Anemias

Question 1

Microcytic Anemias

Answer 1

Thalassemia
Anemia of Chronic Disease (late)
Iron Deficiency
Lead Poisoning
Sideroblastic Anemia

Other Hemoglobinopathies (e.g. sickle-cell)

Question 2

Iron Deficiency Blood Loss Upper GI examples

Answer 2

Peptic ulcer disease, esophageal varices, gastritis, etc

Question 3

Iron Deficiency Blood Loss Lower GI examples:

Answer 3

Hemorrhoids, diverticula, colorectal cancer, Inflammatory Bowel Disease (crohns, ulcerative colitis )

Question 4

Iron Deficiency Clinical Manifestations

Answer 4

symptoms in adults are primarily due to anemia include: weakness, headache, irritability, fatigue and exercise intolerance.
many patients are asymptomatic and present only with anemia.
Pica
Pagophagia-wanting to eat ice

Question 5

Iron Deficiency Anemia Labs/Diagnostics

Answer 5

Serum Ferritin: an excellent indicator of iron stores in otherwise healthy adults and has replaced assessment of bone marrow iron stores as the gold standard for diagnosis in most patients
normal is around 15-200 ng/mL
Serum Iron: Reduced
Total Iron Binding Capacity: Increased
Transferrin Saturation (SI/TIBC): Low

Question 6

Anemia of Chronic Disease (Late)

Answer 6

Occurs in the setting of chronic inflammatory diseases (such as rheumatoid arthritis) and malignancy

Question 7

Anemia of Chronic Disease (Late) MOA

Answer 7

Believed to involve trapping of iron by activated macrophages, which renders the iron unavailable for erythropoiesis

Question 8

Anemia of Chronic Disease (Late) Labs

Answer 8

Anemia usually moderate, Hb around 7-11g/dL
Serum Iron low in both ACD and IDA, and total iron binding capacity (TIBC) is high in IDA and low in ACD
Key is that ACD ferritin is high and IDA ferritin is low
Usually normocytic, but can be microcytic
Ferritin will possibly be normal

Question 9

Megaloblastic Macrocytic Anemias

Answer 9

presence of oval macrocytes and hyper segmented neutrophils
Abnormalities of DNA metabolism
  B12 deficiency
  Folate deficiency
  Drug side effects

Question 10

Nonmegaloblastic Macrocytic Anemias

Answer 10

absence of neutrophil hypersegmentation along with the presence of round macrocytes

Question 11

Absorption of B12 (Cobalamin) depends upon five factors:

Answer 11

Adequate dietary intake
Acid-pepsin in the stomach
Pancreatic proteases
Gastric secretion of a functional intrinsic factor
An ileum with functioning Cobalamin-Intrinsic Factor receptors

Question 12

Pernicious Anemia

Answer 12

Autoimmune disease
Parietal cells of the stomach lining fail to secrete enough intrinsic factor to ensure intestinal absorption of vitamin B12

Question 13

Drugs can also interfere with folate metabolism

Answer 13

Trimethoprim
Methotrexate
Phenytoin

Question 14

Factors that decrease oxygenation

Answer 14

Low Blood volume
Low blood flow
Pulmonary Disease
Low Hgb
Anemia

Question 15

Hemolytic Anemia’s Intrinsic abnormalities of RBC

Answer 15

Contents:
Hb, enzymes
Membranes:
Permeability, lipid content or structure

Question 16

Hemolytic Anemia’s Extrinsic to RBC

Answer 16

Serum antibodies (Abs)
Traumas in the circulation
Infectious agents (malaria)

Question 17

Direct Coombs’ Test

Answer 17

Can help to differentiate between immune and nonimmune hemolytic anemias

Question 18

G6PD Deficiency

Answer 18

Glucose-6-phosphate dehydrogenase helps red blood cells resist oxidant stress

X-Linked Disorder

Affected patients are usually asymptomatic but many patients have episodic anemia while a few have chronic hemolysis

Question 19

Microangiopathic Hemolytic Anemia

Answer 19

Occurs when capillaries are partially occluded by fibrin, which leads to fragmentation of red cells

Peripheral smear characteristically shows schistocytes and helmet cells