Anemia first couple lectures Flashcards
What is the relationshiop between Hepcidin, inflammation and iron?
Inflamation inc. Synthesis of Hepcidin.
Inc Hepcidin = Dec iron absorption.
Involved in Anemia of Chronic Disease.
Characteristics of Iron deficiency
Dec Hemoglobin
Dec Cell proliferation
Mild hemolysis
What are the questions I ask to diagnose anemia.
Questions:
1. Is Anemia associated with other hematologic abnormalities?
- Is there an appropriate reticulocyte response?
3-Yes Hemolysis?
3-No What are the RBC indicies?
Describe the two pathways of pathophysiology of Anemia of Chronic Disease (sepsis and Chronic infection)
Sepsis-> TNF and INFB-> dec EPO and Erythroid proliferation respectively
* with sepsis, think necrosis (TNF)
Chronic Infection-> IL-1 and INFy-> Same effects as above
How does Lead cause Anemia?
Lead inhibits iron from being placed in heme.
Where is EPO produced?
Kidney
What are the clinical features and lab tests associated with Chronic inflammation or infection anemias? Treatment?
Clincal Features:
Fever, Arhralgias, arthritis, swelling
Lab Tests:
Look for normal to dec Iron Binding Capacity and normal or inc ferritin.
Treat underlying disease.
What are the clinical features and lab tests associated with lead intoxication anemias? Treatment?
Clincal Features:
Change in personality, headache, wt loss
Lab Tests:
Microcytosis and hypochromia.
Inc protoporphyrin (heme rings without iron).
Treat with chelation of lead.
What are the clinical features and lab tests associated with renal insufficeiency anemias? Treat?
Clincal Features:
irregular renal fxn
Lab Tests:
Normochromic, normocytic RBCs
Dec EPO
Treat with EPO doses
What are the clinical features and lab tests associated with endocrine anemias? Treat?
Clincal Features:
Hypo/hyper activity.
Lab Tests:
Hypo/Hyper thyroidism
Adrenal
Generally all mild anemias.
Treat with hormone replacement
What do Folic Acid and Vitamin B12 do?
Support proliferation of all cells. Particularly hematopoietic cells.
Where is B12 absorbed?
Ileum
Where is folate absorbed?
Jejunum. Not as much storage as B12 in the body.
What are the main causes of folate and B12 deficiency?
B12- Autoimune
Folate-Diet
How do you describe RBCs in B12/Folate deficient patients?
Macrocytic
Sensory Losses are important in which type of deficiency?
B12 Deficiency
What is RI and how is it calculated?
Reticulocyte index
Reticulocyte count x Pat Hgb/normal hgb x 1/stress factor
1-2 is normal
A patient comes into your clinic with anemia that is not associated with other hematologic abnormalities. She does not exhibit an appropriate reticulocyte response to her anemia. Her RBCs have an MCV of 85. What do you do?
Evaluate for normocytic anemia
+100 macrocytic anemia
80-100 normocytic
>80 microcytic
A patient comes into your clinic with anemia that is not associated with other hematologic abnormalities. She does exhibit an appropriate reticulocyte response to her anemia. What do you do next?
Check to see if there is hemolysis and then evaluate for:
- Hemolytic anemia if yes
- Hemorrhagic anemia if no.
Which form of iron is Fe2+?
Ferro-us
Just the two of US.
True or false:
Iron is actively excreted from the body.
FALSE
Losses of iron include loss from exfoliation of skin and mucosal surfaces (GI tract, etc.), in the urine or with
menstruation.
What are the stages of iron deficiency?
- Iron depletion
- Iron deficient erythropoiesis
- Overt iron deficiency anemia
In which stage of iron deficiency do only iron stores run out?
Iron Depletion
In which stage of iron deficiency do both iron stores and erythron iron run out?
Iron Deficient anemia.
