Anemia II Flashcards

1
Q

Normochromic, Normocytic anemia with increased reticulocyte count

A
  • prior or recent hemorrhage
  • recent hemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Normochromic, Normocytic anemia with normal reticulocyte count and normal bone marrow

A
  • anemia of chronic disease
  • hypothyroidism
  • liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two causes of megaloblastic anemia

A
  • B12 deficiency
  • folate deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

falsely elevated MCV due to

A
  • large number of reticulocytes (larger RBC)
  • RBC clumping mimicking larger RBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause of megaloblastic anemias

A

defective DNA synthesis results in disordered RBC maturation resulting in larger RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does B12 come from

A

diet

  • daily requirement is 1-2ug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is B12 absorbed

A
  • B12 (cobalamin) is bound to intrinsic factor in the somach
  • colbalamin is released from the Cobalamin-IF complex in the ileum where it is absorbed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what cells produce intrinsic factor

A

gastric parietal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is pernicious anemia

A
  • autoimmune
  • autoantibodies against the gastric parietal cells impair IF secretion
  • deficiency of intrinsic factor which causes B12 malabsorption and megaloblastic anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some other conditions that cause B12 deficiency

A
  • ileal disease or resection
  • bacterial overgrowth
  • intestinal parasites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical presentation

  • typical symptoms of anemia
  • glossitis, jaundice, splenomegaly
  • neuro findings: decreased vibratory and position sense, ataxia, paresthesias, confusion
A

B12 deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Peripheral smear

  • hypersegmented neutrophils (> 5 lobes)
  • anisocytosis (size)
  • poikilocytosis (shape)
  • macro-ovaocytes (large, oval RBC)
A
  • could be B12 deficiency anemia or folate deficiency anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

positive schilling test

A
  • detects antibodies to IF
  • test for pernicious anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

elevated serum methylmalonic acid and homocysteine levels are common with which anemia

A

pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

treatment of pernicious anemia

A
  • Parenteral vitamin B12
    • daily injections of 1000 ug for 1 week
    • then weekly injections x 1 month
    • then monthly injections for life
  • ***Do not treat with folic acid alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

where does folic acid come from

A
  • diet
  • fresh, leafy vegetables
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

dailey requirement of folic acid normally? pregnancy?

A
  • daily requirement 200 ug/day
  • 400-800 ug/day in pregnancy
  • **half life of 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

folate deficiency occurs in what conditions

A
  • alcoholism
  • end of pregnancy
  • anticonvulsant therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Homocysteine levels and serum methylmalonic acid levels in folid acid deficiency

A
  • Homocysteine levels elevated
  • serum methylmalonic acid normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

treatment of folate deficiency

A
  • 1 mg folic acid orally daily
  • 5 mg folic acid in patients with malabsorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hemolysis

A

destruction of RBCs

22
Q

bone marrow cannot compensate for RBC survival time less than what?

A
  • 20 days…up to 5 times less than normal
  • ** nml survival time=120days
23
Q

clinical presentation

  • usual features of anemia: pallor, SOB
  • jaundice
  • gallstones
A

hemolytic anemia

24
Q

patients with hemolytic anemia are at an increased risk of infection with?

A
  • salmonella
  • pneumococcus (give vaccine)
25
Q

intravascular hemolysis

A

destruction of RBC within the blood stream

26
Q

extravascular hemolysis

A

destruction of RBC in the spleen

27
Q

lab findings

  • elevated reticulocyte count (polychromasia)
  • peripheral smear
    • immature RBC’s nucleated RBCs
    • possible schistocytes (fragmented RBCs)
  • unconjugated biliruben increased
  • elevated serum LDH: Lactate dehydrogenase
  • plasma hemoglobin increased
A

Hemolytic anemia

28
Q

what lab value is low in intravascular hemolysis

A

serum haptoglobin

  • mucoprotein produced in the liver which binds hemoglobin that has been released from lysed RBC
29
Q

polychromasia

A

reticulocytosis

30
Q

G6PD deficiency can cause intravascular hemolysis. what would you see in peripheral smear

A

Heinz bodies

31
Q

common causes of intravascular hemolysis

A
  • fragmentation syndromes
    • mechanical heart valve
  • G6PD deficiency
  • paroxysmal nocturnal hemoglobinuria
32
Q

positive osmotic fragility test is indicative of what disease

A

hereditary spherocytosis

33
Q

common causes of extravascular hemolysis

A
  • hereditary spherocytosis
  • sick cell anemia
  • autoimmune hemolytic anemia
  • incompatible blood transfusion
  • drug induced
34
Q

positive coombs test is indicative of

A

autoimmune hemolytic anemia

  • usually causes by IgG autoantibody
35
Q

presentation

  • normal MCV but smaller surface area
  • RBCs have dense, globular appearance and lack central pallor
  • RBC are poorly deformable and trapped in splenic sinusoids and phagocytized by splenic macrophages
A

hereditary spherocytosis

36
Q

treatment of hereditary spherocytosis

A
  • splenectomy
    • restores RBC life span back to normal
  • give pneumococcal vaccine
  • delay splenectomy until adulthood
37
Q

sickle cell anemia is what type of genetic disorder

A

autosomal recessive: need HbSS to show symptoms

38
Q

In sickle cell disease, when do RBC become sickle shaped

A

when deoxygenated

  • dehydration
  • hypoxia
  • high altitude
  • intense exercise
39
Q

when do signs and symptoms of sickle cell disease develop

A

age 4-6 months with change from fetal hgb to adult hgb

40
Q

aplastic crisis

A

sudden decrease in hemoglobin seen in chronic hemolysis

41
Q

what is the most common feature of sickle cell disease

A
  • pain crisis: vaso-occlusive ischemic tissue injury
    • pain in back, ribs, limbs lasting 5-7 days
42
Q

diagnosis of sickle cell

A

hemoglobin elecrophoresis reveals HbS

43
Q

peripheral smeal of sick cell disease

A
  • a few sickled RBC
  • howell-jolly bodies
44
Q

Why are RBCs normochronic and normocytic in sickle cell anemia

A

it is an anemia of chronic disease

45
Q

treatment of sickle cell disease

A
  • analgesics, fluids and oxygen in painful crisis
  • hydroxyurea to decrease incidence of painful crisis
    • suppresses bone marrow function of all cell lines
46
Q

peripheral smear seen with autoimmune hemolytic anemia

A
  • polychromasia
  • spherocytosis: sphere-shaped RBC
  • nucleated red cell
47
Q

treatment of hemolysis

A
  • corticosteroids
  • splenectomy is frequently advised
  • folic acid supplementation
48
Q

most antibodies to RBC are directed against?

A

the ABO/Rh blood grouping antigens

49
Q

aplastic anemia

A

acquired abnormality of bone marrow stem cells

  • >50% idiopathic
  • 20% drug exposure
  • 10% viral illness
50
Q

what is the hallmark feature of aplastic anemia

A

pancytopenia

  • anemia (reticulocytopenia)
  • leukopenia
  • thrombocytopenia

** bone marrow shows absense of precursor of these cells

51
Q

treatment of aplastic anemia

A

bone marrow transplant or immunosuppressive tx