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Year II Hematology > Anemia II: Normacytic Anemias > Flashcards

Anemia II: Normacytic Anemias Flashcards

1
Q

Two broad categories for normacytic anemia

A

Normacytic with decreased or increased reticulocyte count (RC)

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2
Q

4 subtypes of decreased RC anemia

A

Anemia of chronic dises
Aplastic anemia
Anemia of CKD
hypoproliferation anemia

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3
Q

Anemia of chronic disease

Lab findings/descriptions

A

Normacytic Anemia with decreased RC count

  • Normochromic
  • Normocytic
  • Hypoproliferative
  • Inc. hepcidin

OR
• Hypochromic & Microcytic

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4
Q

Hepcidin

A

Chronic disease or inflammation anemia

•	Increase of hepcidin
o	 Acute phase-protein
o	Cytokine mediated
•	Hepcidin
o	dec Fe absorption
o	inc ferritin in macrophages
o	dec Epo secretion
o	Inhibit erythropoiesis
o	dec RBC life span
So iron store look normal “functional iron deficiency”
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5
Q

Aplastic Anemia

Causes of primary and secondary

A

Normacytic Anemia with decreased RC count

HSC injured so have hypoprolfertative anemia

1: Congenital famoconia anemia
2: Chloramphenicl, antiepileptics, penicillin, chemotherapy, benzene, radiaton, viruses

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6
Q

Which viruses associated with aplastic anemia

A

HIV
EBV
Parvovirus

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7
Q

Which anti-convilsants associated with aplastic anemia

A

Carbamazepien
Valproic acid
Phenytoin

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8
Q

Anemia of CKD

A

Normacytic anemia with decreased reticulocyte count

CKD means reduced Epo production and the cells that do remain are fragile because or urea in blood

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9
Q

Thee endocrine disorders associated with normocytic anemia with decreased RC

A
  • Panhypopituitarism

* Low testosterone

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10
Q

All anemias assoicated with increased RC area types of A which can be further divided into B and C

A

Hemolysis
Intravascular
Extravascular

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11
Q

In all types of hemolysis

what do you see in labs/smear (4)

A

Inc LDH
Inc indirect bilurupin
Hepatoglobin
Spherocytes

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12
Q

Differences between intra vs extra vascular hemolysis

A

Extravascular
• Normal or decreased hepatoglobin
• Spherocytes

Intravascular
RBC destroyed in the blood vessels
• Hemoglobinemia (excess free Hgb in blood)
• Hemoglobinuria (Hgb in urine)
• Hemosiderinuria (Fe in urine)
• dec serum hepatoglobin (binds to free Hgb and is low because it gets used up by the excess Hgb)
• Schistocytes (RBC whose membrane has been partial removed)

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13
Q

In normal extravascular hemolysis
what is the fate or

globin
Heme
Porphyrin

A
  • Globin  amino acids
  • Heme  Fe & porphyrin
  • Porphyrin  unconjugated bilirubin  conjugated in liver  bile
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14
Q

5 types of normocytic anemias with increased RC, intravascular anemia

A

Immune hemolytic anemias

Drug Induced Hemolytic Anemia

Microangiopathic Hemolytic Anemias

G6PD Deficiency

Membranopathies - Paroxysmal nocturnal hemoglobinuria (PNH)
Infection

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15
Q

2 types of immune hemolytic anemias

A

Warm

Cold

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16
Q

Warm Immune hemolytic Anemias

A

Normocytic anmeia with inc RC, IV

Pathophysiology
•	IgG
•	Acquired
•	Bind at 37C
•	Lysed in spleen
•	Cause (SLE, lymphoma, idiopathic & methyldopa)
Treatment
•	Underlying disease
•	Steroids
•	Immune suppression
•	Splenectomy
17
Q

Cold Immune hemolytic anemias

A

Normocytic anemia with inc RC

Pathophysology
Cold
•	IgM
•	Bind nose, ears, finger tips
•	Lysed intra(complement) or extravascular
•	Post infection (Mycoplasma pneumoniae)

Treatment
• Wear gloves
• Warm weather
• NOT splenectomy

18
Q

3 mechanism f & examples of drug induced hemolytic anemias

A

Normocytic anemia, inc. RC, IV

Hapten
• RBC + drug = antigenic
• Penicillin

Bystander
• Drug accidentally binds antibody which lands on a RBC
• Quinidine

Drug incorporated into RBC membrane
• Methyldopa

19
Q

Microangiopathic Hemolytic Anemias

Mechanism & common causes

A

Normocytic anemia, inc. RC, IV

RBC destroyed by vasculature as they circulate so torn apart forming schistocytes

Causes
•	Mechanical heart valves
•	Aortic stenosis
•	Microthrombi
o	DIC
o	TTP-HUS
20
Q

G6PD Deficiency

Inheritance pattern
Protective against
Characteristic appearance on smear

A

Normocytic anemia, inc. RC, IV

  • X-linked recessive
  • Protective against malaria
  • Lack of G6PD results in Hb participation due to oxcidative stress
  • Splenic macrophages “bite out” the Heinz bodies forming bite cells
  • Occurs after oxidative stress (drugs) or chronic an ongoing
21
Q

Paroxysmal nocturnal hemoglobinuria (PNH)

How do you get it?
Mechanism?

Clinical Signs

Diagnostic test

Treatment

A

Normocytic anemia, inc. RC, IV

  • Acquired
  • Lack PIG-A gene so membrane prone to complement destruction
Clinical Signs
•	Episodic Hemoglobinuria
•	DVT
•	Leukopenia
•	Thrombocytopenia

Diagnosis
Flow cytometry for abscense of CD 59

Treatment
• Transfusions
• Eculizumab (anti compliment)
• Stem cell transplant

22
Q

3 types of normocytic anemias with increased RC, extravascular hemolysis

A

Membranopathy: Hereditary Spherocytosis
Hemoglobinopathies: Sickle Cell disease
Hemoglobin C

23
Q

Membranopathy: Hereditary Spherocytosis

genetic pattern
Whats wrong?

3 laboratory tests

Diagnosis?

A

Normocytic anemias with increased RC, EV hemolysis

  • Autosomal dominant
  • Membrane defect = destruction by spleen
Laboratory findings
Polychromasia
Spherocytes
Inc. bilurbin,
Inc eticulocytes
Inc MCHC
Dec hepatoglobin

Diagnosis
• Osmotic fragility test

24
Q

Sickle Cell Disease
Whcih cromosome
Which chain on Hgb
Difference btween sickle cell trait & disease

Diagnosis

Treatment (proplaxis, acute & long term)

A

Normocytic anemias with increased RC, EV hemolysis

•	Amino acid substitution on chromosome 16
•	Mutated B chain
Sickle Cell trait
•	 1 chromosome (Hb AS)
•	No anemia or other signs
Sickle cell disease
•	2 chromosomes (Hb SS)
•	When deoxygenated Hgb poorly soluble and forms Hgb S (HBs)
•	Anemia

Diagnosis
• Blood test for Hb S

Treatment
Prophylaxis
•	Hydration
•	Oxygenation
•	Warm temperature
•	Vaccines
Acute Therapy
•	Hydroxuria
•	Hydration
•	Oxygenation
•	Analgesics
Long Term
•	Stem cell transplant
25
Q

Hemoglobin C

Genetic pattern
Which chain?
What do you see on smear?

A

Normocytic anemias with increased RC, EV hemolysis

  • Autosomal recessive
  • B chain mutation
  • HbC Crystals seen
  • Mild extravascular anemia

Year II Hematology (3 decks)

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