Anemias Flashcards
02 content=
Sa02(bound) + p02(dissolved_
Chronic Hypoxia
high erythropoietin production (kidney parenchyma)
increase mito density
angiogenesis (digital clubbing)
2 approches to anemia
inadequate production (reticulocytes high in serum)
excessive destruction
cyanosis
02 not getting to tissue(deoxyhemoglobin 5g of Hg)
Hypo-proliferative bone marrow problem
low reticulocyte count
how does Renal failure affect anemia
dec erythropoietin
treat with: Procrit, Epogen, Darbepoetin
Hypothyroidism: erythropoietin
can’t work, treat with
levothyroxine
mcc is infection: parvo b19, mcc: drugs, chemicals, chemo: chloramphenicol, Benzene, AZT, Vinblastine
aplastic anemia
Fanconi anemia
pure RBC aplasia, hereditary or 2nd to thymoma
Diamond blackfen syndrome
RBC aplasia + finger abnormalities like triphalangeal thumb
high retic count
destruction leading to bone marrow creating more
Mcc of high retic count
extravascular hemolytic anemia
intravascular hemolytic anemia
vasculitis: schistocytes, Burr cells, Helmet cells, dec haptoglobin (protein that binds free Hb)
extravascular hemolytic anemia sign
splenomegaly & jaundice
diseases causing extravascular hemolytic anemia
Hereditary spherocytosis
G6PD
sickle cell anemia
hemoglobin c disease (lysine for glutamate)
pyruvate kinase def
osmotic fragility test, defective spectrin/ankyrin, AD
hereditary spherocytosis
Coombs test
test antibodies that attack RBC: directly on the RBC surface or in the plasma
pos direct Coombs test:
autoimmune Hemolytic anemia: IgG warm, IgM cold
drugs causing H.Anemia
penicillins
cephalosporins
sulfa drugs
alpha-methyldopa
PTU
antimalarials
Dapsone
Lupus causing drugs
Ethusuximide
Isoniazid.
Hydralazine.
Procainamide.
Tumor-necrosis factor (TNF) alpha inhibitors (such as etanercept, infliximab and adalimumab)
Minocycline.
Quinidine
Pennicillamide
Phenytoin
Howell jolly bodies.. think
hemolytic anemia and splenectomy
schistocytes …think
vasculitis
Target cell …think
iron def anemia or thalassemia
Hienz body….think
G6PD
Basophilic stippling…think
lead poisoning
example of non-immune hemolytic anemia
G6PD
malaria
MAHA: MicroAngiopathic Hemolytic Anemia
PNH: paroxysmal Nocturnal Hemoglobin
CBC with differential
MCV
MCH
MCHC=MCH/MCV=concentration of MCH
Microcytic Hypochromic
Impaired Hg production
low retic count
low MCV or low MCH
mcc micro. hypochromic
Fe def: Rx: Ferrous iron with Vit C
fe &ferritin low, Transferrin(TIBC) high
late chronic disease : any dz lasting over 3 weeks affect Bone marrow
low Fe, low TIBC
RBC dies 60-90 day instead of 140 days
lead poisoning
Blocks Delta ALA dehydrate and Ferrochetolase
basophil stippling
high free erythrocyte protoporphyrin
Hemoglobinopathies
Thalassemia:
Alpha
Beta
Hemoglobin S
SCD glu to Val on position 6 beta chain
SCD trait
Sideroblastic anemia: cells, inheritance,test
hereditary
macrophages holding on to iron
Prussian blue stain
hereditary spherocytoisis
low mcv, high MCHC, high Retic count, hight bill, hyperkalemia
high MCV with defective nuclear division
Macrocytic anemia
B12 def mcc, enzymes
mcc type A Gastritis(pernicious Anemia)
enzymes: Malonyl-CoA mutase
Homocysteine Methyl transferase
how does anti-convulsive drug cause macrocytic anemia
they block Ca(needed for microtubules)
block folate (B9)
block sodium
Anti-convulsive drugs
phenytoin
Ethosuximide
Valproic acid
carbamazepine
Blocks
Ca and folate
Ca
Na, Ca, folate
Na and Ca
Glycosyl-phosphatidylinositol (GPI) missing on RBC, complement tag for destruction
Paroxysmal nocturnal Hg
pt may present with usual clot due to thrombosis
may die of MI and stroke
Dx. PNH
flow cytometry to detect CD55 and CD59
Block C5 with
Eculizumab
mepolizumab
Reslizumab
Benralizumab
