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Hematology/Immunology Part 1 > Anemia Review > Flashcards

Anemia Review Flashcards

1
Q

What is microcytosis?

A

A condition defined as a mean corpuscular volume of less than 80 µm³ (80 fL) in adults, often associated with anemia.

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2
Q

How is microcytosis usually discovered?

A

Incidentally during a complete blood count (CBC).

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3
Q

What is the normal mean corpuscular volume in adults?

A

Greater than 80 µm³ (80 fL).

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4
Q

What factors can affect normal hemoglobin levels?

A

Ethnicity, tobacco use, and altitude.

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5
Q

What is the most common cause of microcytosis in the United States?

A

Iron deficiency anemia.

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6
Q

Name other causes of microcytosis besides iron deficiency anemia.

A

Anemia of chronic disease, lead toxicity, sideroblastic anemia, and thalassemia trait.

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7
Q

Are most patients with microcytosis symptomatic or asymptomatic?

A

Asymptomatic.

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8
Q

What happens to serum iron levels in iron deficiency anemia?

A

They decrease.

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9
Q

How do serum iron levels vary throughout the day?

A

They have diurnal variations with higher concentrations later in the day.

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10
Q

What physical findings may be present as the severity of anemia increases?

A

Systolic murmur, pallor of the mucous membranes, nail beds, and palmar creases.

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11
Q

What can cause transient increases in serum iron levels?

A

Meat ingestion or iron supplementation.

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12
Q

What do transient increases in serum iron levels not represent?

A

An increase in true iron stores.

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13
Q

What are useful in differentiating iron deficiency anemia and anemia of chronic disease when serum iron is decreased?

A

Ferritin, transferrin saturation levels, and TIBC.

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14
Q

What laboratory tests help differentiate the cause of microcytosis?

A

Red blood cell distribution width, serum iron levels, serum ferritin levels, total iron-binding capacity (TIBC), transferrin saturation, hemoglobin electrophoresis, reticulocyte blood count, and peripheral blood smears.

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15
Q

What does red blood cell distribution width measure?

A

The variation in red blood cell size.

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16
Q

What does TIBC refer to?

A

The ability of unsaturated transferrin to bind to iron.

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17
Q

How is TIBC usually affected in iron deficiency?

A

It is increased.

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18
Q

How does red blood cell distribution width differ in iron deficiency anemia and anemia of chronic disease?

A

Increased in iron deficiency, normal in anemia of chronic disease.

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19
Q

How is TIBC usually affected in anemia of chronic disease?

A

It is decreased.

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20
Q

How is TIBC usually affected in less severe thalassemias?

A

It is normal.

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21
Q

What is transferrin saturation?

A

A percentage calculated as serum iron concentration/TIBC x 100.

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22
Q

Is red blood cell distribution width sensitive or specific enough to differentiate iron deficiency and beta-thalassemia trait?

A

No.

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23
Q

How can the red blood cell count help differentiate iron deficiency anemia and beta-thalassemia trait?

A

It is often high to normal in beta-thalassemia trait.

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24
Q

What happens to serum iron levels in iron deficiency anemia?

A

They are decreased.

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25
Q

What does a transferrin saturation level less than 16 percent indicate?

A

Iron deficiency anemia.

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26
Q

What is ferritin?

A

A complex of iron and the binding protein apoferritin.

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27
Q

What does ferritin reflect?

A

True iron stores.

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28
Q

What can cause transient increases in serum iron levels?

A

Meat ingestion or iron supplementation.

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29
Q

What can cause ferritin to be elevated?

A

Liver disease, malignancy, and chronic renal disease.

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30
Q

What ferritin level indicates iron deficiency anemia in a healthy person?

A

Less than 15 ng per mL (15 mcg per L).

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31
Q

What are the main categories of etiologies for increased red blood cell loss or destruction?

A

Acute blood loss, hypersplenism, hemolytic disorders, congenital conditions, acquired conditions.

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32
Q

What ferritin level indicates iron deficiency anemia in a person with chronic inflammation?

A

Less than 50 ng per mL (50 mcg per L).

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33
Q

Name two congenital conditions that can lead to increased red blood cell loss.

A

red cell membrane disorders (e.g. hereditary spherocytosis) hemoglobinopathies (e.g. sickle cell disease and thalassemia) hemolytic anemia

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34
Q

What ferritin level usually excludes iron deficiency?

A

Greater than 100 ng per mL (100 mcg per L).

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35
Q

What is TIBC?

A

Total iron-binding capacity, the ability of unsaturated transferrin to bind to iron.

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36
Q

What are hemoglobinopathies?

A

Disorders related to abnormal hemoglobin, such as sickle cell disease.

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37
Q

How does TIBC differ in iron deficiency anemia and anemia of chronic disease?

A

Increased in iron deficiency, decreased in anemia of chronic disease.

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38
Q

What are the etiologies of microcytic anemia?

A

Iron deficiency anemia, thalassemia, anemia of chronic disease.

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39
Q

What is homozygous sickle cell disease also known as?

A

Hemoglobin SS disease.

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40
Q

What affects TIBC besides the type of anemia?

A

Diurnal variations.

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41
Q

What is heterozygous sickle hemoglobin C disease also known as?

A

Hemoglobin SC disease.

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42
Q

What are the etiologies of normocytic anemia?

A

Decreased production of normal-sized red blood cells, increased destruction or loss of red blood cells, uncompensated increase in plasma volume, mixture of conditions producing microcytic and macrocytic anemias.

43
Q

Name two disorders of red blood cell membranes.

A

Hereditary spherocytosis and hereditary elliptocytosis.

44
Q

What happens in the initial stage of nearly all anemias?

A

They are normocytic.

45
Q

What are the causes of increased red blood cell loss or destruction?

A

Acute blood loss, hypersplenism, hemolytic disorders, congenital conditions, acquired conditions.

46
Q

What enzyme deficiency is associated with hemolytic anemia?

A

Glucose-6-phosphate dehydrogenase deficiency.

47
Q

What is another enzyme deficiency that can cause hemolytic anemia?

A

Pyruvate kinase deficiency.

48
Q

What are some congenital conditions causing increased red blood cell loss?

A

Hemoglobinopathies, disorders of red blood cell membranes, red blood cell enzyme deficiencies.

49
Q

What are some acquired conditions causing increased red blood cell loss?

A

Mechanical hemolysis, macrovascular disorders, microangiopathic disorders, autoimmune hemolytic anemias, drug-induced anemias, paroxysmal nocturnal hemoglobinuria.

50
Q

What are some acquired conditions that can lead to increased red blood cell destruction?

A

Mechanical hemolysis, macrovascular disorders, microangiopathic disorders, disseminated intravascular coagulopathy, hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, autoimmune hemolytic anemias, drug-induced anemias, paroxysmal nocturnal hemoglobinuria.

51
Q

What are examples of hemoglobinopathies?

A

Homozygous sickle cell disease, heterozygous sickle hemoglobin C disease.

52
Q

What is mechanical hemolysis?

A

Destruction of red blood cells due to physical damage.

53
Q

What are macrovascular disorders?

A

Conditions affecting large blood vessels that can lead to hemolysis.

54
Q

What are examples of disorders of red blood cell membranes?

A

Hereditary spherocytosis, hereditary elliptocytosis.

55
Q

What are examples of red blood cell enzyme deficiencies?

A

Glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiency.

56
Q

What are microangiopathic disorders?

A

Conditions affecting small blood vessels that can lead to hemolysis.

57
Q

What are examples of autoimmune hemolytic anemias?

A

Warm-reactive anemias, cold-reactive anemias.

58
Q

What is paroxysmal nocturnal hemoglobinuria?

A

An acquired condition causing increased red blood cell loss.

59
Q

What is disseminated intravascular coagulopathy?

A

A condition where blood clots form throughout the body’s small blood vessels.

60
Q

Where is Vitamin B12 absorbed in the body?

A

Ileum

61
Q

What is hemolytic-uremic syndrome?

A

A condition characterized by hemolysis, kidney failure, and low platelet count.

62
Q

What is necessary for Vitamin B12 absorption?

A

Intrinsic factor

63
Q

What condition results from the loss of parietal cells?

A

Pernicious anemia

64
Q

What is the most common cause of pernicious anemia?

A

Autoimmune atrophic gastritis

65
Q

What is thrombotic thrombocytopenic purpura?

A

A rare blood disorder causing blood clots in small vessels, leading to low platelet count and hemolysis.

66
Q

What are autoimmune hemolytic anemias?

A

Conditions where the immune system attacks and destroys red blood cells.

67
Q

What are warm-reactive anemias?

A

Autoimmune hemolytic anemias where antibodies react at body temperature.

68
Q

What are cold-reactive anemias?

A

Autoimmune hemolytic anemias where antibodies react at cold temperatures.

69
Q

What are drug-induced anemias?

A

Hemolytic anemias caused by medications.

70
Q

What are less common causes of pernicious anemia?

A

Nonautoimmune gastritis secondary to H. pylori infections and Zollinger-Ellison syndrome

71
Q

What is paroxysmal nocturnal hemoglobinuria?

A

A rare, acquired, life-threatening disease of the blood characterized by destruction of red blood cells.

72
Q

Why are serum folate levels not useful?

A

They fluctuate rapidly with dietary intake and are not cost effective.

73
Q

What are the primary causes of decreased red blood cell production?

A

Marrow hypoplasia or aplasia, myelopathies, myeloproliferative diseases, pure red blood cell aplasia.

74
Q

What test more accurately correlates with folate stores?

A

RBC folate levels

75
Q

What are the secondary causes of decreased red blood cell production?

A

Chronic renal failure, liver disease, endocrine deficiency states, anemia of chronic disease, sideroblastic anemias, overexpansion of plasma volume.

76
Q

What is anemia of chronic disease?

A

A type of anemia associated with chronic disorders, characterized by hypo-activity of the bone marrow and inadequate production or response to erythropoietin.

77
Q

What does a normal methylmalonic acid level indicate in the context of megaloblastic anemia?

A

Folate deficiency

78
Q

What can cause anemia of chronic disease?

A

Inflammatory conditions, infections, neoplasms, and various systemic diseases.

79
Q

What is the second most common form of anemia worldwide?

A

Anemia of chronic disease.

80
Q

Who can be contacted for questions?

A

Clay W. Walker, PA-C

81
Q

What will be elevated with both vitamin B12 and folate deficiencies?

A

Homocysteine levels

82
Q

What is the pathogenesis of anemia of chronic disease?

A

It is multifactorial, involving hypo-activity of the bone marrow, inadequate production of erythropoietin, poor response to erythropoietin, and slightly shortened red blood cell survival.

83
Q

What are some chronic disorders associated with anemia of chronic disease?

A

Inflammatory conditions, infections, neoplasms, and various systemic diseases.

84
Q

What is the email address provided for inquiries?

A

clay_walker@rush.edu

85
Q

What effect do reverse transcriptase inhibitors have on patients with HIV?

A

Cause macrocytosis

86
Q

What is the professional title of Clay W. Walker?

A

PA-C

87
Q

What are some conditions that can lead to decreased red blood cell production due to endocrine and renal pathology?

A

Chronic renal failure and endocrine deficiency states.

88
Q

What does macrocytosis indicate in patients treated with reverse transcriptase inhibitors?

A

Medication compliance

89
Q

Which institution is associated with the email address provided?

A

Rush University

90
Q

What is uncompensated blood loss?

A

Blood loss that the body cannot adequately replace.

91
Q

What is hypersplenism?

A

An overactive spleen that destroys blood cells too quickly.

92
Q

What are the two most sensitive tests for detecting alcohol misuse in patients with macrocytosis?

A

Michigan Alcoholism Screening test and Gamma-glutamyltransferase levels

93
Q

What are some etiologies of macrocytic anemia?

A

Alcohol misuse, B12 deficiency, medications, folate deficiency, hypothyroidism, bone marrow dysplasias, liver disease, reticulocytotic, miscellaneous not established.

94
Q

What physical findings are consistent with alcohol misuse?

A

Gynecomastia, caput medusae, and jaundice

95
Q

What is macrocytosis?

A

The presence of abnormally large red blood cells in the blood.

96
Q

What can cause B12 deficiency?

A

Poor dietary intake, malabsorption, pernicious anemia.

97
Q

How does alcohol use more commonly cause macrocytosis?

A

Through its toxic effect

98
Q

What can cause folate deficiency?

A

Poor dietary intake, malabsorption, increased demand.

99
Q

What is the role of the American Academy of Family Physicians in the context of this text?

A

They provided the source material for the information on anemia.

100
Q

What is the mean corpuscular volume generally less than with chronic alcohol use?

A

110 fL

101
Q

What rapidly corrects the elevated mean corpuscular volume caused by alcohol use?

A

Abstinence from alcohol

102
Q

What is required to establish a diagnosis of myeloproliferative disorders?

A

Bone marrow biopsy

103
Q

Who will likely be necessary for the work-up and management of myeloproliferative disorders?

A

Hematology referral

Hematology/Immunology Part 1 (12 decks)

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