Anemia Flashcards
define hematopoeisis
is RBC production. It is regulated by Epo (made in kidneys when low oxygen). Epo binds to receptors on erythroid progenitors in bone marrow encouraging them to proliferate
define anemia parameters. Define mild/moderate/severe anemia
men <13 g/dl Hb women <12 g/dl Hb mild 10 g/dl moderate <10-8 g/dl severe <8 g/dl
what are the most common causes of anemia in the elderly
- VB12/folate/iron deficiency (26%0
- anemia of chronic disease (17%)
- renal insufficiency (15%)
- unexplained 26%
routine lab tests for anemia diagnosis
- hematocrit 45-49% men, 39-47 females
- mean cell volume 90+/- 8 fl
- mean cell Hb weight 30+/- 3 pg
- mean cell Hb concentration 33+/- 2%
treatment of anemia
if due to chronic kidney failure, give recombinant Epo.
- if megaloblastic anemia: B12/folate supplements
clinical presentation of anemia
fatigue, breathlessness, tachycardia on physical exertion
define macrocytosis
anema where MCV .100
define macrocytosis
anema where MCV >100
classification of anemia
- normocytic and normochromic
- macrocytic and normochromic
- microcytic and hypochromic
what are reticulocytes
are RBC recently released from bone marrow. They provide info on RBC production
classification of anemia
With normal bone marrow response (increase in reticulocytes) or without (hypoproliferation, this is more common)
- normocytic and normochromic
- macrocytic and normochromic
- microcytic and hypochromic
what are reticulocytes
are RBC recently released from bone marrow. They provide info on RBC production
examples of microcytic/macrocytic anemia
iron deficiency
B12 folate deficiency
thalassemia
MDS
examples of normocytic and normochromic anemia
BM failure, inflammation, Renal disease
what things let you know the iron status of an individual
serum iron, transferrin saturation, ferritin, TIBC
what is hepcidin
effector of iron hemostasis secreted by liver, it decreases iron release from reticulo endothelial macrophages and duodenal enterocytes. It causes decreased serum iron levels
causes of iron deficiency anemia
pregnancy
acute/chronic blood loss in GI
malnutrition, or malabsorption
megaloblastic anemia is caused by
A cobalamine deficiency can be due to?
A folic acid deficiency can be due to?
Signs and Symptoms?
impaired DNA synthesis. Is associated with B12 and folic acid (cobalamine) deficiency. It is a maturation defect
- gastrectomy (bc parietal cells in stomach make intrinsic factor), celiacs
- alcoholics, pregnancy, malabsorption, inhibition of DHF reductase from methotrexte (a chemotherapy drug)
- GI malaise, neurological involvement (demylination, axonal degenration, neuronal death), ataxia, weakness
Hemolytic Anemia is defined as
diseases that lead to reduced RBC survival in peripheral blood. note that if hemolysis occurs inside the vessels you will have hemosiderin and Hb in urine
what causes hemolysis
hemoglobinopathy, enzymopathy
- abnormal membrane structure
- mechanical destruction (trauma), or autoantibodies
hereditary spherocytosis. (IS a RBC membrane disorder)
- signs
- diagnosis
causes hemolysis, and is AD, defect in ankyrin gene
- mild splenomegaly, jaundice
- osmotic fragility of RBC test, or check ankyrin with gene test
- is microcytic
most common red cell enzyme defects
G6PDH (defect in hexose monophosphate shunt), and pyruvate kinase (aka glycolytic enzyme defect- is normocytic)
patients of G6PD deficiency should be warned against
fava beans, anti malarial drugs, sulfamethoxazole, nitrofurantoin, acetanilide
treatment for immune hemolytic anemia
steroids, immunosuppressive drugs, splenectomy
what are the characteristics of bone marrow failure anemia
normocytic and normochromic
aplastic anemia is
when there is peripheral blood cytopenia, bone marrow hypocellularity. It can be called acquired if it is immune mediated. It can be iatrogenic aplasia if bone marrow hypocellularity is due to cancer therapy, or fanconis, dyskeratosis congenita
what infection is associated with pure red cell aplasia
parvovirus infection
paroxysmal nocturnal hemoglobinuria is due to
mutation in PIG-A gene which codes for GPI which is where T cells should bind, the GPI defect causes strong activation of platelets so they have thrombosis (increased LDH shows high risk of thrombosis) and thrombocytopenia.
- symptoms: anemia with hemoglobinuria (intravascular hemolysis)
treatment of paroxysmal nocturnal hemoglobinuria
eculizumab which inhibits the complement cascade
