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Hematology Exam I > Anemia Part II > Flashcards

Anemia Part II Flashcards

1
Q

What are RBCs made from?

A

Iron, Folic Acid, Vitamin B12

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2
Q

RBC Measures

  1. Hgb, Hct, RBC: Low vs High
A

Hemoglobin: Low = anemia, High = polycythemia

Hematocrit: Low = anemia, High = polycythemia

RBC: Low = anemia, High = thalassemia

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3
Q

Absolute Reticulocyte Count

A

(RBC count x % reticulocytes)/100

< 100,000/microL reticulocytosis can be excluded

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4
Q

Classification of Anemia (3)

A

By onset

By pathophysiology (Hypoproliferative (RR<40,000) Proliferative (RR>100,000))

By morphology

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5
Q

Anemia Classification (causes)

  1. Micro
  2. Macro
  3. Normo
A

Micro –> almost always due to decreased hemoglobin production

Macro –> usually from a defect in the maturation of RBCs

Normo –> usually from decreased production or increased destruction of RBCs

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6
Q

Microcytic Anemias

(4)

A

Iron Deficiency

Anemia of Chronic Disease

Thalassemias

Sideroblastic Anemia

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7
Q

Macrocytic Anemias

  1. Megaloblastic (3)
A

Megaloblastic:

  1. Vitamin B12 deficiency
  2. Folate Deficiency
  3. Drug-related
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8
Q

Macrocytic Anemias

  1. Non-Megaloblastic (4)
A
  1. Hypothyroidism
  2. Liver Disease
  3. Alcoholism
  4. Myelodysplastic Syndromes
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9
Q

Normocytic Anemias

  1. Hemolytic (2 types; 3 subtypes)
A

Hemolytic

  1. Intrinsic
    - Membrane Defects
    - Enzyme deficiencies
    - Hemoglobinopathies
  2. Extrinsic
    - Autoimmune (warm and cold antbody mediated)
    - Alloimmune
    - Nonimmune (splenomegaly, physical trauma, inefctions)
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10
Q

Normocytic Anemias

  1. Non-Hemolytic (4)
A
  1. Acute blood loss
  2. Aplastic anemia
  3. Anemia of chronic disease
  4. Chronic renal insufficiency
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11
Q

Macrocytic Anemia

  1. Causes (Name the main 3 of the 14 total)
A

BIG FAT RED CELLS

B- B12 malabsorption

I- Inherited

F-Folic acid deficiency

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12
Q

Anemia

  1. Objective Findings
A

Tachycardia, Tachypnea, Weight Loss

Pale Skin or Mucous Membranes, Nail Changes

Systolic Murmur (may be heard)

Vibratory Sense Loss (B12 deficiency)

Jaundice

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13
Q

Megaloblastic Anemia

  1. 3 key findings
A

MCV > 100 fL

Macroovalocytosis

Hypersegmented neutrophils (5+ lobes)

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14
Q

Vitamin B12

  1. Total Body Stores
  2. Daily Requirement
  3. Source
  4. Site of Absorption
  5. Complications (if deficient)
A

Total Body Stores: 2-5 mg

Daily Requirement: 1-3 mcg

Source: Animal sources only

Site of Absorption: Terminal Ileum

Complications (if deficient): Megaloblastic anemia, Neurologic Abnormalities

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15
Q

Folate (Folic Acid)

  1. Total Body Stores
  2. Daily Requirement
  3. Source
  4. Site of Absorption
  5. Complications (if deficient)
A

Total Body Stores: 5-10 mg

Daily Requirements: 50-100 mcg

Source: Animal products, Leafy Vegetables, Nuts, Beans, Fruit

Site of Absorption: Proximal jejunum

Complications (if deficient): Megaloblastic Anemia, Neural Tube Defects

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16
Q

How long does it take to become B12 deficient? Folate deficient?

A

B12 deficiency = 3-4 years

Folate = 3-4 months

17
Q

Vitamin B12 (Cobalamin) Deficiency

  1. Causes
  2. Incidence
  3. Prevalence
A
  1. Causes interference in DNA synthesis (via methylmalonic acid to succinyl Coa and homocystine to methionine reactions)
  2. Incidence: women over 60 y/o
  3. Prevalence: highest in African and Asian countries
18
Q

What is the most common cause fo Vitamin B12 deficiency?

What causes it?

A

Pernicious Anemia

-Due to autoantibodies against Intrinsic Factor or atrophy of the cells that produce it

19
Q

Other Causes of B12 deficiency (6)

A

Diet (Vegans)

Malabsorption

  • Gastrectomy
  • Zollinger Ellison Syndrome
  • Ileal Disease (Crohn’s)
  • Drugs (Meformin, Prolonged PPIs for GERD/PUD)
  • Fish tapeworm
20
Q

B12 Deficiency

  1. Specific Symptoms
  2. PE Findings
A
  1. Neurologic –> Paresthesias, Atazia, Change in Mental Status
  2. PE Findings –> Decreased Position and Vibratory Sense, Disturbances of Vision, Taste, and Smell, Romberg’s Sign, Babinski’s Sign, Neuropathy
21
Q

B12 Deficiency

  1. Diagnostic Labs (6)
A
  1. Need CBC and Retic Count
  2. Increased MCV
  3. Decreased Retic Count
  4. Low B12 level, High serum Methylmalonic Acid and Homocysteine levels (Normal B12 level is 160-1000 ng/L)
  5. Peripheral Blood Smear –> Macrocytic RBCs, Anisocytosis, Poikilocytosis, and Hypersegmented Neutrophils
  6. Bone Marrow may show megaloblasts, erythroid platelets
22
Q

B12 Deficiency

  1. Treatments
  2. Responses
A
  1. FIND THE CAUSE
    - B12 1000 mcg SC or IM weekly x1 month, then monthly
    - Sublingual or oral B12 1-2 mg PO if not due to malabsorption
    - Intranasal gel
  2. ***Hypokalemia*** (watch for this)

Response: Bone marrow becomes normoblastic in 12 hours, Reticulocytosis in 3-5 days, Hgb normalizes in 2 months

23
Q

B12 Deficiency

  1. Implications (3)
A
  1. Demyelination of the posterior spinal cord can occur, causing spastic ataxia and dementia
  2. Can lead to infertility in both men and women
  3. Can cause cervical smear abnormalities
24
Q

***Post Gastrectomy Patients***

A

ALL total gastrectomy patients need B12 supplementation

10-15% of partial gastrectomy patients will develop deficiency

25
Q

Pernicious Anemia

  1. What is it?
  2. Results
  3. Most common
  4. Highly associated with
  5. Increased incidence of
  6. Average age of onset
A
  1. What is it? –> Hereditary Autoimmune disorder-immune-mediated atrophy of gastric parietal cells
  2. Results –> Absent gastric acid/intrinsic factor
  3. Most common –> among Northern Europeans/African Americans
  4. Highly associated with –> Autoimmune Disorders
  5. Increased incidence of –> Intestinal Type Gastric Cancer/Gastric Carcinoid Tumors
  6. Average age of onset –> 60 years old
26
Q

Pernicious Anemia

  1. Diagnostic Labs
A

Parietal cell and Intrinsic Factor antibody positive (90% and 70%)

Serum Gastrin level is high; Serum Pepsinogen 1 level is low (90%)

Gastric biopsy shows atrpohy of all layers of the body and fundus with absence of parietal and chief cells and replacement by mucous cells

27
Q

Subclinical B12 Deficiency

  1. What is it?
  2. Elevated?
  3. Treatment
A
  1. Borderline Serum B12 level
  2. Elevated homocysteine or methylmalonic acid levels
  3. No clear guidelines for treatment
    - MVI with B12 is not sufficient
    - 500-1000 mcg daily is lowest dose sufficient to correct

***Basically treated as if they have B12 deficiency***

28
Q

Folate Deficiency Anemia

  1. Main Causes (5)
A
  1. Inadequate Dietary Intake –> Alcoholism, Elderly
  2. Increased needs –> pregnancy, lactation, prematurity, hemolytic anemia, exfoliative dermiatitis, RA, Crohn’s, Dialysis patients
  3. Malabsorption –> Celiac disease, IBS
  4. Drugs –> Methotrexate, Trimethoprim, Dilantin, OCPs
  5. Liver Disease
29
Q

Folace Deficiency Anemia

  1. Signs/Symptoms
  2. Objective Findings
A
  1. Similar to B12 deficiency, but no neurologic abnormalities
    - Fatigue, weight loss, lightheadedness, abdominal pain
    - Neural Tube Defects (pregnant women)
  2. Objective Findings –> Pallor, Glossitis, Jaundice
30
Q

Folate Deficiency

  1. Diagnostic Labs
A
  1. Low Hgb with macrocytosis
  2. Low serum (2-15 mcg/L) and RBC folate level
  3. Peripheral smear –> Hypersegmented neutrophils
  4. High homocysteine levels
  5. Normal or low B12 level
  6. Normal methylmalonic acid
31
Q

Folate Deficiency

  1. Treatment
A
  1. Consume foods rich in folate
  2. Supplement Folate (1-5 mg/day) orally
  3. Correction may take up to 8 weeks, common to continue longer
32
Q

Aplastic Anemia

  1. Causes
  2. Results
A
  1. Bone marrow failure caused by suppression or injury to stem cells
    - Bone marrow fails to produce mature blood cells
  2. Pancytopenia results
33
Q

Aplastic Anemia

  1. Causes (most common)
A
  1. Autoimmune: Idopathic, SLE

Congenital

Chemotherapy, Radiotherapy

Toxins

Drugs

Posti-viral Hepatitis

Pregnancy

Paroxysmal Nocturnal Hemoglobinuria

34
Q

Aplastic Anemia

  1. Symptoms (3)
  2. PE Findings (3)
A

Symptoms:

  1. Weakness/Fatigue (Anemia)
  2. Bacterial/Fungal Infections (Neutropenia)
  3. Mucosal/Skin Bleeding/Petechiae (Thrombocytoepnia)

PE Findings:

  1. Pallor, Petechiae, Purpura
  2. HSM (in advanced disease) Hepatosplenomegaly
  3. ***Lymphadenopathy and bone pain should NOT BE PRESENT***

(This is actually suggestive of CANCER)

35
Q

Aplastic Anemia

  1. Diagnostic Labs
A

Pancytopenia (more severe = worse prognosis)

Bone Marrow Biopsy –> Will appear hypocellular (hardly any cells present)

36
Q

Aplastic Anemia

  1. Treatment (Mild vs Severe)
A

Mild –> Supportive Care

(Not too many transfusions to avoid sensitizing potential transplant candidates)

Severe –> Bone Marrow Transplant

37
Q

What lab findings help you differentiate between Vitamin B12 Deficiency and Folate Deficiency?

A

Serum Folate:

B12 Deficiency –> Normal

Folate Deficiency –> Low

Methylmalonic Acid:

B12 Deficiency –> High

Folate Deficiency –> Normal

Hematology Exam I (12 decks)

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