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Blood and Lymph > Anemia- Decreased Red Blood Cells > Flashcards

Anemia- Decreased Red Blood Cells Flashcards

1
Q

What role does TNF play in anemia?

A
  1. It decreases the production of erythropoietin

2. Decreases iron availability stores

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2
Q

What role does IL-1 play in anemia?

A
  1. Diminishes Iron Metabolism

2. Diminishes erythropoietin production

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3
Q

What role does INFBeta play in anemia?

A

It inhibits erythropoiesis

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4
Q

What role does INFGamma play in anemia?

A

It inhibits proliferation of erythroid precursors

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5
Q

How do neoplasms and sepsis play a role in anemia?

A

They produce TNF and INFBeta

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6
Q

How does chronic infection and inflammation play a role in anemia?

A

They produce IL-1 and INF Gamma

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7
Q

How can renal insufficiency cause anemia?

A

Leads to a lack of erythropoietin

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8
Q

How can lead intoxication lead to anemia?

A

Lead inhibits synthesis of protoporphyrin and the enzyme that ligates iron to porphyrin ring

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9
Q

What are the clinical findings of someone with chronic infection/inflammation/malignancy?

A

Smear- Normocytic, normochromic or microcytic and hypochromic

Reticulocytopenia

Ferritin can be normal or elevated

Epo low

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10
Q

What are the clinical findings of someone with Lead intoxication?

A

Decrease reticulocyte count
Microcytosis
Basophilic stippling
increase in zinc protoporphyrin

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11
Q

What are the clinical findings of someone with Thyroid Disorder?

A

Normochromic and normocyti
Microcytosis can be seen
Macrocytosis (Hypothyroidism)

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12
Q

What are the clinical findings of someone with renal insufficiency?

A

-Occurs only when kidney function is

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13
Q

What are the clinical findings of someone with adrenal insufficiency?

A

Normochromic and normocytic

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14
Q

How do you manage anemia caused by chronic disease?

A
  • Treat the underlying disease to decrease cytokines and chemokines
  • Treat co-morbid conditions
  • Epo can be effective
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15
Q

How do you manage anemia caused by lead intoxication?

A

Chelation therapy

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16
Q

How do you manage anemia caused by renal deficiency?

A

Administration of epo

treat co-morbid condition

17
Q

How do you manage anemia caused by endocrine disorders?

A

Hormone replaecment

18
Q

What is the most common cause of B12 deficiency?

A

Pernicious anemia

19
Q

Describe the events that lead to B12 absorption

A

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

20
Q

What is perniciious anemia?

A

Autoimmune destruction of IF-producing gastric parietal cells. Occurs in older patients

21
Q

What is the most common cause of folate deficiency?

A

Low folate in the diet

22
Q

Where is folate absorbed?

A

Jejunum

23
Q

Where is folate stored?

A

In the liver as methytetrahydrofolate

24
Q

What is the clinical feature of B12 and folate deficiency?

A

Megaloblastic anemia

25
Q

Name some hematological changes due to B12 and folate deficiency.

A
  • 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
26
Q

Name some neurological features of vitamin B12 deficiency.

A
  1. Sensory abnormalities
  2. Proprioception
  3. Ataxia
  4. Spasticity, gait disturbances
  5. Positive babinski test
  6. Cognitive dysfunction and emotional changes
27
Q

What would an increase in homocysteine indicate?

A

Either a deficiency in vitamin B12 or folate

28
Q

What would an increase in methylmalonic acid indicate?

A

Vitamin B12 deficiency

29
Q

Describe the Schilling test

A
  1. 1 microgram orally radiolabeled B12 (normal absorption)
  2. Unlabeled B12 IM 2 hours later
  3. Collect urine over 24 Hours (5-35%) radiolabeled should be seen
  4. IF (+) test (aka decreased radioactive in urine) repeat with IF + B12
  5. Corrected (indicative of pernicious anemia)
30
Q

What is the treatment for B12 deficiency?

A

IM injection daily for 2 weeks monthly for life

31
Q

What is the treatment for folate deficiency?

A

Img/day orally

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