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HEMA 1 Finals > Anemias > Flashcards

Anemias Flashcards

1
Q

What is an impoverished condition of the blood caused by ____ in ____, ____, or ____

A

Anemia
reduction in RBC, Hgb, or BOTH

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2
Q

It is considered to be present if the hemoglobin conc. of the hematocrit is ____ the lower limit of the ___ reference interval for the individual’s age, sex, and geographic location

A

Anemia
below; 95%

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3
Q

Anemias is defined as a _____
Resulting in ______ to the tissue’s

A

decrease in erythrocytes and hemoglobin
decreased oxygen delivery

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4
Q

Anemias can be classified morphologically using

A

RBC indices (MCV, MCH, MCHC)
Etiology/ Cause

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5
Q

RBC indices that is more accurate than MCH for Anemia

A

MCHC

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6
Q

Anemia is suspected when the hemoglobin level is

A

<12 g/dL in men
<11 g/dL in women

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7
Q

Anemia is mainly caused by:

A

Decreased RBC production
Increased RBC destruction

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8
Q

Decreased RBC production

A

problems in site of production in long bones

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9
Q

Increased RBC destruction

A

healthy BM, but are easily destroyed (e.g. thalassemia)

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10
Q

Total production of RBC

A

Total Erythropoiesis

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11
Q

Total production of RBC & can be measured through: Total production of RBC & can be measured through:

A
  • M:E ratio
  • Fecal urobilinogen – color of stool (stercobilin pigment) is from the product of RBC thru bilirubin synthesis
  • Plasma iron Turnover
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12
Q

Production of RBC that reaches the circulation of peripheral blood

A

Effective Erythropoiesis

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13
Q

Production of RBC that reaches the circulation of peripheral blood (it reaches its lifespan of 120 days). Measured through:

A
  • RBC Turnover Utilization of Iron
  • RBC Lifespan
  • Reticulocyte Count
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14
Q

General Clinical Signs & Symptoms of Anemia

A
  1. Low hemoglobin concentration & Blood Volume
  2. Fatigue
  3. Dyspnea on exertion
  4. Faintness
  5. Vertigo
  6. Palpitation
  7. Headache
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15
Q

Common Clinical Signs & Symptoms of Anemia

A
  1. Pallor
  2. Rapid Bounding Pulse
  3. Low Blood Pressure (80/70-60 mmHg)
    • Normal: 120/80 mmHg
    • Warning: 140/90 mmHg
  4. Slight Fever
  5. Some Dependent Edema (rare)
  6. Systolic Murmurs
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16
Q

Morphologic Classification of Anemia (3)

A
  1. Macrocytic normochromic anemia
  2. Microcytic hypochromic anemia
  3. Normocytic normochromic anemia
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17
Q

In Macrocytic normochromic anemia, it is the presence of abnormal erythroblast in BM w/ delayed maturation

A

Megaloblastic Anemia

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18
Q

Causes (inherited/ lifestyle) of Macrocytic normochromic anemia

A
  1. Vitamin B12 deficiency
  2. Folic Acid Deficiency
  3. Abnormalities of Vit B12 or folate metabolism
  4. Inherited disorders of DNA synthesis
  5. Drug-induced disorders of DNA synthesis
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19
Q

It is pernicious anemia

A

Vit. B12 deficiency

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20
Q

Nutritional megaloblastic anemia

A

Folic acid deficiency

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21
Q

Laboratory findings of Macrocytic normochromic anemia

A
  1. Red cells are macrocytic – MCV is >95 fL and often as high as 120-140 fL (Normal: 80-96 fL)
  2. Macrocytes are typically oval shape
  3. Reticulocytes count is low in relation to the degree of anemia
  4. Total white cell count and platelet counts may be moderately reduced, especially in severely anemic patients
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22
Q

TRUE or FALSE
In Macrocytic normochromic anemia, Peripheral smears have increased RBC in morphology despite:
- the DROP of Hgb, Hct and RBC count

A

FALSE
Peripheral smears have NORMAL RBC in morphology despite:
- the DROP of Hgb, Hct and RBC count

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23
Q

TRUE or FALSE
In Macrocytic normochromic anemia, Peripheral smears have normal bone marrow activity:
– increased of Reticulocyte count
– w/o increased red cell or hgb breakdown

A

FALSE
INCREASED bone marrow activity:
– increased of Reticulocyte count
– w/o increased red cell or hgb breakdown

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24
Q

In Macrocytic normochromic anemia, it shows macrocytic, normoblastic cells

A

Non-Megaloblastic Anemia

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25
Q

Non-megaloblastic anemia causes (6)

A
  1. Accelerated erythropoiesis
  2. Increased membrane surface area
    • 1 RBC = 23 Potassium
  3. Obscure causes (hypoplastic & aplastic anemias)
  4. Alcohol
  5. Liver disease
  6. Cytotoxic drugs (e.g. metronidazole)
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26
Q

In Macrocytic normochromic anemia, MCV has a value of

A

> 96 fL

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27
Q

In Macrocytic normochromic anemia, MCHC has a value of

A

Normal

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28
Q

Microcytic hypochromic anemia has

A

Small RBC size
Decreased Hemoglobin

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29
Q

Causes of Microcytic hypochromic anemia

A
  1. Iron deficiency (IDA)
  2. Disorder of globin synthesis as in thalassemia
  3. Disorders of porphyrin & heme synthesis as in sideroblastic anemia
  4. Other disorders of iron metabolism
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30
Q

In Microcytic hypochromic anemia, peripheral smear are:

A
  • Anisocytosis & Poikilocytosis
  • Microcytic – since many are smaller than the nucleus of the lymphocyte
  • Hypochromic – with increased central pallor
  • Presence of elliptocytic & pencil-shaped forms
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31
Q

In Microcytic hypochromic anemia, MCV has a value of

A

< 80 fL

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32
Q

In Microcytic hypochromic anemia, MCHC has a value of

A

< 30%

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33
Q

Causes of Normocytic normochromic anemia

A
  1. Recent blood loss
  2. Overexpansion of plasma volume as in pregnancy
  3. Hemolytic diseases
  4. Hypoplastic BM (aplastic anemia)
  5. Infiltrated BM (leukemia)
  6. Endocrine abnormality
  7. Chronic disorders
  8. Renal disorders
  9. Liver diseases
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34
Q

A Normochromic, normocytic anemia w/ Effective Erythropoiesis has

A

INCREASED Reticulocyte Count

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35
Q

INCREASED Reticulocyte Count (3)

A

a. Acute Blood Loss
b. Hemolytic Anemia
c. Response to specific therapy in nutritional anemia

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36
Q

Acute Blood Loss (3)

A
  • Very acutely, with hypovolemia
  • May have normal blood count
  • Will become anemic w/ volume replenishment
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37
Q

Increased reticulocyte production cannot keep pace with loss of RBCs peripherally

A

Hemolytic Anemia

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38
Q

Laboratory findings in Normocytic normochromic anemia

A
  1. Plasma volume and red cell volume are REDUCED in proportionate amount
  2. Normal Hct
  3. Reduced platelet count
  4. Reduced plasma fibrinogen
  5. Neutrophilic leukocytosis is present
  6. Normocytes and normochromic cells are present
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39
Q

CLASSIFICATION OF ANEMIA ACCORDING TO CAUSE

A
  • Anemia due to Impaired Red Cell Production
  • Anemia due to Blood Loss – Post Hemorrhagic Anemia
  • Anemia due to Accelerated Red Cell Destruction – Hemolytic Anemia
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40
Q

ANEMIA DUE TO IMPAIRED OR DEFECTIVE PRODUCTION OF ANEMIAS

A
  1. Iron Deficiency Anemia (IDA)
  2. Anemia of Chronic Dse (ACD)
  3. Sideroblastic Anemia
  4. Thalassemia
  5. Lead poisoning
  6. Porphyrias
  7. Megaloblastic Anemias
  8. Aplastic Anemia
  9. Myelophthisic (Bone Marrow Replacement) Anemia
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41
Q

MOST COMMON FORM OF ANEMIA (DOH)

A

Iron Deficiency Anemia (IDA)

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42
Q

Iron Deficiency Anemia (IDA) is a _____

A

Microcytic/ hypochromic anemia

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43
Q

Iron Deficiency Anemia (IDA) is LOW in

A

Serum iron, ferritin, hemoglobin/ hematocrit, RBC indices, reticulocyte count

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44
Q

Iron Deficiency Anemia (IDA) is HIGH in

A

RDW (variations in RBC sizes) and TIBC

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45
Q

Inability to use available NORMAL red blood cells
Impaired release of storage iron associated with increased HEPCIDIN levels
Associated with persistent infections, chronic inflammatory disorders (arthritis, gout)

A

Anemia of Chronic Disease (ACD)

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46
Q

Anemia of Chronic Disease (ACD) is a ____

A

Normocytic/ normochromic anemia, or slightly microcytic/ hypochromic anemia

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47
Q

Anemia of Chronic Dse (ACD) is INCREASED in

A

ESR, Ferritin

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48
Q

Anemia of Chronic Disease (ACD) is DECREASED in

A

Serum Iron and TIBC

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49
Q

Caused by blocks on the protoporphyrin pathway resulting in defective hemoglobin synthesis and iron overload
Two RBC populations (dimorphic) are seen

A

Sideroblastic Anemia

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50
Q

Excess iron accumulates in the mitochondrial region of immature erythrocytes (ringed sideroblasts)

A

Sideroblastic Anemia

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51
Q

Sideroblastic Anemia is a ____

A

Microcytic/ Hypochromic anemia

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52
Q

Sideroblastic Anemia is INCREASED in

A

Ferritin and Serum iron

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53
Q

Sideroblastic Anemia is DECREASED in

A

TIBC

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54
Q

Is an INHERITED blood disorder that causes your body to have less hemoglobin than normal

A

Thalassemia

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55
Q

Multiple blocks in the protoporphyrin pathway
Normocytic/ normochromic anemia with characteristic course basophilic stippling

A

Lead poisoning

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56
Q

Lead poisoning is a ____

A

Normocytic/ normochromic anemia

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57
Q

Group of INHERITED disorders characterized by a block in the protoporphyrin pathway
Hematologic findings are insignificant
Photosensitivity, abdominal pain, CNS disorders

A

Porphyrias

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58
Q

Heme precursors before the block accumulate in the tissues, and large amounts are excreted in urine/feces

A

Porphyrias

59
Q

Defective DNA synthesis
Caused by either Vitamin B12 deficiency or folic acid deficiency

A

Megaloblastic Anemias

60
Q

Megaloblastic anemias are defective DNA synthesis causes _____; RNA synthesis is ____, so the cytoplasm is _____

A

abnormal NUCLEAR MATURATION
normal
not affected

61
Q

In megaloblastic anemias, nucleus matures slower than the cytoplasm and is called

A

Asynchronism

62
Q

Megaloblastic Anemias is a _____

A

Macrocytic/ Normochromic anemia

63
Q

Bone marrow failure

A

Aplastic Anemia

64
Q

Aplastic Anemia is DECREASED in

A

Hemoglobin/ hematocrit and reticulocytes

65
Q

Aplastic Anemia is a _____

A

Normocytic/ Normochromic anemia

66
Q

Hypoproliferative anemia caused by replacement of bone marrow hematopoietic cells by MALIGNANT CELLS or FIBROTIC TISSUE

A

Myelophthisic (Bone Marrow Replacement) Anemia

67
Q

Myelophthisic (Bone Marrow Replacement) Anemia is a _____

A

Normocytic/ Normochromic anemia

68
Q

ANEMIA DUE TO BLOOD LOSS – Post Hemorrhagic Anemia

A
  1. Acute Blood Loss
  2. Chronic Blood Loss
  3. Acute Post- Hemorrhagic Anemia
  4. Chronic Post- Hemorrhagic Anemia
69
Q

Sudden loss of blood resulting from trauma or other severe forms of injury

A

Acute Blood Loss

70
Q

Acute Blood Loss is a ____

A

Normocytic/normochromic anemia (if the px w/ acute bleeding was healthy before the episode)

71
Q

In Acute Blood Loss, this may occur due to increased number of reticulocytes

A

Transient macrocytosis

72
Q

Gradual, long-term loss of blood, often caused by GI bleeding

A

Chronic Blood Loss

73
Q

Chronic Blood Loss is a ______
But becomes ______caused by gradual loss of iron

A

Normocytic/normochromic anemia (initially)
Microcytic/hypochromic

74
Q

If blood is lost over a short period of time in amount sufficient to cause anemia

A

Acute Post- Hemorrhagic Anemia

75
Q

Acute Post- Hemorrhagic Anemia is DECREASED in

A

Hgb, Hct, & RBC count

76
Q

Acute Post- Hemorrhagic Anemia is INCREASED in

A

BM Activity, without increase red cell or hgb breakdown

77
Q

TRUE or FALSE
In Acute Post- Hemorrhagic Anemia, PBS shows ABNORMAL red cells

A

FALSE
It shows NORMAL red cells

78
Q

Usually in women reaching their menopausal pd

A

Chronic Post- Hemorrhagic Anemia

79
Q

If blood is lost in small amount over an extended period of time, both the clinical and hematologic features that characterize acute post-hemorrhagic anemia are lacking

A

Chronic Post- Hemorrhagic Anemia

80
Q

Chronic Post- Hemorrhagic Anemia is NORMAL/ SLIGHTLY DECREASED in

81
Q

Chronic Post- Hemorrhagic Anemia is NORMAL/ SLIGHTLY INCREASED in

A

Platelet count

82
Q

TRUE or FALSE
In Chronic Post- Hemorrhagic Anemia, PBS result in Reticulocyte count may be normal or slightly increased

83
Q

TRUE or FALSE
In Chronic Post- Hemorrhagic Anemia, PBS RBC at first normochromic and normocytic and gradually formed red cells become microcytic and hypochromic

84
Q

ANEMIA DUE TO ACCELERATED RED CELL DESTRUCTION

A

Hemolytic Anemia

85
Q

HEMOLYTIC ANEMIA MAY BE DUE TO:

A

Intrinsic Hemolytic Anemia
Extrinsic Hemolytic Anemia

86
Q

defect or red cell itself, usually hereditary & grouped as membrane, metabolic, or hemoglobin defects

A

Intrinsic Hemolytic Anemia

87
Q

factor outside the red cell & acting upon it. Almost always ACQUIRED

A

Extrinsic Hemolytic Anemia

88
Q

INTRINSIC HEMOLYTIC ANEMIAS: DUE TO “MEMBRANE” DISORDERS

A
  1. Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia
  2. Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome
  3. Hereditary Elliptocytosis/ Ovalocytosis
  4. Hereditary Pyropoikilocytosis
  5. Hereditary stomatocytosis (Hydrocytosis)
  6. Hereditary Acanthocytosis (Abeta- lipoproteinemia)
  7. Rhnull Disease
  8. High Phosphatidyl Hemolytic Anemia
89
Q

Inherited a a non-sex-linked dominant trait
Most common in North Europeans

A

Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia

90
Q

Spherocytes die prematurely

A

Hereditary Spherocytosis/ Congenital Hemolytic Jaundice Anemia

91
Q

Very rare chronic and acquired defect
SPLENOMEGALY
Nocturnal hemoglobinuria occurs DURING sleep or AFTER awakening

A

Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome

92
Q

Chronic intravascular hemolysis
pH of plasma is low due to red cells

A

Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome

93
Q

ACIDOSIS (due to CO2 retention)
Hemosiderinuria is a feature

A

Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome

94
Q

Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome is POSITIVE in

A

Sucrose hemolysis test or Ham’s Acidified Serum Test or Sugar Water Test

95
Q

Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome is LOW in

A

WBC & Platelet Count

96
Q

TRUE or FALSE
In Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome, Peripheral smears is ELEVATED in Reticulocyte Count

97
Q

TRUE or FALSE
In Paroxysmal Nocturnal Hemoglobinuria (PNH)/ Machiava-Micheli Syndrome, Peripheral smears has Normocytic, normochromic anemia present

98
Q

Inherited dominant trait
Associated with severe hemolytic anemia in infants
Defect involves the impaired association of spectrin dimers resulting in FREE, UNCONNECTED dimers

A

Hereditary Elliptocytosis/ Ovalocytosis

99
Q

Hereditary Elliptocytosis/ Ovalocytosis is INCREASED in

A

Osmotic Fragility Test

100
Q

Hereditary Elliptocytosis/ Ovalocytosis has the presence of

A

Autohemolysis of red cells

101
Q

TRUE or FALSE
In Hereditary Elliptocytosis/ Ovalocytosis, Peripheral smears has Non-hypochromic elliptocytes are ABUNDANT on blood films Count

102
Q

Rare, moderately severe congenital hemolytic anemia
Inherited as recessive autosomal traits
Occurs in blacks

A

Hereditary Pyropoikilocytosis

103
Q

TRUE or FALSE
In Hereditary Pyropoikilocytosis, PBS has Microcytosis, Striking Micro-poikilocytosis & Fragmentation

104
Q

Rare congenital anemia
Inherited as recessive autosomal trait caused by INCREASED Na and DECREASED K due to increased permeability of membrane

A

Hereditary stomatocytosis (Hydrocytosis)

105
Q

In Hereditary stomatocytosis (Hydrocytosis) about _____ red cells appear as _____

A

10-30%
mouth like

106
Q

Caused by absence of beta-lipoprotein
Associated w/ plasma lipid abnormalities

A

Hereditary Acanthocytosis (Abeta- lipoproteinemia)

107
Q

Hereditary Acanthocytosis (Abeta- lipoproteinemia) has LOW

A

total lipid, cholesterol & phospholipids

108
Q

Sample used in Hereditary Acanthocytosis (Abeta- lipoproteinemia)

109
Q

Autohemolysis occurs
Presence of MILD ANEMIA

A

Hereditary Acanthocytosis (Abeta- lipoproteinemia)

110
Q

In Hereditary Acanthocytosis (Abeta- lipoproteinemia) RCT ranges from

A

Normal to Increased

111
Q

Inherited due to gene suppression or presence of silent Rh gene (Xo)
Membrane abnormalities due to absence of all Rh-Hr antigens on the red cells outer layer
Rh negative mother & Rh pos baby

A

Rhnull Disease

112
Q

Rhnull Disease has HIGH

A

Reticulocyte Count

113
Q

Rhnull Disease is INCREASED in

A

Autohemolysis & Osmotic Fragility

114
Q

TRUE or FALSE
In Rhnull Disease, Peripheral smears has Mild, chronic normocytic normochromic hemolytic anemia

115
Q

TRUE or FALSE
In Rhnull Disease, Peripheral smears shows stomatocytes & spherocytes

116
Q

Inherited; Represents an imbalance in the membrane phospholipids in the red cells
Anemia may increase due to infection or under condition of stress

A

High Phosphatidyl Hemolytic Anemia

117
Q

TRUE or FALSE
In High Phosphatidyl Hemolytic Anemia, Peripheral smears it causes SEVERE anemia w/ morphologically normal cells

A

FALSE
causes MILD anemia w/
morphologically normal cells

118
Q

INTRINSIC HEMOLYTIC ANEMIAS: DUE TO “METABOLIC” DISORDERS

A
  1. G6PD Deficiency
  2. Pyruvate Kinase Deficiency
  3. Pyrimidine-5- Nucleotidase (PN) Deficiency
  4. Glucose Phosphate Isomerase Deficiency
  5. Other Diseases
    • Triosephosphate Isomerase, Hexokinase and Diphosphoglycerate Mutase Deficiency
    • Glutathione synthase, glutathione peroxidase and glutathione reductase deficiencies
119
Q

Inherited sex-linked
Complex heterogenous disorder w/c is ubiquitous
MOST COMMON defect seen in enzyme deficient hemolytic anemia

A

G6PD Deficiency

120
Q

Seen in black
With mild hemolytic conditions

A

Type A of G6PD Deficiency

121
Q

Seen in Mediterranean race
more susceptible to severe oxidant hemolysis compared to Type A

A

Type B of G6PD Deficiency

122
Q

most delicate
life threatening and occurs within an hour after eating fava beans

A

Favism of G6PD Deficiency

123
Q

G6PD Deficiency Laboratory tests

A

Methyl violet or crystal violet stains Dye Reduction test

124
Q

Inherited disorder
MOST COMMON RED CELL ENZYME DEFICIENCY involving the Embden-Meyerhof Glycolytic Pathway

A

Pyruvate Kinase Deficiency

125
Q

PK converted to _____ to _____ in the EMP w/ the production of ATP

A

phosphoenolpyruvate
pyruvate

126
Q

In Pyruvate Kinase Deficiency, RBC loses its flexibility due to ____

A

decreased ATP

127
Q

Seen commonly in children
Mild to moderately hemolytic anemia w/ splenomegaly

A

Pyruvate Kinase Deficiency

128
Q

TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is notable red cell abnormalities until after splenomegaly

A

FALSE
There NO notable red cell abnormalities until after splenomegaly

129
Q

TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is Echinocytes/ Spiculated RBCs

130
Q

TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears there is regularly contracted red cell

A

FALSE
there is IRREGULARLY contracted red cell

131
Q

TRUE or FALSE
In Pyruvate Kinase Deficiency, Peripheral smears nucleated red cells may be prominent

A

FALSE
CRENATED red cells may be prominent

132
Q

INHERITED; caused by an abnormality in nucleotide metabolism
Acquired occurs in LEAD POISONING & responsible for the BASOPHILIC STRIPPING

A

Pyrimidine-5- Nucleotidase (PN) Deficiency

133
Q

Pyrimidine-5- Nucleotidase (PN) Deficiency laboratory findings:
____ is observed

A

Reticulocytosis

134
Q

Pyrimidine-5- Nucleotidase (PN) Deficiency laboratory findings is _____ demonstration of ______ Nucleosidase activities

A

Positive
decreased

135
Q

This causes an abnormality in ANAEROBIC GLYCOLYSIS (dec. O2 content) causing a moderately severe anemia

A

Glucose Phosphate Isomerase Deficiency

136
Q

Glucose Phosphate Isomerase Deficiency Laboratory findings is that Reticulocyte count may be significantly

137
Q

TRUE or FALSE
In Glucose Phosphate Isomerase Deficiency, Peripheral smear the red cell does not show

A

FALSE
The red cell SHOWS

138
Q

ANISOCYTOSIS & POIKILOCYTOSIS

A

Glucose Phosphate Isomerase Deficiency

139
Q

Triosephosphate Isomerase, Hexokinase and Diphosphoglycerate Mutase Deficiency

A

other enzyme deficiencies in anaerobic glycolysis

140
Q

Glutathione synthase, glutathione peroxidase and glutathione reductase deficiencies (3)

A
  • Also show hemolytic anemia
  • These enzymes are required in the HMP like G-6-PD
  • Hemolysis increase due to oxidant drug
    exposure or infection
141
Q

Causes of EXTRINSIC HEMOLYTIC ANEMIA (5)

A
  1. Chemical agents
  2. Physical agents
  3. Vegetable and animal poisons
  4. Infectious agents
  5. Presence of autoantibodies, isoantibodies or drug-related antibodies causes
142
Q

Causes of EXTRINSIC HEMOLYTIC ANEMIA which are drugs and chemicals

A

Chemical agents

143
Q

Causes of EXTRINSIC HEMOLYTIC ANEMIA which are heat and trauma

A

Physical agents

144
Q

Causes of EXTRINSIC HEMOLYTIC ANEMIA which are malarial parasite, bacteria (causes sepsis/ bacteremia)

A

Infectious agents

HEMA 1 Finals (4 decks)

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