Anemias (Exam 2) Flashcards by Julia Gumirov

What are the 3 underlying causes of normocytic noromochromic anemias?

1) insufficient RBC production (BM problem)
2) premature RBC destruction= hemolysis
3) blood loss

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Anemias of chromic disease start as what type of anemia and progress to what type?

starts as normocytic normochromic and progresses into microcytic hypochromic

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What anemia is this?
-red cells destroyed faster than they can be made
-anemias are due to the shortening of the RBC life cycle because of red cell destruction
-increased RBC destruction
-increased polychromatic RBCs= reticulocytosis
-RBC destruction leads to increased unconjugated bilirubin and increased urobilinogen in urine
-hemosiderosis: systemic iron deposits

hemolytic anemias

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What vit deficiency may cause a mild hemolytic anemia but is not classified as hemolytic anemia?

vit E def

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What anemia is this?
-hereditary hemoglobinopathy (involves the structure of hemoglobin)
-an autosomal recessive genetic blood disorder
-caused by a mutation in coding sequence of the beta globin chain
-homozygous form of HgbSS/ hemoglobin S (heterozygous carrier would be HgbSA)
-problem with hemoglobin is qualitative
-something wrong with the structure of the hemoglobin chain

sickle cell anemia

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Sickle cell anemia is caused by a mutation in coding sequence of what globin chain?

beta

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In sickle cell anemia, certain triggers cause Hgb to undergo _____________, changing the shape of the RBC

crystallization

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RBCs become rigid, sticky, and shaped like crescent moons. Sickle cells are inflexible and cause….

-increased blood viscosity
-stasis
-obstruction of small arterioles and capillaries
-ischemia

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Sickle cell anemia is marked by chronic ___________ anemia, acute episodes of painful crises and increased susceptibility to infections

hemolytic

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In sickle cell anemia, obstruction of blood flow results in regional __________ and ___________, creating a recurrent pattern of further sickling, tissue injury, and pain

test q

hypoxia, acidosis

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What organ is frequently affected because of narrow vessels and function in clearing defective RBCs with sickle cell anemia?

test q!!!!!!

spleen

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T/F: after sickling, the RBCs revert back to biconcave disc form

FALSE, they stay sickled

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____________________ is the most common and most severe of the sickle cell disorders

Sickle cell disease

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What are the most common sickle cell crisis triggers?

-dehydration
-infections
-cold temps
-stress
-high altitudes

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What are the most common signs and symptoms of sickle cell anemia?

-pain crises (vaso-occlusive crises in chest, bones, and joints)
-frequent infections (impairs spleen function)
-swelling in hands and feet especially in kids
-delayed growth in kids
-vision problems/damage to retina
-prehepatic jaundice
-leg ulcers

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What are some long term complications of sickle cell anemia?

-bone damage (bone death due to lack of blood supply)*****
-stroke
-organ damage to liver, kidneys, SPLEEN
-acute chest syndrome (chest pain, fever, lung infiltrates)
-pulmonary hypertension
-kidney problems (proteinuria and then eventually kidney failure)
-spleen dysfunction
-retinal damage
-delayed puberty and growth

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What are the 2 major ways to diagnose sickle cell anemia?

family history and hemoglobin electrophoresis

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What anemia would have these lab findings?
-decreased RBCs and HGB
-polychromasia
-increased reticulocyte count
-drepanocytes present
-increased unconjugated bilirubin in blood
-increased urobilinogen in urine
-hemoglobin SS pattern in electrophoresis

sickle cell anemia

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What anemia is this?
-person is known as carrier
-hereditary heterozygous condition
-carry one HgbA and one HgbS gene
-generally hematologically normal (normal hemoglobin, hematocrit, and MCV)***

sickle cell trait

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How is sickle cell trait diagnosed?

hemoglobin electrophoresis

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What anemia is this?
-heterozygous condition
HgbS from one parent and HgbC from other***
-generally a milder course than with sickle cell disease
-usually less anemic

hemoglobin SC disease

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What anemia has folded RBCs with glove/mitten shaped intracellular crystals?

hemoglobin SC disease

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What anemia is this?
-homozygous HgbCC
-not as severe as sickle cell disease
-trait= HgbAC heterozygous

hemoglobin C disease

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What anemia has bar of gold or Washington monument crystals within the RBCs?

hemoglobin C disease

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Who is most likely to have glucose 6 phosphate dehydrogenase (G6PD) deficiency?

African and Mediterranean descent

________ is an enzyme which helps cells convert carbs to usable form

G6PD

G6PD protects ________

RBCs

def of G6PD=

RBCs are not protected from oxidative stress

What are the 3 main triggers that cause hemolysis of RBCs in G6PD def?

1) consumption of certain foods like fava beans (legumes) and broad beans (increases oxidative stress= damage) 2) illness 3) drugs

What are the signs and symptoms of G6PD def?

-anemia -prehepatic jaundice -unconjugated bilirubin -dark urine (urobilinogen) -rapid heart rate -splenomegaly

What anemia is this? -rare mutation in bone marrow -intravascular hemolysis and hemoglobinuria -leukopenia -thrombocytopenia -arterial and venous thromboses -hemolysis occurs throughout the day

PNH

What are the signs and symptoms of PNH?

-abdominal, chest, and lumbar pain -symptoms of severe anemia -hemoglobinuria -splenomegaly -manifestations of vascular thromboses

What anemia is this? -normochromic normocytic -hemolytic anemia that occurs in the fetus when mom and baby have different blood types usually with Rh antigen -happens when baby has the Rh antigen (Rh positive) on its RBCs but mom does not -mom makes Abs against the Rh antigen -immunological response -1st baby is not at risk, 2nd baby is

hemolytic disease of the newborn/ erythroblastosis fetalis

A foreign substance which induces an immune response

antigen

A part of the antigen molecule to which the antibody attaches

antigenic determinant or epitope

What blood types have the Rh antigen on their RBCs?

O+, A+, and AB+

What blood types DO NOT have the Rh antigen on their RBCs?

O-, A-, AB neg

What are some complications for the next baby after the 1st baby triggered hemolytic disease of the newborn/ erythroblastosis fetalis?

-severe anemia -stillborn -jaundice -kernicterus (bilirubin deposit in brain, especially basal ganglia and brainstem nuclei)

opisthotonos=

baby arching back

What is the first Ab made?

IgM

Why is first baby not at risk with hemolytic disease of the newborn/ erythroblastosis fetalis?

IgM abs are too large to cross placenta, by the time IgG is made baby is born

What Ab can cross the placenta?

IgG

What is the treatment for a baby born with HDN?

immediate transfusion of Rh- blood

What is the test for hemolytic disease of the newborn/ erythroblastosis fetalis?

AHG test (anti human globulin test) also known as Coombs test (detects if Abs or complement system factors have bound to RBC surface antigens for transfusion purposes and autoimmune issues)

How do you prevent hemolytic disease of the newborn/ erythroblastosis fetalis?

Rhogam prevents mom from making anti Rh Abs (given to mom at 28 weeks and again after delivery)

What anemia is this? -normocytic normochromic -proteins forming RBC membrane are deformed -RBCs are spherical and more prone to hemolysis -vulnerable to spleen sequestration -osmotic fragility test will be increased*** -cells are fragile -unconjugaed bilirubin will be increased bc of hemolysis

hereditary spherocytosis

What anemia is this? -premature destruction of RBCs due to RBC injury -trauma leads to RBC changes -injury to vascular endothelium causing intravascular clotting and platelet activation leading to fibrin strands forming and damaging RBCs

traumatic hemolytic anemia/ microangiopathic hemolytic anemia

What are the 3 major causes of traumatic hemolytic anemia/ microangiopathic hemolytic anemia?

1) disseminated intravascular coagulation (DIC) 2) thrombotic thrombocytopenia purpura (TTP) 3) hemolytic uremic syndrome (HUS)

What anemia is due to inactive bone marrow?

aplastic anemia

a- =?

without

plasia =

growth

What anemia is this? -suppression of multipotential stem cells (WBCs, RBCs, and platelets) -almost total loss of hematopoietic cells including erythroid, myeloid, and megakaryocytes -pancytopenia (anemia, leukopenia, thrombocytopenia, reticulocytopenia)***

aplastic anemia

pan=

all

penia=

decreased

What are the causes of acquired aplastic anemia?

1) idiopathic (most common) 2) autoimmunity 3) viral infections like measles, mumps, etc

What anemia is this? -due to inflammation caused by a chronic disorder -slows the production of RBCs -sometimes decreases survival of RBCs -may cause problems with how body uses iron -inflammation= increased hepcidin production (normal hormone that controls iron homeostasis)= inhibited iron release

anemia of chronic disease

What is the 2nd most common cause of anemia after iron def anemia?

anemia of chronic disease

What happens with chronic inflammation?

cytokines suppress erythropoiesis and iron uptake from iron stores

Who is most likely to have anemia of chronic disease?

elderly

myelo=

bone marrow

phthsic=

atrophy

myelophthisis=

displacement of bone marrow tissue by fibrosis, tumors, or granulomas

What anemia is this? -normochromic normocytic -form of bone marrow failure that results from the destruction of bone marrow precursor cells -bone marrow is replaced by infiltrative neoplasms

myelophthisic anemia

What is the most common cause of myelophthisic anemia?

metastatic carcinoma from breast, prostate, lung, thyroid

What anemia would have these findings on blood smear? -anisocytosis -poikilocytosis -teardrop cells***

myelophthisic anemia

hemorrhagic anemia is most common in who?

elderly

What anemia is this? -normochromic normocytic -if a person survives acute blood loss and iron stores are normal, erythropoiesis occurs= reticulocytosis

hemorrhagic anemia

What are the causes of hemorrhagic anemia?

-GI bleeds -perforations -wounds -malignancies

What is the test for hemorrhagic anemia?

guaiac test/occult blood test/hemoccult test (tests for blood in stool aka melena)

megaloblastic anemias (macrocytic normochromic) are caused by what?

vit B12 or B9/folate def

megalo=

very large

blast=

young cell

common feature in all megaloblastic anemias=

defect in DNA synthesis in the dividing cells (both vit B12 and folate are needed for DNA production)

What anemia is this? -caused by vit B12 or folate def -all cell lines have dyspoiesis (intramedullary cell death, making erythropoiesis ineffective) -pancytopenia -impaired RBC production and hemolysis

megaloblastic anemia

What anemia has these lab findings? -decreased RBCs= anemia and macro-ovalocytes -decreased WBCs= leukopenia and neutrophils have hypersegmentation********** -decreased platelets= thrombocytopenia and platelet malfunction TEST Q

megaloblastic anemia

How many segments do normal neutrophils have?

3-5 segments

Who typically has megaloblastic anemia?

40-60 y/o, celtic ancestry (English, Irish, Scottish, Scandinavian)

If CBC shows macrocytic anemia, what test is next?

serum vit B12 and serum B9

What are the 7 causes of vit B12 def?

1) pernicious anemia (autoimmune, most common cause) 2) total gastric resection (intrinsic factor is produced in the fundus) 3) disorders of the distal ileum (intrinsic factor is absorbed in distal ileum) 4) strict vegan diet (B12 is scarce in plants) 5) intestinal malabsorption syndromes (B12 not absorbed) 6) blind loop syndrome (bacterial overgrowth in a surgically induced intestinal blind loop results in depletion of B12) 7) diphyllobothrium latum infection (giant fish tapeworm, acquired by ingestion of raw freshwater fish, competes for B12 causing depletion

What is needed for B12 to be absorbed?

intrinsic factor

What are some signs and symptoms of megaloblastic anemia?

-paresthesia -difficulty walking -cognitive impairments -loss of vibratory and position sense -glossitis -anorexia -diarrhea -tachycardia -heart murmurs -icterus/prehepatic jaundice -splenomegaly -lemon yellow waxy skin with premature whitening of hair

What is the most common form of vit B12 def?

pernicious anemia

What anemia is due to lack of intrinsic factor?

pernicious anemia

Intrinsic factor is essential for....

B12 absorption

pernicious anemia is an autoimmune disorder so what do we look for in the blood?

Abs

If there is a lack of intrinsic factor, ______ cannot be absorbed

B12

Lack of intrinsic factor is usually due to?

anti intrinsic factor antibodies or anti parietal cell antibodies

A decreased vit B12 level, as well as a positive test for intrinsic factor antibodies and or parietal cell antibodies means that it is likely the person has....

pernicious anemia

What anemia would have these lab findings? -RBCs= anemia and macro-ovalocytes -WBCs= leukopenia -neutrophils have hypersegmentation -platelets= thrombocytopenia and thrombocyte malformation -decreased serum vit B12 level** -anti intrinsic factor antibody and or anti parietal cell antibody*** -achlorhydria (decreased HCl in stomach, increased gastrin levels, increased risk for gastric carcinoma)

pernicious anemia

T/F: the other causes of vit B12 def will have same lab testing as pernicious anemia, except antibodies will not be positive

TRUE

What are some complications of pernicious anemia?

-peripheral neuropathy -subacute combined degeneration NOT DONE