Anemia Pathophysiology Important Terms

Question 1

What is Anemia?

Answer 1

• Blood as reduced capacity to deliver oxygen
• Reduced amount of ⬆️ hematocrit, hemoglobin, RBC

Question 2

What are the 3 disorder/disease groups that anemia is an indication for? (anemia triad)

Answer 2

1) Blood loss, 2) Inadequate productio of normal RBC 3) Red blood cell destruction

Question 3

What conditions lead to anemia triad?

Answer 3

• • **Heavy periods & ulcers & surgery **(blood loss)
• A diet low in iron, folic acid, vitamin B12 (inadequate RBC production)
• Sickle cell anemia (inadequate production of normal RBCs)
• Lack of erythropoietin (inadequate RBC production)
• Pregnancy (blood ‘loss’, inadequate production)
• Kidney disease requiring dialysis & Hemolytic anemia (RBC destruction)

Question 4

Symptoms of Anemia: ACUTE

Answer 4

• Tachycardia (fast heart rate), palpitations
• Hypotension, lightheadedness
• Dyspnea (shortness of breath)

Question 5

Symptoms of Anemia: CHRONIC

Answer 5

• Chronic
• Weakness, fatigue
• Headache, vertigo, faintness
• Sensitivity to cold, pallor, loss of skin tone

Question 6

Symptoms of Anemia: Other

Answer 6

Other (typically when Hgb falls to 90 g/L or less):
Tongue pain, smooth tongue, pica, pagophagia (ice eating)

Question 7

Erythropoiesis

Answer 7

The production of RBC. Important catalyst for this process is the hormone eryhtropoietin (EPO)

Question 8

Erythropoiesis: 4 points+ location about the bone marrow part

Answer 8

1. Hemoglobin and iron are being incorporated
2. Nucleus becomes smaller as the cell matures
3. Cell size decreases
4. Process takes about a week

Location: Vertebrae, ribs, sternum, clavicle, pelvic crest, long bones

Question 9

Which cell in the erythropoiesis pathway is first to get hemoglobin?

Answer 9

Polychromatic erythroblast

Question 10

Which cell in the erythropoiesis pathway is first to get iron?

Answer 10

PROerythroblast

Question 11

What and where is hemoglobin made?

Answer 11

Increased number of ribosomes make hemoglobin in basophilic erythroblast

Question 12

What are the 5 ways EPO can increase RBC?

Answer 12

1. Stimulate stem cells to differentiate into proerythroblasts
2. Increase rate of mitosis in each cell maturation stage
3. Prevent breakdown of erythoid precursor cells
4. Increase release of reticulocytes into circulation
5. Increase hemoglobin production

Question 13

What is Transferrin? (3 points+ 1 about extra iron)

Answer 13

• Plasma transport protein
• Delivers iron to the bone marrow, to be incorporated into maturing RBC
• circulating transferrin is ~30% saturated with iron [20-50%]
• EXTRA IRON- delivers extra iron to storage sites-> which are: macrophages in liver, marrow, and spleen.

Question 14

What is Ferritin? What is Hemosiderin?

Answer 14

stored iron is called ferritn, and compacted stored iron is called hemosiderin

Question 15

Reticuloendothelial system

Answer 15

1. Bone marrow for erythopoiesis
2. Reticuoendothelial system (liver, spleen) storage of iron
3. Other cells and tissues ( myoglobin, respiratory enzymes, immune system)

Question 16

Percentages of where Iron is stored

Answer 16

75%- hemoglobin/erythropoiesis
10-20% ferritin
5-15% other processes

Question 17

Hemoglobin releases oxygen to tissues when:

Answer 17

INCREASES IN:
– Concentration of carbon dioxide
– Concentration of hydrogen ions (¯ pH)
– temperature
– 2,3- diphosphoglycerate (an oxygen affinity regulator)

Question 18

2,3-Diphosphoglycerate (2,3-DPG)

Answer 18

Increase in this, causes right shift by decreasing the affinity to oxygen, causing the release of it

Question 19

Ways you can classify anemia

Answer 19

3 different approaches:
1. Morphology (size, shape, colour)
2. Etiology (cause of the anemia)
3. Pathophysiology

Question 20

Microcytice Size

Answer 20

Check reference

Question 21

Normocytic Size

Answer 21

Check notes

Question 22

Macrocytic Size

Answer 22

Check Notes

Question 23

Anemia size distribution: RDW

Answer 23

Red Cell Distribution Width (RDW)
-A measure of variation in RBC size expressed as a percentage
-normal RDW (11-16%) variation
-high RDW (>16%) variation
Causes: Vitamin/mineral/iron deficiencies, pts with blood transfusions

Question 24

Low reticulocyte when anemic is due to?

Answer 24

• Anemia is due to impaired bone marrow function and bone marrow unable to compensate for anemia
• Iron & B12 deficiency, anemia of chronic disease, malnutrition, renal insufficiency, malignancy

Question 25

High reticulocyte Index when anemic is duet to?

Answer 25

Cause of anemia unlikely to be related to bone marrow. Bone marrow is functioning finr
Acute blood loss
hemolysis (RI > 2,5%, suggestive)

Question 26

Peripheral Blood smear

Answer 26

Allows for morphological examination: RBC size, shape, colour
Can asess for variations in cell size (anisocytosis) or variations in cell shape (poikilocytosis)
Help assess functional status of bone marrow and defects in RBC production

Question 27

Negative acute phase protein

Answer 27

Transferrin is an example. Production of this in the liver decreases under a state of inflammation, trauma or infection

Question 28

High TIBC with low serum iron is suggestive of?

Answer 28

Iron Deficiency Anemia (IDA)

Question 29

Serum Iron, TIBC, TSAT

Answer 29

see notes

Question 30

Positive acute phase protein

Answer 30

Ferritin INCREASES due to chronic infection or inflammation, trauma. It is a positive acute phase protein, so it is of limited clinical utility in chronically ill patients