Anemias

Question 1

Why is it so important to confirm that a patient has low iron when they present with microcytic anemia before giving them iron supplements?

Answer 1

b/c they could have beta thalassemia and experience iron overload as a result

Question 2

What is a weird physical feature w/ anemia of chronic disease?

Answer 2

spooned nails

Question 3

What is the triad for plummer vinson syndrome?

Answer 3

iron deficiency anemia
esophageal webs
glossitis

Question 4

What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Iron deficiency anemia

Answer 4

Serum iron low
TIBC high (trying to transport stuff)
ferritin low
% transferrin saturation low (

Question 5

What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Anemia of chronic disease?

Answer 5

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.

Question 6

What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Hemochromatosis (no anemia)

Answer 6

serum iron high
TIBC low
ferritin high
%transferrin saturation high

Question 7

What happens to serum iron, TIBC, Ferritin, % transferrin saturation w/ the following:
Sideroblastic anemia

Answer 7

can't make heme, excess iron chillin'
serum iron high
TIBC low
ferritin high
% transferrin saturation high or normal

Question 8

Which of the lab markers for iron studies is an acute phase reactant?

Answer 8

ferritin

Question 9

Microcytic anemia + swallowing difficulty + glossitis=?

Answer 9

Plummer Vinson syndrome, includes iron deficiency anemia

Question 10

Microcytic anemia + >3.5% HbA2=?

Answer 10

beta thal minor

Question 11

Megaloblastic anemia not correctable by B12 or folate?

Answer 11

Orotic aciduria

Question 12

HIV + patient w/ macrocytic anemia?

Answer 12

Think non-megaloblastic macrocytic anemia, prompted by drug use.
Zidovudine

Question 13

What are the microcytic anemias?

Answer 13

iron deficiency
beta-thalassemia
alpha thalassemia
lead poisoning
sideroblastic anemia
anemia of chronic disease (early)

Question 14

What are the normocytic non-hemolytic anemias?

Answer 14

anemia of chronic disease (at first)
aplastic anemia
chronic kidney disease
early iron deficiency

Question 15

What are the macrocytic megaloblastic anemias?

Answer 15

Folate deficiency
VB12 deficiency
Orotic aciduria

Question 16

What are the non-megaloblastic macrocytic anemias?

Answer 16

liver disease
alcoholism
reticulocytosis
hypothyroidism
5-FU
Zidovudine
hydroxyurea

Question 17

Alcoholic. What type of anemia?

Answer 17

could be folate or VB12 deficiency b/c of malnutrition problems
could also be non-megaloblastic macrocytic anemia

Question 18

Give the important details of alpha thalassemia.

Answer 18

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

Question 19

What are the important things to know about beta thalassemia?

Answer 19

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

Question 20

If you get secondary hemochromatosis from blood transfusions in treatment of beta thal major…what is the treatment?

Answer 20

not phlebotomy

but deferoxamine

Question 21

If you have beta thal major and extra medullary hematopoiesis and hepatomegaly…what are you at increased risk for?

Answer 21

Parvovirus B19 aplastic anemia

Question 22

What is the HbS/beta thal heterozygote?

Answer 22

mild-moderate sickle cell disease

Question 23

Once again, what is the inheritance for sideroblastic anemia? Enzyme deficiency? Causes?

Answer 23

X-linked
delta-ALA synthase
Causes–genetic, acquired (myelodysplastic), alcohol, lead, Vit B6 deficiency, copper deficiency, isoniazid

Question 24

What is the treatment for sideroblastic anemia?

Answer 24

VIT B6

Question 25

Describe the lab values and neuro symptoms in folate v. VB12 deficiency megaloblastic anemias.

Answer 25

Folate–increased homocysteine, normal MMA
no neuro

VB12–increased homocysteine, increased MMA
neuro symptoms

Question 26

What are some possible causes of folate deficiency?

Answer 26

malnutrition-alcoholism
malabsorption
drugs: methotrexate, trimethoprim, phenytoin
hemolytic anemia
pregnancy

Question 27

What are some possible causes of VB12 deficiency?

Answer 27

veganism
malabsorption-Crohn's
pernicious anemia
gastrectomy
Diphyllobothrium latum (fish tapeworm)

Question 28

What’s the deal with orotic aciduria?

Answer 28

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

Question 29

What happens in anemia of chronic disease?

Answer 29

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

Question 30

What is aplastic anemia?

Answer 30

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

Question 31

Which drugs can cause aplastic anemia?

Answer 31

benzene
chloramphenicol
alkylating agents
antimetabolites

Question 32

Which viruses can cause aplastic anemia?

Answer 32

Parvovirus B19
EBV
HIV
HCV

**if you have sickle cell & one of these infections–more likely to develop aplastic anemia