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X Clin Med Final > Anemia I > Flashcards

Anemia I Flashcards

1
Q

What is anemia?

A

A decrease in the circulating RBC mass

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2
Q

What are the major RBC measurements that when reduced indicate anemia?

A

RBC count (number of RBCs in a specified vol of whole blood)
Hemoglobin (conc of Hb in whole blood)
Hematocrit (vol of packed RBCs)

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3
Q

What Hb and Hct level indicates anemia?

A

<14 g/dL for men and <12 g/dL for women

<40% for men and <35% for women

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4
Q

What do RBCs originate from?

A

Myeloid stem cell

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5
Q

What are reticulocytes and what is their life span?

A

Immature RBCs

3 days in bone marrow and 1 day in circulation

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6
Q

What is the life span of RBCs?

A

120 days (then removed by spleen primarily)

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7
Q

What does retic count indicate?

A

Bone marrow production of RBCs to see if it is working well

Normal: .5-2%

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8
Q

What do reticulocytes look like on a peripheral smear?

A

“Lots of blue means lots of new”- bigger than normal RBCs and have a hint of blue because lack central pallor that indicated mature RBC

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9
Q

3 causes of anemia

A 
Decreased RBC production (nutritional deficiencies, chronic disease, ineffective erythropoesis)
Increased RBC desctruction (hemolysis)
Blood loss (menstrual, GI, trauma)
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10
Q

What are the RBC indices?

A

MCV, MCH and MCHC

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11
Q

How do you classify RBCs by size?

A

Normocytic, microcytic or macrocytic

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12
Q

Mean corpuscular volume (MCV)

A

Calculated value to determine avg vol (size) or RBCs

Normocytic is 80-100

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13
Q

Mean corpuscular hemoglobin (MCH)

A

Average Hb content in a RBC

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14
Q

Mean corpuscular hemoglobin concentration (MCHC)

A

Average Hb concentration per RBC

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15
Q

How do you talk about MCH and MCHC?

A

Usually follow MCV so “microcytic hypochromic”

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16
Q

Red cell distribution width (RDW)

A

Measure of variation in RBC size

Normal: 11-15%

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17
Q

What is anisocytosis?

A

Variation in size of RBCs

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18
Q

Signs and symptoms of anemia

A

Fatigue/weakness, HA, dizzy, dyspnea, palpitations

Pallor, heme + stool, orthostatic chances, tachycardia

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19
Q

3 categories of anemia and their probable causes

A 
Microcytic hypochromic (iron deficiency, thalassemia, sideroblastic anemia)
Normocytic normochromic (hypothyroidism, liver disease, chronic disease)
Macrocytic/megaloblastic (folate or B12 deficiency)
20
Q

What are the major causes of iron deficiency anemia?

A

Blood loss (most common), decreased dietary intake, decreased iron absorption (Celiac, bariatric surgery, H pylori)

21
Q

Diagnostic studies for iron deficiency anemia

A

Decreased RBC, H/H
MCV can be normal early on but will be microcytic later
Iron: decreased ferritin and serum Fe, increased TIBC
Increased RDW
Retic count probably low (but may be inappropriately normal)

22
Q

What do you see on a peripheral smear of iron deficiency anemia?

A

RBCs that are microcytic and hypochromic, anisocytosis and poikilocytosis (varies in shape)

23
Q

Other manifestations of iron deficiency anemia

A

Glossitis, angular cheilitis, koilonychia (spoon nails)
Pica (crave ice)
Dysphagia (esophageal webs- Plummer Vinson syndrome)
Restless legs syndrome

24
Q

What is the most important part of treating iron deficiency anemia?

A

Determine the underlying cause!

25
Q

Treatments for iron deficiency anemia

A

Replace iron stores:
Orally ferrous sulfate 325 mg BID-TID and should see return of HCT 1/2 way to normal in 3 weeks and full return to baseline at 2 months (continue for 3-6 mos to replenish stores)
Parenteral iron used in some people
Blood transfusions in ppl not recommended for iron replacement

26
Q

What are the thalassemias?

A

Inherited hemoglobinopathy with reduction in the synthesis of globin chains
Leads to ineffective erythropoiesis and hemolysis

27
Q

What is the result of the thalassemias?

A

Varying anemia and extramedullary hematopoiesis (produce RBCs outside of bone marrow)
Bone changes, impaired growth and iron overload

28
Q

What is alpha-thalassemia?

A

Deletion of one or more of the four alpha-globin chains

29
Q

4 types of alpha-thalassemia

A

1 deletion: silent carrier
2 deletions: alpha-thal minor or mild microcytic anemia
3 deletions: Hb H disease or mod microcytic anemia-chronic hemolytic anemia
4 deletions: hydrops fetalis (fatal in utero)

30
Q

What is beta-thalassemia?

A

Reduced or absent beta-globin chain synthesis (usually due to pt mutation)

31
Q

3 types of beta-thalassemia

A 
Thalassemia minor (trait)- 1 chain, asymptomatic and mild microcytic anemia
Thalassemia intermedia- less sever than major, non-transfusion dependent, chronic hemolytic anemia
Thalassemia major- both chains, transfusion-dependent, sever hemolytic anemia
32
Q

Labs seen in the thalassemias

A 
Normal to increased RBC
MCV super low (<75)
RDW is normal
Retic count: variably increased
Normal to increased ferritin and iron
Normal to decreased TIBC
33
Q

What is hemoglobin electrophoresis?

A

Used in the diagnosis of the thalassemias to detect the type of Hb present

34
Q

Treatments for thalassemia

A

Tailored to severity obvi
Folic acid supplementation (for chronic hemolysis)
AVOID IRON SUPPLEMENTS
Severe: regular transfusion schedule, hematopoietic cell transplant or genetic counseling

35
Q

What is the process of sideroblastic anemia?

A

Hereditary or acquired RBC disorder

Abnormal RBC iron metabolism- diminished heme synthesis- iron accumulates in cells

36
Q

What do you use to seesideroblastic anemia?

A

Bone marrow aspirate: ring sideroblasts (blue-stained iron) *hallmark
Peripheral smear: siderocytes with pappenheimer bodies

37
Q

Causes of sideroblastic anemia

A

Acquired is most common in adults
Often a variant of myelodysplastic syndrome
Chronic alcoholism, meds, copper deficiency

38
Q

What is the highest prevalence of thalassemias?

A

Africa, Asia and the Mediterranean region

39
Q

Diagnostics of sideroblastic anemia

A

Elevated RDW
Normal to low retic count
Normal or elevated ferritin (leads to systemic volume overload- may look just like hereditary hemochromatosis)

40
Q

Treatments for sideroblastic anemia

A

Treat the underlying cause duh
Discontinue offending drugs/toxic agents
Pyridoxine (vitamin B6) to help with Hb synthesis
Transfusion/manage iron overload

41
Q

What is the second most common cause of anemia worldwide?

A

Anemia of chronic disease

42
Q

What causes anemia of chronic disease?

A

Hepcidin-induced alterations in iron metabolism
Inability to increase erythropoiesis
Impaired to erythropoietin production

43
Q

What is hepcidin?

A

Key regulator of the entry of iron into circulation

High levels are seen in inflammation (because of iron trapping in macrophages and decreased gut iron absorption)

44
Q

Labs seen in anemia of chronic disease

A

Mild anemia: Hb or 10-11 g/dL
Normocytic, normochromic
Retic count may be low
Normal or increased serum ferritin (acute phase reactant)
Serum Fe and TIBC low (inflammation setting)

45
Q

Treatment for anemia of chronic disease

A

Obvi treat the underlying cause

Erythropoietin may help

X Clin Med Final (5 decks)

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