anemia of diminished erythropoiesis

Question 1

causes of anemia

Answer 1

diminished production
accelerated destruction
blood loss

Question 2

causes of diminished production

Answer 2

renal failure
vitamin deficiency
iron deficiency
anemia of chronic disease
aplastic anemia

Question 3

causes of accelerated destruction

Answer 3

hemolysis

RBC structural abnormality

Question 4

causes of acute blood loss

Answer 4

loss of intravascular volume

dilution with fluids

Question 5

treatment of acute blood loss

Answer 5

stop bleeding

transfusion with blood products

Question 6

normocytic/normochromic causes of anemia

Answer 6

acute hemorrhage

anemia of chronic disease

Question 7

microcytic/hypochromic causes of anemia

Answer 7

iron deficiency
thalassemia
anemia of chronic disease
hemoglobin disorders

Question 8

macrocytic/normochromic causes of anemia

Answer 8

B12/folate deficiency
myelodysplastic syndromes
liver/alcohol disease

Question 9

signs of anemia

Answer 9

weakness
fatigue
headache
dizziness
palpitations
dyspnea
pallor
tachycardia
systolic murmur
low PB

Question 10

megaloblastic anemia

Answer 10

impaired DNA synthesis leading to large erythroid precursor cells
cytoplasm replicates but nucleus can’t

Question 11

causes of megaloblastic anemia

Answer 11

b12/folate deficiency
impaired absorption
chemo, antiretrovirals
rare inherited

Question 12

signs/symptoms of megaloblastic anemia

Answer 12

low Hb
high MCV, MCH
low reticulocyte count
hyper chromic, microcytic
ovalocytes
hyperhsegmented neutrophils
large erythroid cells in bone marrow

Question 13

pancytopenia

Answer 13

neutropenic
thrombopenic
anemic

Question 14

normal B12 metabolism

Answer 14

B12 separated from proteins by pepsin
free b12 binds r binders
pancreatic enzymes separates the complex
B12 binds IF in ileum
released, absorbed, and binds transcobalamin II in plasma

Question 15

B12 use

Answer 15

needed to switch folic acid from active into usable form and transfers a methyl group to homocysteine to make methionine

Question 16

B12 functions

Answer 16

DNA synthesis

fatty acid synthesis for nerve sheaths

Question 17

pernicious anemia

Answer 17

IF deficiency impairing B12 absorption

Question 18

morphology of pernicious anemia

Answer 18

atrophic glossitis and gastritis of funds
increased risk gastric cancer
increased acid secretion
myelin degeneration in dorsal and lateral tracts
neuropsychiatric changes

Question 19

Schilling test

Answer 19

radio labeled B12 given with IF to determine if IF is the cause of b12 deficiency

Question 20

treatment of megaloblastic anemia

Answer 20

b12 deficiency responds to folate, but neuro symptoms worsen

Question 21

causes of microcytic anemia

Answer 21

iron deficiency
thalassemia
anemia of chronic disease
sideroblastic anemia
red cell fragments
hereditary spherocytosis
defective porphyrin synthesis

Question 22

hemosiderin

Answer 22

iron binding protein for iron storage

water insoluble- outside cell

Question 23

ferritin

Answer 23

iron binding protein for storage

water soluble- inside cell

Question 24

transferrin

Answer 24

glycoprotein that delivers iron to cells

Question 25

causes of iron loss

Answer 25

gut cells sweat blood loss

Question 26

ferroportin

Answer 26

iron transporter that moves iron from inside the cell to the plasma

Question 27

hepaestin

Answer 27

oxidizes iron in plasma

Question 28

hepcidin

Answer 28

acute phase reactant | downregulates ferroportin to decrease iron absorption

Question 29

hepcidin synthesis control

Answer 29

IL6 increases synthesis increased RBC demand decreases synthesis increased plasma/stores of iron decreases synthesis

Question 30

hemochromatosis

Answer 30

excess iron

Question 31

consequences of no hepcidin

Answer 31

``` hemochromatosis increased iron absorption increased TIBC transferrin saturated increased ferritin ```

Question 32

anemic older male

Answer 32

colon adenocarcinoma

Question 33

clinical features of iron deficiency

Answer 33

``` numbness/tingling angular stomatitis atrophy and soreness of tongue pica brittle nails difficulty swallowing ```

Question 34

TIBC relationship with iron levels

Answer 34

low iron = high TIBC

Question 35

TIBC

Answer 35

total iron biding capacity | measure of affinity of iron for transferrin

Question 36

ferritin is proportional to

Answer 36

cellular iron stores | EXCEPT with inflammation

Question 37

anemia of chronic disease

Answer 37

low plasma iron but normal stores because hepcidin is produced which decreases iferroportin which reduces iron movement

Question 38

markers of anemia of chronic disease

Answer 38

low TIBC- lots of iron present but not used | high ferritin- iron is held inside cells

Question 39

markers of iron deficiency anemia

Answer 39

high TIBC- low iron means transferrin (takes iron to cellS) | low ferritin- iron NOT in cells because it is needed

Question 40

aplastic anemia

Answer 40

chronic primary hematopoietic failure with pancytopenia

Question 41

main cause of aplastic anemia

Answer 41

idiopathic

Question 42

causes of aplastic anemia

Answer 42

idiopathic acquired- drugs, radiation, chemicals, viruses inherited- fanconi's anemia

Question 43

pathophysiology of aplastic anemia

Answer 43

immune mediated marrow suppression | damaged stem cells stimulate T cell response which stops stem cell proliferation

Question 44

treatment for aplastic anemia

Answer 44

young- bone marrow transplant | old- immunosuppressants

Question 45

pure red cell apalsia

Answer 45

erythroid hypoplasia with normal other eclls

Question 46

cause of pure red cell aplasia

Answer 46

tyoma large granular lymphocytic leukemia drugs viruses

Question 47

causes of marrow failure syndromes

Answer 47

diffuse liver disease chronic renal failure myelophthic anemia

Question 48

diffuse liver disease

Answer 48

linked to alcoholism- toxic effect on erythroid precursors chronic disease vitamin deficiency

Question 49

chronic renal failure

Answer 49

decreased EPO --> reduced production dn survival

Question 50

myelophthic anemia

Answer 50

normal marrow replaced by other cells metastatic cancer granulomatous disease spent phase myeloproliferative disorder