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Blood & Lymph > Anemia: Diminished Erythropoiesis - Aplastic Anemia > Flashcards

Anemia: Diminished Erythropoiesis - Aplastic Anemia Flashcards

1
Q

MCC of anemia among hospitalized patients in the US?

A

Anemia of chronic disease → systemic inflammation

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2
Q

In general, what is anemia of chronic disease?

A
  1. systemic inflammation
  2. reduced proliferation of erythroid progenitors
  3. impaired iron utilization (it is there, just can’t be used)
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3
Q

3 categories of chronic illnesses that cause anemia

A
  1. chronic microbial infection
  2. chronic immune disorders
  3. neoplasms
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4
Q

3 examples of chronic microbial infections that may → anemia

A
  1. osteomyelitis
  2. bacterial endocarditis
  3. lung abscess
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5
Q

Which neoplasms may lead to anemia?

A
  1. lung/breast carcinoma
  2. Hodgkin’s
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6
Q

Which chronic immune disorders may lead to anemia?

A
  1. RA
  2. regional enteritis
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7
Q

Anemia resulting from chronic disease is similar to which type of anemia?

A

iron deficiency anemia

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8
Q

lab findings for anemia of chronic disease

A
  1. ⇡ stored Fe
  2. ⇣ Fe
  3. ⇡serum ferritin
  4. ⇣ total iron-binding capacity

(do NOT give oral Fe, but EPO can help)

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9
Q

Anemia of chronic disease pathogenesis: due to persistent systemic inflammation →

A

iron sequestration → IL-6 = increased hepatic hepcidin synthesis

(results in decreased absorption & hematopoiesis; progenitors can’t use the iron)

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10
Q

How does iron sequestration help the body fight infection?

A

keeps it from microbes that might also need it to survive (ex: H. flu)

(hepcidin = structurally similar to defensins)

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11
Q

Anemia of chronic disease: tx

A
  1. underlying causes
  2. EPO
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12
Q

Define aplastic anemia

A

Chronic primary hematopoietic failure and pancytopenia (no RBC, WBC, or platelets)

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13
Q

4 Causes of aplastic anemia

A
  1. Autoimmune
  2. Chemical / drug exposure
  3. Viral infection
  4. Whole body radiation
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14
Q

Define fanconi anemia

A

Rare AR disorder caused by inherited defects in DNA repair complex → hypofunctioning marrow early in life

(also have other congenital anomalies)

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15
Q

Congenital anomalies seen with fanconi anemia

A
  1. Hyperplasia of kidney and spleen
  2. Bone anomalies → thumbs of radii
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16
Q

10-15% of adult-onset aplastic anemia is due to _____

A

inherited telomerase defects or abnormally short telomerases

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17
Q

Inherited telomerase defects → ______(2)

A
  1. premature hematopoietic stem cell exhaustion
  2. marrow aplasia
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18
Q
A
19
Q

2 major etiologies of aplastic anemia (pathogenesis)

A
  1. T-cell suppression of hematopoietic stem cells
  2. fundamental stem cell abnormality
20
Q

T-cell suppression of hematopoietic stem cells that leads to aplastic anemia is caused by _______.

A

Stem cell antigenically altered by drug exposure, infection, etc → killing of progenitors

(apoptotic pathways upregulated by IFN-g)

21
Q

Karyotypic abnormalities may transform aplastic anemia into _____ or _____.

A
  • myeloid neoplasms
  • AML
22
Q

If ______ is present, it is NOT aplastic anemia

A

splenomegaly

23
Q

Aplastic anemia has an insidious onset and initial findings depend on ______.

A

which cell line is affected first

(eventually → pancytopenia)

24
Q

Signs of thrombocytopenia (2)

A
  1. petechiae
  2. ecchymoses
25
Q

Anema: s/sx (3)

A
  1. progressive weakness
  2. pallor
  3. dyspnea
26
Q

Neutropenia s/sx (2)

A
  1. persistent minor infections
  2. sudden onset or chills/fever/prostration
27
Q

Bone marrow biopsy of a patient with aplastic anemia will show _____; whereas myeloid neoplasms will show _____.

A
  • very hypocellular marrow
  • hypercellular marrow
28
Q

Viral causes of aplastic anemia (3)

A
  1. CMV
  2. EBV
  3. Herpes Zoster (Varicella)
29
Q

Chemical agents that may cause aplastic anemia (5)

A
  1. Alkylating agents
  2. Antimetabolites
  3. Benzene
  4. Chloramphenicol
  5. Inorganic arsenicals
30
Q

5 Idiosyncratic causes of aplastic anemia

A
  1. Carbamazepine
  2. Gold salts
  3. Mesantoin
  4. Phenylbutazone
  5. Penicillamine
31
Q

“Dry tap”

A

marrow aspirates w/little material

(better to do a marrow biopsy)

32
Q

In addition to hypocellular bone marrow, aplastic anemia may show _____ (morphological findings)

A
  1. granulocytopenia
  2. thrombocytopenia → mucocutaneous bacterial infections, abnormal bleeding
33
Q

If aplastic anemia patients need multiple transfusions, this could lead to _____.

A

hemosiderosis

34
Q

aplastic anemia tx : _____ or _____.

A
  • bone marrow transplant
  • immunosuppressive tx (if no donor or they are too old)

(Blood transfusion if progressing)

35
Q

Morphology unique to myelophthisic anemia (2)

A
  1. Teardrop red cells (aka Dacrocytes) : due to tortuous escape from fibrotic marrow
  2. Leukoerythroblastosis: abnormal release of RBC precursors and immature granulocytes
36
Q

Myelophthisic anemia is a form of bone marrow failure where _____ replace normal marrow.

A

space-occupying lesions

37
Q

In myelophthisic anemia space-occupying lesions replace normal bone marrow leading to

A
  1. Distortion
  2. Fibrosis
  3. Disturbed the egress of WBC/RBC
38
Q

Most common cause of myelophthisic anemia

A

metastatic cancer

(usually breast, lung or prostate; can be any marrow infiltrative process i.e. granulomatous disease)

39
Q

How does chronic renal failure lead to anemia (3)?

A
  1. Decreased renal EPO synthesis → decreased RBC production
  2. Extracorpuscular defect reduces RBC lifespan
  3. Platelet dysfunction → Iron deficiency
40
Q

Treatment of anemia in chronic renal failure

A

EPO + iron

41
Q

Hepatocellular liver disease can be associated with macrocytic anemia due to ______

A

decreased marrow function

(toxic, infectious or cirrhotic)

42
Q

Liver failure causes lipid abnormalities → RBC membrane to acquire _____ in the blood.

A

phospholipids/cholesterol

43
Q

Hypothyroidism can cause a mild _____ anemia

A

normochromic, normocytic

Blood & Lymph (29 decks)

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