Anemia and Hemolytic Anemia (Exam 2) Flashcards
What is the definition of anemia?
increase RBC destruction | decrease RBC production | excessive blood loss | = all contribute to reduced O2 delivery to tissues (mild asymptomatic to severe symptomatic)
What are the 5 causes of anemia?
impaired RBC production | fast RBC destruction | excessive blood loss | hemodilution | combined mechanism
What are the 4 differential diagnoses of anemia due to impaired RBC production?
aplastic anemia | Fe-deficiency anemia | pernicious anemia | sickle cell anemia
What are the 4 differential diagnoses of anemia due to accelerated RBC destruction?
congenital spherocytic anemia (inherited) | pernicious anemia | sickle cell anemia | erythroblastosis fetalis
What are the 2 differential diagnoses of anemia due to accelerated RBC destruction?
acute and chronic blood loss »_space;> normochromic and normocytic anemia
What is erythroblastosis fetalis?
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
What is the differential diagnosis of anemia due to hemodilution?
renal disease - body retains water = decrease urine excretion
What are the 2 differential diagnoses of anemia due to combined mechanism?
pernicious anemia and sickle cell anemia = impaired RBC production + accelerated destruction
What are the symptoms of anemia based on differing (2-8g) Hb levels?
8g = pale | 6g = dizzy | 4g = nausea | 2g = coma
What are 4 causes of anemia secondary to BM injury?
ionizing radiation targets nucleus | chemicals | infection in BM | malignancy in BM
What are the 7 differential diagnoses of hypochromic microcytic anemia? Which is the most common?
lead poisoning | thalassemia | pyridoxine deficiency | sideroblastic anemia | Fe-def anemia (most common) | chronic inflammation (macrogphage doesn’t release) | porphyria
What is the urine color from patients with acute porphyria? What is this due to?
burgundy wine color | patient does not have isomerase present in heme synthesis, only deaminase = produces only uroporphyrinogen I not III
What is porphyria? What does it result in?
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
How can one diagnose porphyria?
urine = abnormal color, yellowish | fluorescents under UV
What are 2 causes of porphyria?
certain medications | lead poisoning
What is transferrin deficiency caused by?
individual producing Abs against transferrin
How much of the 1% old RBCs are lysed inside macrophages? (daily) And how much are lysed outside macrophages?
90% | 10%
What is hemolytic anemia due to?
anemia due to RBC lysis in vessels | bacterial infections and certain meds can contribute to this anemia
How common is hemolytic anemia?
very common
What is the difference between extravascular hemolysis and intravascular hemolysis?
extravascular = outside blood stream (ie: hematomas) | intravascular = inside blood stream (more common)
If the individual has a haptoglobin level of 200mg/dl, would you expect this individual to have a lot of abnormal intravascular hemolysis?
No | there is enough haptoglobin to neutralize Hb
What does a haptoglobin value of 0 or a low value mean?
a lot of hemolysis outside of macrophages
Where does the excess Hb go into when it cannot be picked up by tubular cells of the kidney?
goes into urine
Would it be considered extensive hemolysis of RBC outside of macrophages when urine shows high levels of Hb? How can you confirm this hypothesis?
yes = Hb seen in urine (hemoglobinuria) | observe a low haptoglobin level
What is intrinsic defect factor of hemolytic anemia?
defect in the RBC itself
What are 2 examples of intrinsic defect in hemolytic anemia?
congenital spherocytic anemia and elliptocytosis
What are the 2 diagnosis for hemolytic anemia due to intrinsic defect?
low haptoglobin | poikilocytosis (cell membrane not stable = easily lyse)
What is the treatment for hemolytic anemia due to intrinsic defect?
remove spleen = remove lyses
What does extracorpuscular mean?
outside factors
What are the 3 extracorpuscular factors causing hemolytic anemia?
autoimmune anemia | bacterial and parasitic infections | certain medications
What is an example of an autoimmune disease that causes hemolytic anemia?
lupus | low haptoglobin and patient looks pale
How can bacterial and parasitic infections cause hemolytic anemia?
can produce toxins that lyse RBC
