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Heme > Anemia I > Flashcards

Anemia I Flashcards

1
Q

what vitamins are required for RBC production?

A

iron, folate, vit B12

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2
Q

what conditions will lead to decreased hgb affinity for oxygen?

A

decreased pH
increased DPG
increased temp
(think exercising!)

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3
Q

MCH

A

mean corpuscular hemoglobin - measure of mass of hemoglobin per RBC. low = hypochromic

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4
Q

MCHC

A

conc of hemoglobin in a given volume of packed RBCs

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5
Q

diseases w/ low MCHC

A

iron deficiency

thalessemia

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6
Q

diseases w/ high MCHC

A

hereditary spherocytosis, hemolytic anemias

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7
Q

MCV

A

volume of the average RBC

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8
Q

RDW

A

measure of degree of variation in RBC size

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9
Q

aniscytosis

A

high RDW

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10
Q

polychromasia

A

indicates shift of marrow reticulocytes into the periphery

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11
Q

normal reticulocyte count

A

0.5% to 2.0% of total RBCS

absolute usually 25K to 75K

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12
Q

reticulocyte production index (RPI)

A

RPI = reticulocyte % x (Hct/normal Hct) / maturation factor

> 2 = adequate response; <2 inadequate response

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13
Q

if you have anemia and another cell line down, what should you do?

A

bone marrow biopsy!

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14
Q

with acute blood loss, what will happen to Hgb/Hct?

A

they may lag (normal at first despite lots of blood loss) - will decrease later as compensatory fluid moves from extravascular to intravascular space

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15
Q

causes of microcytic anemia (5)

A
  1. iron deficiency anemia
  2. lack of iron release from macrophages
  3. failure of heme synthesis
  4. failure of globin synthesis
  5. lead intoxication (inhibits heme and globin synthesis)
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16
Q

hepcidin

A

peptide that regulates absorption of iron at the duodenum

17
Q

transferrin and ferritin

A

transferritin: transporter for circulating iron
ferritin: intracellular storage protein for iron - can be elevated by inflammation

18
Q

plummer-vinson syndrome

A

dysphageia
esophageal web
atrophic glossitis

due to IDA

19
Q

koilonychia

A

spoon nails assoc w/ IDA

20
Q

iron deficiency in a patient over 50 raise red flags for ______

A

colon cancer (until proven otherwise)

21
Q

tx of iron deficiency

A 
ferrous sulfate (oral or IV)
address cause
22
Q

normal hemoglobin composition in adults

A

Hgb A1: alpha2-beta2 - 95-98%
Hgb A2: alpha2-delta2 - 2-3%
HgbF: alpha2gamma2 - 0.8-2.0%

23
Q

beta-thalessemia Hgb levels

A

beta–thal trait (B/B0): increased Hgb F (1-5%) and increased Hgb A2 (4-7%)
beta-thad major (B0/B0): very increased Hgb F (95+%), Hgb A2 (0-5%)

24
Q

beta-thal blood smear findings

A

target cells

microcytosis, hypochromia

25
Q

geographic distribution of beta-thal and alpha-thalal

A

beta: mediterranean and SE Asia
alpha: SE asia, africa, india

26
Q

alpha thalessemia

A

gene deletion causes impaired production of alpha globin

  • 1-2 genes = alpha trait –> low MCV, but no tx req
  • 3 genes = beta chains form Hemoglobin H tetramers which are toxic to RBCs. Pts have anemia w/ hemolysis, sometimes need splenectomy.
  • 4 genes = formation of gamma aggregates –> hydrops fetalis
27
Q

sideroblastic anemia

A

anemia due to a problem with protoporphyrin synthesis –> microcytic anemia
- erythroblasts accumulate iron in the mitochondria but can’t produce adequate heme

28
Q

sideroblastic anemia blood smear

A

ringed sideroblasts

basophilic stippling

29
Q

congenital causes of sideroblastic anemia

A 
ALAS mutation (rate-limiting step in porphyrin synthesis)
other steps less common
30
Q

acquired causes of sideroblastic anemia

A

primary: myelodysplasia w/ ringed sideroblasts
secondary:
- nutritional (B6 or copper deficiency)
- drugs: isoniazid, other alkalating agents
- alcoholism
- toxins: lead poisoning, zinc

31
Q

labs in sideroblastic anemia

A

iron high
high ferritin
normal TIBC
high transferrin

32
Q

lead poisoning

A

inhibits heme and globin synthesis
interferes w/ RNA breakdown –> basophilic stippling (sideroblast)
labs: increased Fe, ringed sideroblasts in marrow,

dx: lead level in blood or urine

33
Q

lead poisoning sx

A

abdominal pain
neurologial symptoms: neuropathy, headaches, disorientation, insomnia
irritability, psychosis

34
Q

anemia of chronic disease/inflammation

A

iron trapped in macrophages –> microcytic anemia

Heme (16 decks)

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