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Clinical Medicine > Anemias > Flashcards

Anemias Flashcards

1
Q

WBC

A

4.5-10.5

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2
Q

RBC

A

3.7-5.4

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3
Q

Hemoglobin

A

12-16

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4
Q

Hematocrit

A

35-48%

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5
Q

MCV

A

78-100. Mean corpuscular volume. The average size of the RBC. (micro/normo/macrocytic)

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6
Q

MCH

A

27-34. Mean cell hemoglobin. (normo vs. hypochromic)

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7
Q

MCHC

A

31-37. Mean cell hemoglobin concentration.

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8
Q

RDW

A

11.5-14.5% Measure of the variation in size.

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9
Q

Platelets

A

150-450.

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10
Q

Reticulocytes

A

1-2%. “lots of blue mean lots of new” on peripheral smear. Indication of the bone marrow’s RBC production. Usually mature within 1-2 days.

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11
Q

Anisocytosis

A

Large variation in RBC size

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12
Q

Poikilocytosis

A

abnormally shaped RBCs

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13
Q

Symptoms of anemia

A

Usually occur when Hb is less than 7. fatigue, weakness, lightheadedness, syncope, dyspnea, palpitations

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14
Q

Signs of anemia

A

Pallor, tachycardia, bounding pulse, orthostatic changes, GI blood loss, High output heart failure and shock.

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15
Q

Microcytic Hypochromic anemias

A

Iron deficiency, thalassemias, sideroblastic.

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16
Q

Normocytic normochromic anemias

A

Hypothyroidism, liver disease, chronic disease (can be micro and/or hypo).

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17
Q

Macrocytic (megaloblastic) anemias

A

folate and B12 deficiency.

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18
Q

Most common cause of anemia

A

Iron deficiency

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19
Q

Iron Deficiency Anemia etiology

A

menstruation, pregnancy, GI bleed, decreased iron absorption (celiacs, bariatric surgery, H.pylori infection).

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20
Q

Iron Deficiency Anemia Classification

A

Microcytic Hypochromic

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21
Q

Iron Deficiency Anemia MCV

A

Decreased

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22
Q

Iron Deficiency Anemia RDW

A

increased

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23
Q

Iron Deficiency Anemia Ferritin

A

Decreased less than 12

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24
Q

Iron Deficiency Anemia TIBC

A

Increased

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25
Q

Iron Deficiency Anemia manifestations

A

Glossitis, cheilitis, Koilonychia, pica, dysphagia (esophageal webs/plummer-vinson syndrome), restless leg syndrome.

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26
Q

Iron Deficiency Anemia treatment

A

Determine the underlying cause (colonoscopy and/or radiographic testing), replace iron stores

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27
Q

Thalassemia definition

A

Inherited disorder. Reduction in the synthesis of the globin chains of Hb.

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28
Q

Alpha Thalassemia classifications

A

1=silent carrier
2=Trait. Mild microcytic anemia
3=hemolytic anemia
4=hydrops fetalis

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29
Q

Beta Thalassemia classifications

A

Minor (trait): dysfunction of one beta chain. asymptomatic micro/hypo anemia
Major (Cooley anemia): Dysfunction of both beta chains. Usually die before 30.

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30
Q

Thalassemia MCV

A

Extremely LOW (60-75)

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31
Q

Thalassemia classification

A

microcytic hypochromic.

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32
Q

Thalassemia RDW

A

normal

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33
Q

Thalassemia serum Fe

A

Normal to elevated

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34
Q

Thalassemia Ferritin

A

Normal to elevated

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35
Q

Thalassemia TIBC

A

decreased

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36
Q

Thalassemia peripheral smear

A

Poikilocytosis, target cell, nucleated RBC.

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37
Q

Thalassemia electrophoresis

A

Is Diagnostic.

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38
Q

Thalassemia treatment

A

folic acid supplementation. If severe: regular transfusions or splenectomy. Severe beta Thalassemia: hematopoietic cell transplant.

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39
Q

Anemia of chronic disease

A

Seen in the elderly, chronic inflammation and organ failure. Due to abnormal iron metabolism, impaired EPO production etc.

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40
Q

Anemia of Chronic Disease MCV

A

Normal

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41
Q

Anemia of Chronic Disease classification

A

Normocytic normochromic

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42
Q

Anemia of Chronic Disease ferririn

A

normal or increased

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43
Q

Anemia of Chronic Disease serum Fe

A

variable. low with chronic inflammation

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44
Q

Anemia of Chronic Disease TIBC

A

variable. low with chronic inflammation.

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45
Q

Anemia of Chronic Disease treatment

A

Treat the underlying condition. EPO may be beneficial. refer.

46
Q

Myelodysplastic syndrome definition

A

acquired disorder of hematopoietic stem cells causing dysplastic and ineffective RBC production. Group of underlying conditions. Can progress to marrow failure or leukemia.

47
Q

Myelodysplastic syndrome etiology

A

idiopathic or secondary to an exposure (radiation etc)

48
Q

Sideroblastic Anemia Etiology

A

Usually myelodysplastic syndrome. Can be hereditary. Alcoholism, lead poisoning, medication, chronic infection/inflammation.

49
Q

Sideroblastic Anemia definition

A

abnormal RBC iron metabolism, diminished heme synthesis, bone marrow produces ring sideroblasts.

50
Q

Sideroblasts

A

Nucleated RBC precursors that contain iron. Granulocytes filled with iron.

51
Q

Sideroblastic Anemia MCV

A

varies

52
Q

Sideroblastic Anemia Hct

A

Moderate (20-30%)

53
Q

Sideroblastic Anemia ferritin

A

Normal or elevated

54
Q

Sideroblastic Anemia peripheral smear

A

anisocytosis and poikilocytosis

55
Q

Sideroblastic Anemia bone marrow biopsy

A

Ring sideroblasts is diagnostic

56
Q

Sideroblastic Anemia treatment

A

discontinue the med, treat the infection/inflammation, pyridoxine (vitamin B6) if hereditary. refer.

57
Q

Normocytic Normochromic with increased reticulocytes

A

Prior/recent hemorrhage or recent hemolysis.

58
Q

Normocytic Normochromic with normal reticulocytes and normal bone marrow

A

anemia of chronic disease, hypothyroidism, liver disease.

59
Q

Normocytic Normochromic with normal reticulocytes and abnormal bone marrow

A

Myelofibrosis, luekemia, myeloma, mestastases and renal failure.

60
Q

Mactocytic anemias

A

MCV >100. Megaloblastics (folate and B12 deficiency), acute hemorrhage, hemolysis.

61
Q

Megaloblastic anemias

A

Folate and B12 deficiency. Impaired DNA sythesis results in disorderd RBC maturation resulting in large RBC. Have to differentiate between the two. Untreated B12 deficiency can lead to subacute combined degeneration of the spinal cord.

62
Q

Vitamin B12 deficiency symptoms

A

glossitis, jaundice, splenomegaly, decreased vibratory sense and proprioception. Paresthesia, ataxia, confusion and dementia.

63
Q

Vitamin B12 metabolism

A

Only available in the diet. Binds intrinsic factor (from gastric parietal cells) in the stomach. In the ileum B12 is released from IF and absorbed.

64
Q

Pernicious anemia

A

Deficiency of intrinsic factor due to autoimmunity (parietal cells), gastrectomy, ileal disease/resection, bacterial overgrowth or intestinal parasite.

65
Q

Vitamin B12 deficiency MCV

A

elevated >100

66
Q

Vitamin B12 deficiency peripheral smear

A

hypersegmented neutrophils, anisocytosis, poikilocytosis, macro-ovalcytes.

67
Q

Schilling test

A

Vitamin B12 deficiency. tests for autoantibodies to IF.

68
Q

Vitamin B12 deficiency methylmalonic acid

A

elevated

69
Q

Vitamin B12 deficiency homocysteine

A

elevated.

70
Q

Vitamin B12 deficiency Treatment

A

Parenteral vitamin B12. Daily IM of 1,000 micrograms for a week then weekly for a month then monthly for life.

71
Q

Folic Acid metabolism

A

Available in the diet but has a short half life (3 weeks) so the body stores are small. Deprivation for 4-5 months can result in anema.

72
Q

Folic Acid Deficiency etiology

A

alcoholism, end of pregnancy, anticonvulstant therapy, malabsorption syndrome, hemolytic anemias.

73
Q

Folic Acid Deficiency MCV

A

elevated >100

74
Q

Folic Acid Deficiency peripheral smear

A

hypersegmented neutrophils, anisocytosis, poikilocytosis, macro-ovalcytes.

75
Q

Folic Acid Deficiency methylmalonic acid

A

Normal

76
Q

Folic Acid Deficiency homocysteine

A

elevated.

77
Q

Folic Acid Deficiency treatement

A

treat the underlying cause. Replacement 1mg daily or 5mg daily for malabsorption.

78
Q

Hemolytic anemia

A

Destruction of RBC. Marrow can’t compensate for survival time of less than 20 days

79
Q

Hemolytic anemia symptoms

A

jaundice, gallstones (bilirubin), increased risk of salmonella and pneumococcus infections.

80
Q

Hemolytic anemia reticulocytes

A

elevated

81
Q

Hemolytic anemia peripheral smear

A

immature RBC, nucleated RBC, schistocytes (RBC fragments).

82
Q

Hemolytic anemia Unconjugated bili

A

increased

83
Q

Hemolytic anemia LDH

A

elevated.

84
Q

Hemolytic anemia Hb

A

increased

85
Q

Serum haptoglobin

A

mucoprotein produced in the liver that binds Hb released from lysed RBC. Bound haptoglobin is then catabolized by the spleen.

86
Q

Hemolytic anemia serum haptoglobin

A

decreased with intravascular hemolysis.

87
Q

Intravascular hemolysis causes

A

Fragmentation: either traumatic/macroangiopathic (prosthetic heart valve) or microangiopathic from fibrin strands in the vessels. Enzyme deficiency (G6PD) or paroxysmal nocturnal hemoglobinuria.

88
Q

Extravascular hemolysis causes

A

hereditary spherocytosis, sickle cell, autoimmune hemolytic anemia, incompatible blood transfusion, drug induced.

89
Q

Hereditary Spherocytosis

A

autosomal dominant disease with mild hemolytic anemia. RBC become easily trapped in the spleen and destroyed

90
Q

Hereditary Spherocytosis peripheral smear

A

Dense globular appearance with lack of central pallor

91
Q

Hereditary Spherocytosis MCV

A

normal

92
Q

Hereditary Spherocytosis symptoms

A

often asymptomatic, mild jaundice, splenomegaly, can develop megaloblastic anemia (need more folate).

93
Q

Hereditary Spherocytosis diagnosis

A

osmotic fragility test. Cells hemolyze in a hypotonic fluid.

94
Q

Hereditary Spherocytosis treatment

A

spleenectomy. Increased risk of infection so wait until adulthood and give pneumococcal vaccine.

95
Q

Sickle Cell anemia

A

Autosomal reccessive disorder of Hb structure. African american population. RBC becomes sickle shaped when deoxygenated.

96
Q

Sickle Cell anemia symptoms

A

usually begin at 4-6 months. Delayed growth/development, increased infections. Symptoms are worsened by dehydration, hypoxia, altitude and exercise.

97
Q

Sickle Cell anemia Symptoms are caused by:

A

chronic hemolysis (aplastic crisis, bilirubin gallstones), vaso-occlusive ischemic tissues (pain crisis, osteonecrosis, CV incidents, MI, splenic infacrts, leg ulcers.

98
Q

Sickle Cell anemia classification

A

normochromic normocytic

99
Q

Sickle Cell anemia Hb

A

5-11

100
Q

Sickle Cell anemia reticulocytes

A

elevated 10-20%

101
Q

Sickle Cell anemia peripheral smear

A

sickled RBC, nucleated RBC, target cells, Howell-jolly bodies, thrombocytosis.

102
Q

Sickle Cell anemia diagnosis

A

screen with sickledex and Hb electrophoresis reveals HbS

103
Q

Autoimmune hemolytic anemia peripheral smear

A

polychromasia, spherocytosis, nucleated RBC

104
Q

Autoimmune hemolytic anemia treatmen

A

ID the cause, corticosteroids, splenectomy, folic acid supplementation.

105
Q

Incompatible blood transfusion diagnosis

A

coombs test detects antibodies coating the transfused RBC.

106
Q

Aplastic anemia etiology

A

acquired abnormality of bone marrow stem cells. Idiopathic, chemical/drug exposure, viral illness, ionizing radiation. Pancytopenia is hallmark.

107
Q

Aplastic anemia bone marrow

A

absence of precursor cells.

108
Q

Aplastic anemia symptoms

A

weakness, infections, bleeding.

109
Q

Aplastic anemia treatment

A

Refer to hematology. Blood component replacement, bone marrow transplant, immunosuppressants.

110
Q

Iron deficiency treatment iron stores

A

Ferrous sulfate 325mg BID-TID until corrected then an additional 3-6 months. Parenteral iron may be needed in select patients as well as possible blood transfusions.

Clinical Medicine (7 decks)

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