Anemia- Decreased Red Blood Cells Flashcards
What role does TNF play in anemia?
- It decreases the production of erythropoietin
2. Decreases iron availability stores
What role does IL-1 play in anemia?
- Diminishes Iron Metabolism
2. Diminishes erythropoietin production
What role does INFBeta play in anemia?
It inhibits erythropoiesis
What role does INFGamma play in anemia?
It inhibits proliferation of erythroid precursors
How do neoplasms and sepsis play a role in anemia?
They produce TNF and INFBeta
How does chronic infection and inflammation play a role in anemia?
They produce IL-1 and INF Gamma
How can renal insufficiency cause anemia?
Leads to a lack of erythropoietin
How can lead intoxication lead to anemia?
Lead inhibits synthesis of protoporphyrin and the enzyme that ligates iron to porphyrin ring
What are the clinical findings of someone with chronic infection/inflammation/malignancy?
Smear- Normocytic, normochromic or microcytic and hypochromic
Reticulocytopenia
Ferritin can be normal or elevated
Epo low
What are the clinical findings of someone with Lead intoxication?
Decrease reticulocyte count
Microcytosis
Basophilic stippling
increase in zinc protoporphyrin
What are the clinical findings of someone with Thyroid Disorder?
Normochromic and normocyti
Microcytosis can be seen
Macrocytosis (Hypothyroidism)
What are the clinical findings of someone with renal insufficiency?
-Occurs only when kidney function is
What are the clinical findings of someone with adrenal insufficiency?
Normochromic and normocytic
How do you manage anemia caused by chronic disease?
- Treat the underlying disease to decrease cytokines and chemokines
- Treat co-morbid conditions
- Epo can be effective
How do you manage anemia caused by lead intoxication?
Chelation therapy
How do you manage anemia caused by renal deficiency?
Administration of epo
treat co-morbid condition
How do you manage anemia caused by endocrine disorders?
Hormone replaecment
What is the most common cause of B12 deficiency?
Pernicious anemia
Describe the events that lead to B12 absorption
Vitamin B12 released by gastric acid —> Binds to intrinsic factor II until it gets to the terminal ilium–> Released by IFII and binds transcobalamin binding protein II (TcII)—> Transported to the liver and bone marrow
What is perniciious anemia?
Autoimmune destruction of IF-producing gastric parietal cells. Occurs in older patients
What is the most common cause of folate deficiency?
Low folate in the diet
Where is folate absorbed?
Jejunum
Where is folate stored?
In the liver as methytetrahydrofolate
What is the clinical feature of B12 and folate deficiency?
Megaloblastic anemia
Name some hematological changes due to B12 and folate deficiency.
- Erythroid hyperplasia
- change in myeloid:erythroid ratio
- Marrow precursors have large immature nuclei
- Macrocytosis
- Decrease in reticulocytes
- Macro-ovalocytes and hyper-segmented neutrophils
- poikilocytes and fragmentation
- neutropenia and thrombocytopenia
- increased bilirubin, and LDH intramedullary destruction
Name some neurological features of vitamin B12 deficiency.
- Sensory abnormalities
- Proprioception
- Ataxia
- Spasticity, gait disturbances
- Positive babinski test
- Cognitive dysfunction and emotional changes
What would an increase in homocysteine indicate?
Either a deficiency in vitamin B12 or folate
What would an increase in methylmalonic acid indicate?
Vitamin B12 deficiency
Describe the Schilling test
- 1 microgram orally radiolabeled B12 (normal absorption)
- Unlabeled B12 IM 2 hours later
- Collect urine over 24 Hours (5-35%) radiolabeled should be seen
- IF (+) test (aka decreased radioactive in urine) repeat with IF + B12
- Corrected (indicative of pernicious anemia)
What is the treatment for B12 deficiency?
IM injection daily for 2 weeks monthly for life
What is the treatment for folate deficiency?
Img/day orally
