochromic-microcytic anemia
- Normochromic-normocytic anemia
- Macrocytic anemia
7
Q
Deficient or defective heme or globin synthesis produces a _____ RBC population (morphology)
A
Hypochromic-microcytic
8
Q
A very important lab test for hypochromic-microcytic anemia?
A
Serum ferritin
9
Q
___ is an iron storage glycoprotein closely correlated with total body iron stores.
A
Ferritin
10
Q
Where is most iron absorbed by the body?
A
Duodenum and jejunum
11
Q
Name a subgroup most likely to get iron deficiency anemia (IDA)?
A
Pregnant women (infants/toddlers next)
12
Q
The most common cause of IDA?
A
Menorrhagia (heavy or prolonged menstruation)
13
Q
An eating disorder in which a person eats things w/no nutritional value (dirt, paint chips, etc.)
A
Pica
14
Q
A type of pica in which the person craves and likes chewing ice
A
Pagophagia
15
Q
The name for a person getting “spoon nails”, usually due to iron deficiency anemia.
A
Koilonychia
16
Q
Painful inflammation and cracking of the corners of the mouth - can be caused by IDA.
A
Cheilosis
17
Q
RBC index that indicates average RBC size/volume
A
Mean corpuscular volume (MCV)
18
Q
The first lab test to become decreased in IDA?
A
Serum ferritin
19
Q
Cell found in persons w/G6PD deficiency?
A
Bite cell
20
Q
Test for antibodies coating RBCs?
A
Coombs
21
Q
Second most common anemia in the world?
A
Anemia of Chronic Disease (ACD)
22
Q
Anemia with increased RBC count?
A
Thalassemia
23
Q
Increased osmotic fragility of RBCs is called ____
A
Spherocytosis
24
Q
Anemia with hypersegmented PMNs?
A
Megaloblastic/macrocytic
25
Measures effective bone marrow RBC production
Reticulocyte count
26
AKA beta thalassemia major
Cooleys
27
Autoantibody that reacts at cold temps
IgM
28
Causes normochromic, normocytic anemia
Hypothyroidism
29
Macrocytic anemia without neurological findings is due to?
Folic acid deficiency
30
Anemia with all lab parameters decreased?
Iron deficiency anemia (IDA)
31
Thalassemia with deficient synthesis of the beta globin chain
Beta Thalassemia
32
Anemia with koilonychia (spoon nails)
IDA
33
Eating fava beans causes this anemia
Glucose-6-Phosphate Dehydrogenase deficiency (G6PD)
34
Anemia with jaundice and spenomegaly
Hemolytic
35
Anemia with GI and neurological findings
B12 deficiency
36
Symptoms of anemia develop after 6 months of age
Sickle cell anemia
37
Craving for ice
Pagophagia
38
Cells found in microangiopathic anemia
Schistocytes
39
Reticulocyte count is >5%
Hemolysis
40
Most common cause of acquired sideroblastic anemia?
Alcoholism
41
Severe anemia, leukopenia, and thrombocytopenia
Aplastic
42
Cell type in blood of patients with thalassemia?
Target cells
43
A lack of gastric HCL is called ____ (a cause of IDA)
Achlorhydria
44
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.
Sideroblastic anemia (iron utilization anemia)
45
What vitamin deficiency is associated with sideroblastic anemia?
Pyridoxine (B6)
46
What type of cells might be found in a peripheral smear of someone with SA?
Siderocytes
47
Expected results for a patient with SA would be ____ serum iron, and ____ ferritin
Increased, increased
48
Sideroblastic anemia would have a ___ reticulocyte count
Low
49
A ____ is the best test to assess degree of iron overload
Liver biopsy
50
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.
Anemia of Chronic Disease (ACD)= iron-reutilization anemia
51
In ___ anemia, RDW is normal, while in the other two hypochromic, microcytic anemias it is elevated.
Anemia of Chronic Disease (ACD)
52
What morphology of RBCs results from bone marrow failure and the resultant decreased RBC production.
Normochromic-normocytic
53
In anemia of renal disease, the decreased ____ production results in inadequate humoral stimulus of RBC production.
Erythropoietin
54
What type of cells might be found in a smear of anemia of renal disease?
Burr cells
55
In anemia due to ____, metabolism is reduced causing the tissues to require less oxygen and erythropoietin levels to fall.
Hypothyroidism
56
___ anemia is defined as pancytopenia and hypocellular bone marrow in the absence of abnormal cell infiltrate. 2 forms = congenital and acquired.
Aplastic
57
Deficiency of ALL THREE cellular components of blood (RBCs, WBCs, and platelets)
Pancytopenia
58
About __% of aplastic anemia cases are idiopathic
50%
59
CBC findings would include normochromic, normocytic anemia, leukopenia, neutropenia <1,500/dl, marked thrombocytopenia, borderline high MCV (>104)
Aplastic anemia
60
___ 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.
Myelophthisic
61
What RBC morphology is a result of defective DNA synthesis, however, RNA synthesis continues resulting in an increase in cytoplasmic mass and maturation?
Megaloblastic/Macrocytic
62
What type of WBCs are a normal finding in megaloblastic anemias?
Hypersegmented PMN’s
63
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).
Ileum
64
Vitamin B12 attaches to a specific plasma protein, ______, and circulates in this form
Transcobalamin
65
Vitamin B12 stores in the liver are normally sufficient to sustain physiologic needs for __-__ years!
3-5
66
____ is necessary for adequate DNA synthesis through it’s role in folic acid metabolism. It is also involved in the synthesis of myelin.
Cyanocobalamin
67
____ anemia may lead to a deficiency of intrinsic factor which can lead to Vitamin B12 deficiency anemia.
Pernicious
68
Dietary deficiency of vitamin B12 happens often to those who are ____
Strict Vegans
69
MCV would be >___ in B12 deficiency anemia
100
70
A peripheral blood smear would show macro-ovalocytosis, anisocytosis, poikilocytosis, basophilic stippling of RBCs, Howell-Jolly bodies, hypersegmentation of granular leukocytes
Anemia due to B12 deficiency
71
In B12 deficiency anemia, a chem panel would show ___ serum bilirubin, while a UA would show ___ bilirubin
Elevated, negative
72
The ___ test measures the absorption of radioactive B12 with and without intrinsic factor
Schilling
73
____ treatment (another B vitamin) without B12 in patients with pernicious anemia is contraindicated
Folic acid
74
A patient who has B12 deficiency anemia has a 3-fold increase in the risk of developing ___ cancer
Stomach (gastric carcinoma)
75
B12 injections will be needed how often for the rest of a patient’s life if they have B12 deficiency anemia?
Monthly (can be taught to give them to themselves)
76
___ deficiency anemia may be indistinguishable from B12 deficiency anemia, except that neurological symptoms do NOT occur from this deficiency.
Folic acid
77
In folic acid deficiency anemia, serum folic acid levels would be expected to be
Low (<5 ng/ml)
78
___ anemia results when the bone marrow production can no longer keep up with the RBC destruction
Hemolytic
79
Anemia with high lactate dehydrogenase values
Hemolytic
80
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.
Haptoglobin
81
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
Hereditary spherocytosis
82
Management for hereditary spherocytosis?
Splenectomy
83
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.
G6PD Deficiency
84
___ is called sickle cell anemia, while ____ is called sickle cell trait which is normally asymptomatic w/no anemia. (Heterozygous, homozygous)
Homozygous, heterozygous
85
Fetal mortality in a pregnant person with sickle cell anemia is __-__%
35-40%
86
About 1/___ African Americans and 1/____ Hispanics have sickle cell anemia
500, 1,000
87
Aka “Painful crisis” - the most common clinical sign of sickle cell anemia - pain results from tissue necrosis secondary to vascular occlusion and tissue hypoxia.
Vaso-occlusive crisis
88
In sickle cell anemia there is NO Hb __, and 80-100% of Hb is Hb __
A, S
89
Causes thickened cranial bones and malar eminences (bone hyperplasia)
Beta thalassemia major (Cooley’s anemia)
90
This type of anemia will have elevated levels of Hb F (>50%), and reduced or absent Hb A
Beta thalassemia major
91
Iron overload causes most of the morbidity and mortality in this anemia
Beta thalassemia major (Cooley’s)
92
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)
Homozygous, heterozygous
93
In a special test where MCV/RBC count (Mentzer index), <13 means ___ is more likely, while >13 means ___ is more likely
Thalassemia, iron deficiency
94
Schistocytes are formed from some kind of trauma in this anemia
Microangiopathic anemia (Traumatic hemolytic anemia)
95
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)
Isoimmune
96
___ is an acquired anemia induced by binding of autoantibodies to RBC membrane antigens. 3 types: warm, cold, mixed
Autoimmune hemolytic anemia (AIHA)
97
WARM AIHA has reacting ___ antibodies, while cold has reacting ___ antibodies
IgG, IgM
98
Normal range for reticulocyte count?
0.5-1.5%
99
A bone marrow examination confirms the diagnosis of SA. What type of cell would you expect to see?
Ringed sideroblasts
100
In ACD, the transferrin saturation is >10%, meaning the serum transferrin levels are _____
Decreased (because the test is for FREE transferrin)
101
In ACD, anemia of renal disease, anemia due to hypothyroidism, and myelophthisic anemia, what does the management/treatment consist of?
Treatment of the underlying disease
102
The three etiologies of Vitamin B12 deficiency anemia?
1. Deficiency of intrinsic factor
2. Malabsorption syndromes
3. Inadequate dietary intake
102
What clinical finding of B12 deficiency might be found even in the absence of anemia?
Neuropathy (usually peripheral)
102
In hereditary spherocytosis, MCHC should be ____
Elevated (hyperchromasia)
103
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.
Sickle cell anemia
104
Name the three types of “crises” in sickle cell anemia
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
A good screening test for sickle cell anemia
Sickledex test
106
____ 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.
Sickle
107
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
Sickle cell, thalassemia (B-T major)
108
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.
Thalassemia
109
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.
Beta thalassemia minor
110
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.
Microangiopathic anemia (traumatic hemolytic anemia)
111
This excessive RBC destruction anemia can be due to malaria, bacterial toxins such as Clostridium perfringens, streptococci, or meningococci.
Hemolysis due to infectious agents
112
What morphological type of RBCs would you see in Autoimmune Hemolytic anemia?
Normochromic, normocytic
