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IHO: Week 1 - WLB > Anemia I - Krafts > Flashcards

Anemia I - Krafts Flashcards

1
Q

What are the 10 things to look at on a blood smear according to Dr. Krafts?

A
  1. Red cell number
  2. Red cell size
  3. Red cell shape
  4. Red cell chromasia (hemoglobin)
  5. Reticulocytes (RBC precursor cells in blood)
  6. Weird stuff in red cell (malaria, howell-jolly bodies)
  7. White cell number
  8. White cell differential
  9. Platelet count
  10. Platelet morphology
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2
Q

What does anemia mean?

A
  • An (without) -emia (blood)
  • a reduction below normal in hemoglobin or red blood cell number
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3
Q

What are six basic symptoms of anemia?

A
  1. Pale skin & mucous membranes
  2. Jaundice (if hemolytic)
  3. Tachycardia
  4. Shortness of breath
  5. Dizziness
  6. Fatigue
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4
Q

What are three (general) possible ways someone gets anemic?

A
  1. Lose blood
  2. Destroy too much blood
  3. Make too little blood
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5
Q

What are the three morphologic groups or red blood cells in anemia?

A
  1. Weird size
  2. Weird shape
  3. Normal size & shape (look for reticulocytes)
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6
Q

What are the three possible conditions in which red cell morphology is a weird size?

A
  1. Iron-deficiency anemia (microcytic)
  2. Thalassemia (microcytic)
  3. Megaloblastic anemia (macrocytic)
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7
Q

What is the most important cause of Iron-Deficiency Anemia that you should not miss?!?!

A

GI Bleed

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8
Q

Which patients should you be worried about if they have Iron-Deficiency Anemia?

A

Non-female or not in reproductive years

  • Premenopausal women:
    • think MENORRHAGIA
  • Everyone else:
    • think GI BLOOD LOSS
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9
Q

What are the causes of Iron Deficiency?

A
  • Decreased iron intake
    • bad diet
    • bad absorption
  • Increased iron loss
    • GI bleed (don’t want to miss!)
    • menses
    • hemorrhage
  • Increased iron requirement
    • pregnancy
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10
Q

What is the the typical clinical picture of Iron-Deficiency Anemia (symptoms, signs, etc.)?

A
  • Symptoms
    • asymptomatic
    • fatigue, dizziness, etc.
    • PICA
  • Signs
    • pale
    • spoon nails = Koilonychia
    • smooth tongue = atrophic glossitis
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11
Q

What blood morphologies are present in Iron-Deficiency Anemia?

A
  • Hypochromic, Microcytic anemia
    • not much Hgb - large central pallor region
    • small RBCs
  • anisocytosis (weird sized RBCs)
  • poikilocytosis (weird shaped RBCs)
  • decreased reticulocytes
    • bone marrow can’t make RBCs like it should
  • increased platelets
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12
Q

What is hematocrit a measure of in a CBC?

A
  • index that tells the amount of red cells as a percentage of the total blood volume
    • spin a tube of blood and measure percentage of packed RBCs
    • problem: red cells may not pack nicely
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13
Q

What is MCV a measure of in a CBC?

A
  • Mean Cell Volume
    • SIZE of red cell
    • normal = 80-100 fL
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14
Q

What is RDW a measure of in a CBC?

A
  • RBC Distribution Width
    • all small?
    • all big?
    • varied size?
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15
Q

What is MCH a measure of in a CBC?

A

Weight of hemoglobin in red cell

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16
Q

What is MCHC a measure of in a CBC?

A

Concentration of hemoglobin in red cell

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17
Q

What is MPV a measure of in a CBC?

A
  • Mean platelet volume
    • how big platelets are
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18
Q

What bone marrow morphologies are present in Iron-Deficiency Anemia?

A
  • erythroid hypoplasia
    • below average number of cells
  • dyserythropoiesis
    • funny looking red cells because bone marrow tries to release them so fast
  • decreased iron stores
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19
Q

What labs should you perform if suspecting Iron-Deficiency Anemia?

A
  • Ferritin (low)
    • abnormally low is enough to diagnose
    • keep looking if normal and you suspect Iron-Deficiency Anemia
  • Serum iron (low)
    • abnormally low is not enough to diagnose
  • Total iron-binding capacity (high)
    • tests how many sites on transferrin are free
20
Q

How should you treat Iron-Deficiency Anemia?

A
  • Figure out WHY patient is iron-deficient!
  • Then give oral iron supplementation.
21
Q

What causes Megaloblastic Anemia?

A
  • Vitamin B12 Deficiency
  • Folate Deficiency
22
Q

Why is Vitamin B12 important?

A
  • Involved in DNA synthesis
    • lack of slows DNA production or causes defective DNA synthesis
  • Converts homocysteine → methionine
    • increased homocysteine causes endothelial damage (atherosclerosis, thrombosis)
    • low methionine causes myelin damage (subacute combined degeneration)
23
Q

What are the causes of Vitamin B12 Deficiency?

A
  • Lack of intrinsic factor (parietal cells)
  • Pancreatic damage
  • Ileal damage (absorbed in distal ileum)
  • Diet (rare)
  • Tapeworm
24
Q

What are common sources of Vitamin B12?

A
  • Meat
  • Dairy
  • Cereal
  • NOT vegetables
25
Q

What are the causes of folate deficiency?

A
  • Diet (small reserve)
  • Alcohol abuse
  • Jejunal damage
  • Drugs
26
Q

What are common sources of folate?

A

Green leafy vegetables

27
Q

What blood morphologies are present in Megaloblastic Anemia?

A
  • Macrocytic anemia
  • Nuclear/cytoplasmic asynchrony (mature at different rates
  • Oval macrocytes
  • Hypersegmented neutrophils
28
Q

Why do cells get BIG in Megaloblastic Anemia?

A

Retarded DNA synthesis + Unimpaired RNA synthesis

⇒

immature nucleus + mature cytoplasm = BIG cells!

29
Q

What lab value is indicative of Megaloblastic Anemia?

A
  • MCV > 100
  • Blood smear
  • Serum B12
  • Serum folate
  • RBC folate
30
Q

What could cause MCV>100 if there are no megaloblastic changes on the blood smear?

A
  • Alcoholism
  • Myelodysplasia
  • Drugs
  • Other congenital diseases
31
Q

What happens in hemolytic anemia?

A

Increased red cell destruction

leads to →

Increased red cell production

32
Q

What are signs of red cell destruction and production in lab tests?

A
  • Increased RBC destruction
    • Increased serum bilirubin
    • Increased LDH (lactate dehydrogenase)
    • Decreased free haptoglobin (binds free hemoglobin and carries it around in the blood)
    • Hemoglobinemia/Hemoglobinuria (Hgb outside of RBCs in the blood)
  • Increased RBC production
    • Reticulocytes
    • Nucleated RBCs in the blood
  • Direct antiglobulin test (DAT)
    • antibodies on RBC
33
Q

What blood morphologies are present in Hemolytic Anemia?

A
  • Normochromic, normocytic anemia
  • Spherocytes
  • Other poikilocytes (weird shaped cells):
    • targets
    • sickles
    • fragmented red cells
34
Q

How does a physician diagnose a Hemolytic Anemia?

A
  • Look for signs of hemolysis
    • signs of destruction
    • signs of production
  • Determine cause
    • +DAT means immune cause
    • -DAT means non-immune cause
35
Q

What is treatment of hemolytic anemia?

A
  • Depends on cause
  • If acute:
    • treat shock
    • use transfusions with caution
  • Splenectomy may help because that is where a lot of hemolysis occurs
36
Q

What is the clinical picture of hereditary spherocytosis?

A
  • Triad: anemia, jaundice, splenomegaly
    • not all patients will have ALL three
  • “Common” (1 in 5000)
  • Variable age of onset
  • Variable severity
  • Crises often occur with Parvovirus infection
37
Q

What is the pathogenesis of hereditary spherocytosis?

A
  • Abnormal RBC cytoskeleton
  • Loss of surface area
    • little parts of lipid bilayer come off, and cell ends up balling into a sphere
  • Spleen eliminates spheres
38
Q

What type of anemia is present in Hereditary Spherocytosis?

A
  • Mild normochromic, normocytic anemia
    • numerous spherocytes
39
Q

What is the treatment for hereditary spherocytosis?

A
  • Mild cases:
    • no treatment necessary
  • For severe cases:
    • Splenectomy
    • Or RBC transfusions as needed
40
Q

What are the two types of Autoimmune Hemolytic Anemia? What is the difference between them?

A
  • Warm
    • IgG
    • spherocytes
  • Cold
    • IgM, complement
      • binds to red cells in cooler areas/cells of the body (hands, ears, nose, etc.)
    • spherocytes rare
41
Q

What is the pathogenesis of Warm Autoimmune Hemolytic Anemia?

A
  • IgG coats red cells (opsonization)
  • Macrophages respond by either:
    • eliminating entire red cell whole (cells disappears)
    • nibbling at red cells (cells become spherocytes)
42
Q

The clinical picture is not very specific for Warm Autoimmune Hemolytic Anemia, but what is the common factor in all patients?

A

Splenomegaly

43
Q

What are the two treatment options for Warm Autoimmune Hemolytic Anemia?

A
  • Steroids
  • Splenectomy if necessary
44
Q

What is the pathogenesis of Cold Autoimmune Hemolytic Anemia?

A
  • IgM, complement coat red cells
  • IgM falls off in warm body parts
  • IgM bridges red cells (agglutination - clumps)
  • Complement may lyse red cells (in blood)
    • usually just opsonizes them and macrophages in the spleen eat them
45
Q

What is the clinical picutre of Cold Autoimmune Hemolytic Anemia?

A
  • Chronic hemolysis aggravated by cold
  • Pallor, cyanosis in cold body parts
46
Q

What is the treatment for Cold Autoimmune Hemolytic Anemia?

A
  • Keep patient warm
  • Treat underlying cause
    • infections
    • lymphoproliferative diseases

IHO: Week 1 - WLB (8 decks)

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