Anemia Part I Flashcards by LL Cool G

Fundamentally, anemias are generally due to either (1) of red cells and these two major types can be distinguished by (2)

decreased production or increased destruction

2. the reticulocyte count

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Reticulocyte count in anemias of decreased production

low reticulocyte count

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(1) are newly produced red cells and can be identified by their larger size or by stains that identify their (2)

Reticulocytes

2. ribosomes.

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The normal range for reticulocyte count changes based on age since newborns have (1)% reticulocytes in their blood whereas adults have (2)% reticulocytes in their blood.

2-6%

2. 1-2%

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Laboratories often provide a reticulocyte index which is a derived value based on the (1) and the (2). It is based on the idea that there are fewer red blood cells in anemia so the percentage of reticulocytes (3) the number of reticulocytes.

RBC count
reticulocyte count
underestimates

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Reticulocyte count in anemias of increased destruction

elevated reticulocyte count

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Red cell indices are measurements and derivations which describe the (1) of red blood cells (RBCs).

size and color

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The (1) is the measured number of particles of a specific size (bigger than (2) but smaller than (3) present in a microliter of blood measured by light scatter.

RBC count
platelets
white cells

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The (1) is the volume in femtoliters of blood per RBC and is directly determined by measuring the mean volume of cells based on light scatter.

mean corpuscular volume (MCV)

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How is hematocrit determined?

Measure the MCV and the RBC count by light scatter
MCV = hematocrit/RBC count
hematocrit = MCV x RBC count

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MCH =

mean corpuscular hemoglobin

MCH = Hb/RBC count

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MCHC =

mean corpuscular hemoglobin concentration

MCHC = Hb/Hct

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Microchromic

low MCH or MCHC

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Normochromic

normal MCH or MCHC

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Microcytic

low MCV due to low volume per cell

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Macrocytic

high MCV due to high volume per cell

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macrocytic anemias tend to be due to?

impaired bone marrow maturation

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microcytic, microchromic anemias tend to be due to ?

problems with red cell production or synthesis

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Patients with severe anemia due to any cause often have what s/s?

weakness
tire easily
DOE
pale skin and oral mucosa

Hypoxia as a consequence of anemia can also cause CNS problems including:
headache, blurry vision, and confusion or lethargy.

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If the anemia is due to acute blood loss and is leading to hypovolemic shock (shock is a decrease in BP) than (1) can result as a consequence of ?

oliguria or anuria

2. pre-renal azotemia.

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Acute blood loss can rapidly lead to?

decreased intravascular volume, cardiovascular collapse and death

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The initial evaluation of a bleeding patient requires an assessment of ?

vascular volume (BP predominantly)

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How might an acute blood loss anemia lead to an iron deficiency anemia?

If the patient bleeds into tissues then the hemoglobin is recaptured. If the bleed is into the GI tract or outside the body then there will be iron loss.

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The resulting reduction in oxygenation due to decreased blood delivery of oxygen induces the kidneys to produce erythropoietin which stimulates the proliferation of (1) within the bone marrow.

CFUe (colonies of later erythroid progenitors)

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Blood loss can also lead to (1) production along with increased secretion of (2) which will increase the number of (3).

1. increased platelet 2. adrenergic hormones 3. white blood cells

measurements of Hb, Hct, or RBC count in initial acute blood loss

will be normal (there is less blood but it has the same concentration)

measurements of Hb, Hct, or RBC count in acute blood loss a few hours later

decreased hematocrit due to hemodilution as blood volume is restored caused by shifting of water from interstitial fluid to plasma

Five to seven days after the bleed, the progency from the CFUe mature and appear as (1)

1. reticulocytes.

Chronic blood loss outside of the body (including into the GI tract, respiratory tract, urinary tract, female reproductive tract) leads to (1) which must be viewed as a medical finding and not a specific diagnosis.

1. iron deficiency anemia

Why is it important to be concerned about iron deficiency anemia in the elderly?

Many older patients with iron deficiency anemia have early cancers

(1) is a very common cause of GI bleeding and iron deficiency anemia in people over 50.

1. Colon cancer

Iron deficiency anemia is ____cytic and ____chromic. Levels of MCV, MCH/MCHC, Hb, Hct, and RBC?

micro and micro | reduced MCV, MCH/MCHC, Hb, Hct, and RBC count

Iron levels and TIBC levels in iron deficiency anemia?

iron is reduced and TIBC (total iron binding capacity) is increased

Reticulocyte count in iron deficiency anemia?

low

Healthy people have about 80% of their iron in (1) and about 20% in storage forms including (2)

1. hemoglobin | 2. ferritin and hemosiderin.

(1) is the major regulator of iron metabolism and is (2) when the body has excess iron stores.

1. Hepcidin | 2. increased

Hepcidin inhibits iron transfer from the enterocyte to plasma by binding to (1) and causing it to be endocytosed and degraded.

1. ferriportin

What happens to hepcidin levels in iron deficiency?

decrease

What happens to hepcidin levels during increased hematopoiesis?

decrease

What happens to hepcidin levels when the body has excess iron stores?

increase

Anemia of chronic disease (ACD) is seen in many patients with chronic illness particularly those with (1) disorders.

1. inflammatory

Anemia of chronic disease MCV, MCH, and MCHC levels

normocytic normochromic anemia with normal MCV, MCH, and MCHC.

Inflammation increases acute phase reactants such as (2) and (3), leading to anemia due to reduced iron uptake, and

2. ferritin | 3. hepcidin

Iron and TIBC levels in ACD

Iron levels are usually low in ACD but TIBC can be normal or decreased.

Reticulocyte count in ACD

low since this is a production problem

Macrocytic anemias are most commonly seen in patients with ?

vitamin B12 or folate acid deficiencies or correct liver disease

Macrocytic anemias are also called megaloblastic anemias because (1) cells are enlarged in the bone marrow due to the bone marrow maturation defect responsible for this condition.

1. erythroid (megaloblasts) and myeloid precursor

The cellular maturation defect in macrocytic anemia is poorly understood but it is clear that (1) maturation occur independently of (2) maturation.

1. DNA synthesis and nuclear maturation | 2. cytoplasmic

neutrophils can have multiple lobes (>5 is considered abnormal) since the nucleus is continuing to grow and differentiate before the cell divides

megaloblastic anemia/macrocytic anemia

(1) is a disorder in which all three formed elements are decreased in the blood: red cells, white cells, and platelets.

1. Aplastic anemia

Reticulocyte count in megaloblastic anemia

low

Aplastic anemia leads to multiple hematologic problems presenting with what signs and symptoms?

fatigue and pallor (from decreased red cells) frequent infections (from decreased white cells) bruises and bleeding (from decreased platelets)

The causes of aplastic anemia are poorly understood but are thought to involve (1).

1. the immune system

Patients with the autoimmune disorder (1) have an increased risk of aplastic anemia, suggesting an autoimmune connection.

1. paroxysmal nocturnal hemoglobinuria

Bone marrow aspirates from patients with aplastic anemia have (1) and biopsies are (2)

1. very few hematopoietic cells | 2. predominantly fat due to the absence of myeloid or erythroid precursors

RDW

red cell distribution width; indicator of variation in size of RBCs

platelets lack ___ but have ____

nuclei; mitochondria for energy demands

Luminal nonheme iron is mostly in the Fe3+ (ferric) state and must first be reduced to Fe2+ (ferrous) iron by (1)

1. ferrireductases, such as cytochromes

Fe2+ iron transported by (1) which is regulated by (2)

1. divalent metal transporter 1 (DMT1) | 2. hepcidin

Fe2+ iron destined for the circulation, is transported by (1). This process is coupled to the (3) of Fe2+ iron to Fe3+ iron, which is carried out by the iron oxidases (2)

1. ferriportin 3. oxidation 2. hephaestin and ceruloplasmin

Newly absorbed Fe3+ iron binds rapidly to the plasma protein (1), which delivers iron to 2) in the marrow

1. transferrin | 2) red cell progenitors

When lots of Fe: plasma (1) levels are high. This leads to down-regulation of (2) so Fe lost when duodenal epithelial cells are shed

1. hepcidin | 2. ferriportin

When body iron stores decrease or when erythropoiesis is stimulated, (1) levels fall and (2) activity increases, so more absorbed iron transferred to plasma (3)

1. hepcidin 2. ferriportin 3. transferrin

Ferritin levels in ACD

normal or increased

Ferritin levels in iron deficiency anemia

decreased

A 25 year old man is in a severe car accident | and witnesses on the scene say he lost a lot of blood

BP and assessment of fluids as a way to figure out how much blood is lost.

A 65 year old woman is tired and pale

rule out cancer

A 28 year old man with sausage like fingers, | subluxations, and antibodies against Fc is tired and pale

Pt. has RA which is autoimmune; Anemia of chronic disease INC. hepcidin and Ferritin; DEC Iron and TIBC; INC. WBC due to inflammation

A 75 year old woman with long-standing diabetes has recently been diagnosed with colon cancer. Type of anemia and lab values

Diabetes is inflammatory so anemia of chronic disease; Colon cancer leads to blood loss so Iron def anemia; pt has COMBINED anemia; RC low (underproduction) INC. hepcidin; ferritin and TIBC may be high or low depending on whether it is more Iron deficient or Inflammation;

A 24 year old women with heartburn and | achlorhydria now is tired and pale

Pernicious anemia so MACROCYTIC; Low RC; Low B12; INC. methylmalonic acid

A 22 year old woman has nosebleeds, bruises, | frequent infections, and is tired and pale

aplastic anemia; Bleeding and bruises--> low platelet Infections-->low WBC Tired and pale--> Low RBC;

normal RBCs have 1) Too much central pallor seen in 2) NO central palor seen in 3)

1) central palor 2) iron def. anemia 3) hereditary spherocytosis

1) Percentage of blood represented by red cells | 2) Number of red cells per cubic microliter

1) Hct | 2) Red cell count

hct/RBC

CMV

1) Hg/RBC: the average content (mass) of hemoglobin per red cell 2) (Hb/Hct): the average concentration of hemoglobin in a given volume of packed red cells, expressed in grams per deciliter

1) MCH | 2) MCHC

Blood loss produces a compensatory release of adrenergic hormones mobilizes granulocytes and results in 1)

1) leukocytosis

Initially after acute blood loss, red cells 1)

1) normocytic and normochromic

Early recovery from blood loss is also often accompanied by 1), which results from an increase in platelet production

1) thrombocytosis

acute blood loss vs. chronic; differentiate anemia

acute blood loss--> NORMOCYTIC and NORMOCHROMIC; | Chronic blood loss--> Microcytic and HYPOchromic

how do you identify HYPOCHROMIC on histo

Normal RBCs have central palor and should be 1/3rd; | Hypochromic has more than 1/3rd central palor

total body iron content is normally about 1) in women and 2) in men

1) 2 gm | 2) 6 gm

Iron that enters the duodenal cells can follow one of two pathways

1) transport to the blood via transferrin; | 2) storage as mucosal iron

A small circulating peptide that is synthesized and released from the liver in response to increases in intrahepatic iron levels

Hepcidin

mechanism of ACD

Inflammation increases Hepcidin (phase reactant) which leads to inappropriate iron loss

Nuclear maturation doesn’t match cytoplasmic;

Macrocytic anemia; FYI lack of DNA precursors means that cells are stuck in G2 phase and cannot progress to mitosis; cell was able to grow during G1 and S which is why you see DEC. nuclear/cytoplasmic ratio;

Nuclear material/cytoplasm ratio in Macrocytic anemia

DECREASES; | Nuclear maturation doesn’t match cytoplasmic;