Anemia and Hemolytic Anemia (Exam 2)

Question 1

What is the definition of anemia?

Answer 1

increase RBC destruction | decrease RBC production | excessive blood loss | = all contribute to reduced O2 delivery to tissues (mild asymptomatic to severe symptomatic)

Question 2

What are the 5 causes of anemia?

Answer 2

impaired RBC production | fast RBC destruction | excessive blood loss | hemodilution | combined mechanism

Question 3

What are the 4 differential diagnoses of anemia due to impaired RBC production?

Answer 3

aplastic anemia | Fe-deficiency anemia | pernicious anemia | sickle cell anemia

Question 4

What are the 4 differential diagnoses of anemia due to accelerated RBC destruction?

Answer 4

congenital spherocytic anemia (inherited) | pernicious anemia | sickle cell anemia | erythroblastosis fetalis

Question 5

What are the 2 differential diagnoses of anemia due to accelerated RBC destruction?

Answer 5

acute and chronic blood loss &raquo_space;> normochromic and normocytic anemia

Question 6

What is erythroblastosis fetalis?

Answer 6

Rh-hr incompatibility between mother and fetus | mother’s immune system begins to attack fetus RBCs | will be difficult for subsequent children to survive gestation

Question 7

What is the differential diagnosis of anemia due to hemodilution?

Answer 7

renal disease - body retains water = decrease urine excretion

Question 8

What are the 2 differential diagnoses of anemia due to combined mechanism?

Answer 8

pernicious anemia and sickle cell anemia = impaired RBC production + accelerated destruction

Question 9

What are the symptoms of anemia based on differing (2-8g) Hb levels?

Answer 9

8g = pale | 6g = dizzy | 4g = nausea | 2g = coma

Question 10

What are 4 causes of anemia secondary to BM injury?

Answer 10

ionizing radiation targets nucleus | chemicals | infection in BM | malignancy in BM

Question 11

What are the 7 differential diagnoses of hypochromic microcytic anemia? Which is the most common?

Answer 11

lead poisoning | thalassemia | pyridoxine deficiency | sideroblastic anemia | Fe-def anemia (most common) | chronic inflammation (macrogphage doesn’t release) | porphyria

Question 12

What is the urine color from patients with acute porphyria? What is this due to?

Answer 12

burgundy wine color | patient does not have isomerase present in heme synthesis, only deaminase = produces only uroporphyrinogen I not III

Question 13

What is porphyria? What does it result in?

Answer 13

the intermediate products within heme synthesis that cannot be used and will be excreted out into plasma; can include enzyme dysfunction | less Hb production = hypochromic microcytic RBCs

Question 14

How can one diagnose porphyria?

Answer 14

urine = abnormal color, yellowish | fluorescents under UV

Question 15

What are 2 causes of porphyria?

Answer 15

certain medications | lead poisoning

Question 16

What is transferrin deficiency caused by?

Answer 16

individual producing Abs against transferrin

Question 17

How much of the 1% old RBCs are lysed inside macrophages? (daily) And how much are lysed outside macrophages?

Answer 17

90% | 10%

Question 18

What is hemolytic anemia due to?

Answer 18

anemia due to RBC lysis in vessels | bacterial infections and certain meds can contribute to this anemia

Question 19

How common is hemolytic anemia?

Answer 19

very common

Question 20

What is the difference between extravascular hemolysis and intravascular hemolysis?

Answer 20

extravascular = outside blood stream (ie: hematomas) | intravascular = inside blood stream (more common)

Question 21

If the individual has a haptoglobin level of 200mg/dl, would you expect this individual to have a lot of abnormal intravascular hemolysis?

Answer 21

No | there is enough haptoglobin to neutralize Hb

Question 22

What does a haptoglobin value of 0 or a low value mean?

Answer 22

a lot of hemolysis outside of macrophages

Question 23

Where does the excess Hb go into when it cannot be picked up by tubular cells of the kidney?

Answer 23

goes into urine

Question 24

Would it be considered extensive hemolysis of RBC outside of macrophages when urine shows high levels of Hb? How can you confirm this hypothesis?

Answer 24

yes = Hb seen in urine (hemoglobinuria) | observe a low haptoglobin level

Question 25

What is intrinsic defect factor of hemolytic anemia?

Answer 25

defect in the RBC itself

Question 26

What are 2 examples of intrinsic defect in hemolytic anemia?

Answer 26

congenital spherocytic anemia and elliptocytosis

Question 27

What are the 2 diagnosis for hemolytic anemia due to intrinsic defect?

Answer 27

low haptoglobin | poikilocytosis (cell membrane not stable = easily lyse)

Question 28

What is the treatment for hemolytic anemia due to intrinsic defect?

Answer 28

remove spleen = remove lyses

Question 29

What does extracorpuscular mean?

Answer 29

outside factors

Question 30

What are the 3 extracorpuscular factors causing hemolytic anemia?

Answer 30

autoimmune anemia | bacterial and parasitic infections | certain medications

Question 31

What is an example of an autoimmune disease that causes hemolytic anemia?

Answer 31

lupus | low haptoglobin and patient looks pale

Question 32

How can bacterial and parasitic infections cause hemolytic anemia?

Answer 32

can produce toxins that lyse RBC