Anemias Flashcards
Why is it so important to confirm that a patient has low iron when they present with microcytic anemia before giving them iron supplements?
b/c they could have beta thalassemia and experience iron overload as a result
What is a weird physical feature w/ anemia of chronic disease?
spooned nails
What is the triad for plummer vinson syndrome?
iron deficiency anemia
esophageal webs
glossitis
What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Iron deficiency anemia
Serum iron low
TIBC high (trying to transport stuff)
ferritin low
% transferrin saturation low (
What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Anemia of chronic disease?
Serum iron low TIBC low Ferritin High % transferrin saturation is normal >18% **think of it as body thinks a terrorist is coming and looking for a food supply. Hide it in storage. Get rid of the taxi cabs. The taxis that are out there prob have passengers.
What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Hemochromatosis (no anemia)
serum iron high
TIBC low
ferritin high
%transferrin saturation high
What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Sideroblastic anemia
can't make heme, excess iron chillin' serum iron high TIBC low ferritin high % transferrin saturation high or normal
Which of the lab markers for iron studies is an acute phase reactant?
ferritin
Microcytic anemia + swallowing difficulty + glossitis=?
Plummer Vinson syndrome, includes iron deficiency anemia
Microcytic anemia + >3.5% HbA2=?
beta thal minor
Megaloblastic anemia not correctable by B12 or folate?
Orotic aciduria
HIV + patient w/ macrocytic anemia?
Think non-megaloblastic macrocytic anemia, prompted by drug use.
Zidovudine
What are the microcytic anemias?
iron deficiency beta-thalassemia alpha thalassemia lead poisoning sideroblastic anemia anemia of chronic disease (early)
What are the normocytic non-hemolytic anemias?
anemia of chronic disease (at first)
aplastic anemia
chronic kidney disease
early iron deficiency
What are the macrocytic megaloblastic anemias?
Folate deficiency
VB12 deficiency
Orotic aciduria
What are the non-megaloblastic macrocytic anemias?
liver disease alcoholism reticulocytosis hypothyroidism 5-FU Zidovudine hydroxyurea
Alcoholic. What type of anemia?
could be folate or VB12 deficiency b/c of malnutrition problems
could also be non-megaloblastic macrocytic anemia
Give the important details of alpha thalassemia.
cis-Asians
trans-African Americans
decreased alpha globin synthesis
1 allele: asymptomatic
2 alleles: trait, less clinically severe anemia
3: HbH. beta4
4: hydrops fetalis, die. Hb Barts. gamma4
What are the important things to know about beta thalassemia?
Mediterranean
beta thal minor: heterozygote
increase in HbA2>3.5% on electrophoresis, increase in HbF
beta thal major: homozygote
increase in HbF
severe anemia, need blood transfusion
marrow expansion–>crew cut skull, chip munk facies
extramedullary hepatopoiesis–>hepatomegaly.
disease becomes apparent after 6 mo
If you get secondary hemochromatosis from blood transfusions in treatment of beta thal major…what is the treatment?
not phlebotomy
but deferoxamine
If you have beta thal major and extra medullary hematopoiesis and hepatomegaly…what are you at increased risk for?
Parvovirus B19 aplastic anemia
What is the HbS/beta thal heterozygote?
mild-moderate sickle cell disease
Once again, what is the inheritance for sideroblastic anemia? Enzyme deficiency? Causes?
X-linked
delta-ALA synthase
Causes–genetic, acquired (myelodysplastic), alcohol, lead, Vit B6 deficiency, copper deficiency, isoniazid
What is the treatment for sideroblastic anemia?
VIT B6
Describe the lab values and neuro symptoms in folate v. VB12 deficiency megaloblastic anemias.
Folate–increased homocysteine, normal MMA
no neuro
VB12–increased homocysteine, increased MMA
neuro symptoms
What are some possible causes of folate deficiency?
malnutrition-alcoholism malabsorption drugs: methotrexate, trimethoprim, phenytoin hemolytic anemia pregnancy
What are some possible causes of VB12 deficiency?
veganism malabsorption-Crohn's pernicious anemia gastrectomy Diphyllobothrium latum (fish tapeworm)
What’s the deal with orotic aciduria?
defect of UMP synthase. can’t convert orotic acid–>UMP
**Pyrimidine synthesis pathway
failure to thrive, megaloblastic anemia refractory to VB12 and folate deficiency
increased orotic acid in urine
no increased ammonium
What happens in anemia of chronic disease?
inflammation, release of hepcidin
binds ferroportin on intestinal mucosal cells and macrophages
decreases release of iron from macrophages
normocytic–becomes microcytic
treat w/ EPO if the inflammation is from renal failure
**associated w/ RA, SLE, chronic kidney dx
What is aplastic anemia?
destruction of myeloid stem cells
radiation or drugs
viral agents
fanconi anemia (DNA repair defect)
**get pancytopenia
normal cell morphology, but hypo cellular bone w/ fatty infiltration
Which drugs can cause aplastic anemia?
benzene
chloramphenicol
alkylating agents
antimetabolites
Which viruses can cause aplastic anemia?
Parvovirus B19
EBV
HIV
HCV
**if you have sickle cell & one of these infections–more likely to develop aplastic anemia
