Anemias- Lecture Flashcards
Purple blotches in the background that look like dirt are platelets
What does hematocrit (Hct) represent?
Hematocrit (Hct) is the percentage of blood composed of RBCs
MCH vs MCHC
Mean cell hemoglobin (MCH) is the average weight of hemoglobin per RBC
Mean cell hemoglobin concentration (MCHC) is the average concentration of hemoglobin per RBC
Relative erythrocytosis occurs due to _
Absolute erythrocytosis occurs due to _
Relative erythrocytosis occurs due to decreased plasma volume
Absolute erythrocytosis occurs due to increased RBC mass
(True/ False) Anemia is a decrease in red blood cell mass
True; this comes with decreased oxygen and carbon dioxide transport
(True/ False) All anemias will have decreased hemoglobin, hematocrit, and RBC count
True; All anemias will have decreased hemoglobin, hematocrit, and RBC count
Normal sized RBCs are _
Large RBCs are _
Small RBCs are _
Normal sized RBCs are normocytic
Large RBCs are macrocytic
Small RBCs are microcytic
Anisocytosis
Anisocytosis means the RBCs vary in size
If RBCs vary in shape we call this _
If RBCs vary in shape we call this poikilocytosis
“Normochromic, hypochromic, and hyperchromic” reflect the amount of _ and is measured with _ or _
“Normochromic, hypochromic, and hyperchromic” reflects the amount of hemoglobin and is measured with MCH or MCHC
Classify as normocytic, microcytic, or macrocytic
Normocytic: normal RBCs are the size of a lymphocyte nucleus
When might you see the following?
Acanthocyte (spur cell): seen with liver disease
When might you see the following?
Bite cell: seen in G6PD deficiency
When might you see the following?
Target cell (aka codocyte): thalassemia
When might you see the following?
Echinocyte (burr cell): kidney disease
When might you see the following?
Schistocyte: microangiopathic hemolytic anemia
When might you see the following?
Sickle cell: sickle cell anemia
When might you see the following?
Spherocyte: either warm autoimmune hemolytic anemia or hereditary spherocytosis
_ are younger RBCs that have not yet ejected all of their genetic material
Reticulocytes are younger RBCs that have not yet ejected all of their genetic material
* They are visualized using a supravital stain
Supravital stain (for reticulocyte count) will highlight _
Supravital stain (for reticulocyte count) will highlight rRNA
* Uses crystal violet and brilliant cresyl blue
How can the reticulocyte count be interpreted?
Increased reticulocyte: bone marrow is responding to the anemia
Normal or decreased reticulocyte: bone marrow is not responding to anemia (hypoproliferative anemia)
What are the general symptoms of anemia?
- Dyspnea (short of breath)
- Fatigue
- Dizziness
- Tachycardia
- Conjunctival pallor
Jaundice is a sx that is exclusive to _ anemias
Jaundice is a sx that is exclusive to hemolytic anemias
Megaloblastic anemia falls into the (decreased production/ increased destruction) category
Megaloblastic anemia falls into the decreased production category
Sideroblastic anemia falls into the (decreased production/ increased destruction) category
Sideroblastic anemia falls into the decreased production category
Name the 3 microcytic anemias
- Iron-deficiency anemia
- Thalassemia
- Sideroblastic anemia
Name the two macrocytic anemias
- Megaloblastic anemia
- Nonmegaloblastic anemia (alcohol related)
Megaloblastic anemias result from decreased RBC production due to the missing _ which is caused by a deficiency in _ or _
Megaloblastic anemias result from decreased RBC production due to the missing building blocks of DNA synthesis which is caused by a deficiency in folate (B9) or vitamin B12
Megaloblastic anemia can be caused by medications like _ , _ , _
Megaloblastic anemia can be caused by medications like chemo , anti-retroviral drugs , hydroxyurea
Cells in our bone marrow rapidly turn over –> this means they require a lot of _ and _ to constantly synthesize DNA
Cells in our bone marrow rapidly turn over –> this means they require a lot of folate and B12 to constantly synthesize DNA
* A deficiency in these will decrease cell division
Megaloblastoid changes occur in the bone marrow including cytoplasmic assynchrony, which means _
Megaloblastoid changes occur in the bone marrow including cytoplasmic assynchrony, which means cytoplasm continues to grow while the nucleus is stunted –> ineffective erythropoiesis
To get from homocysteine –> methionine we need THF to _ and we need the presence of _
To get from homocysteine –> methionine –> DNA we need THF to donate a methyl group and we need the presence of B12 and folate
Methylmalonyl CoA –> Succinyl CoA –> myelin requires only _
Methylmalonyl CoA –> Succinyl CoA –> myelin requires only B12
* Therefore only B12 deficiency is associated with neuro deficits
B12 deficiency will result in an accumulation of _
B12 deficiency will result in an accumulation of homocysteine and methylmalonic acid
Folate deficiency will result in an accumulation of _
Folate deficiency will result in an accumulation of homocysteine only
Vitamin B12 gets absorbed in the _
Vitamin B12 gets absorbed in the ileum (last part of the small intestine)
* Needs to be bound to intrinsic factor (IF)
_ occurs when there is a lack of intrinsic factor which inhibits the absorption of B12 in the small intestine and leads to megaloblastic anemia
Pernicious anemia occurs when there is a lack of intrinsic factor which inhibits the absorption of B12 in the small intestine and leads to megaloblastic anemia
* Begins with auto-antibodies destroying gastric parietal cells
Three causes of vitamin B12 AND folate deficiency
- Intestinal malabsorption (example crohn’s disease affects the terminal ileum and celiacs affects the duodenum)
- Alcohol (general lack of nutrients)
- Diet (poor diet)
What is non-megaloblastic anemia?
Non-megaloblastic anemia is a macrocytic anemia without B12 or folate deficiency
* Causes: liver disease, medications, hypothyroidism, copper deficiency
Vitamin B12 in our diet comes from sources like _
Vitamin B12 in our diet comes from sources like animal liver, meat, fish, cheese, dairy, eggs
Folate in our diet comes from _
Folate in our diet comes from dark leafy green vegetables
How long does it take to deplete our stores of vitamin B12 vs. folate?
Vitamin B12: stored in the liver; takes months-years to deplete
* Strict vegans can eventually become deficient
Folate: takes months to deplete
Name 5 causes specific to B12 deficiency
- Pernicious anemia
- Pancreatic insufficiency
- Medications
- Diphyllobotrium latum
- Surgically absent ileum
How does pancreatic insufficiency lead to B12 deficiencies?
Trypsin (enzyme produced in the pancreas) is needed to cleave transcobalamin and release B12
_ is a fish tapeworm that is known to cause vitamin B12 deficiency leading to megaloblastic anemia
Diphyllobotrium latum is a fish tapeworm that is known to cause vitamin B12 deficiency leading to megaloblastic anemia
What are 3 causes specific to folate deficiency?
- Rapid cell turnover states (pregnancy, cancer)
- Medications
- Gastric bypass surgery (shortened jejunum)