Anemias of Diminished Erythropoiesis

Question 1

What causes Megaloblastic anemia?

Answer 1

Impaired DNA synthesis due to lack of B12 or Folate

Question 2

With Megaloblastic anemia, growth factors signal for increased production of cell precursors. What then occurs?

Answer 2

Marrow hyperplasia and marrow hypercellularity because hematopoiesis is still ineffective

Question 3

Megaloblastic anemia is _____ and has a ____ reticulocyte count

Answer 3

Macrocytic (high MCV)

LOW reticulocyte count

Question 4

With megaloblastic anemia, RBCs are commonly what shape?

Answer 4

Ovalocytes

Question 5

What specific cell has changes that will be seen with Megaloblastic Anemia?

Answer 5

Neutrophil nuclei are hypersegmented (>5 lobes)

Question 6

If a neutrophil nucleus has greater than 5 lobes, what could that indicate?

Answer 6

Megaloblastic anemia

Question 7

What is an autoimmune disorder that causes megaloblastic anemia?

Answer 7

Pernicious anemia

Question 8

With Pernicious anemia, lymphocytes are targeted against?

Answer 8

Gastric parietal cells that normally secrete intrinsic factor that is needed for absorption of B12

Question 9

With Pernicious anemia, loss of gastric parietal cells = loss of intrinsic factor =

Answer 9

Lack of B12 absorption

Question 10

With Pernicious anemia, chronic atrophic gastritis will be seen. What 3 things does that cause?

Answer 10

Megaloblastic anemia
Atrophic glossitis = smooth tongue
Spinal demyelination

Question 11

Pernicious anemia can lead to spinal demyelination. What symptoms will be present?

Answer 11

Paresthesias
Gait disturbances
Visual impairment
Neural issues

Question 12

Cobalamin

Answer 12

B12

Question 13

HIGH levels of homocysteine and MM CoA could indicate?

Answer 13

Pernicious anemia

Question 14

What things can cause folate deficiency?

Answer 14

Decreased intake, absorption, metabolism
Increased need (i.e. pregnancy)

Question 15

Folate deficiency causes?

Answer 15

Neural tube defects

Megaloblastic anemia

Question 16

HIGH levels of homocysteine could indicate?

Answer 16

Folate deficiency

Question 17

_____ of iron is tightly controlled

Answer 17

Absorption

Question 18

What controls absorption of iron?

Answer 18

Hepcidin

Question 19

Low iron = ____ hepcidin and _____ absorption

Answer 19

LOW hepcidin

Increased absorption

Question 20

High iron = ____ hepcidin and _____ absorption

Answer 20

HIGH hepcidin

Decreased absorption

Question 21

How does hepcidin work?

Answer 21

If the iron is high, hepcidin will be high.

Hepcidin destroys the ferroportin 1 transporter which then causes no iron to be absorbed

Question 22

What else can cause an increase in hepcidin and thus a decrease in iron absorption?

Answer 22

Systemic inflammation

Question 23

What binds iron to carry it?

Answer 23

Transferrin

Question 24

Transferrin takes iron to either?

Answer 24

Storage

Bone marrow

Question 25

If iron is taken to storage, it is converted to?

Answer 25

Ferritin

Question 26

If iron is taken to bone marrow, it is incorporated into?

Answer 26

Hemoglobin in RBCs and sent to circulation

Question 27

Once RBCs die, the iron that was used in the Hgb is used to create?

Answer 27

More transferrin

Question 28

Microcytic, hypochromic and anisocytosis (variability in shape) is seen with what type of anemia?

Answer 28

Iron deficient anemia

Question 29

What type of blood loss can also cause iron deficient anemia?

Answer 29

Chronic blood loss

Question 30

Koilonychia

Answer 30

Fragile nails with vertical stripes | - seen with iron deficient anemia

Question 31

Alopecia

Answer 31

Hair loss | - seen with iron deficient anemia

Question 32

Angular chelitis

Answer 32

Red creases of the mouth | - seen with iron deficient anemia

Question 33

What are 4 symptoms of iron deficient anemia?

Answer 33

Alopecia Angular chelitis Atropic glossitis Koilonychia

Question 34

Describe iron deficient anemia levels of iron, ferritin, total iron binding capacity and hepcidin

Answer 34

``` Iron = LOW Ferritin = LOW TIBC = HIGH Hepcidin = LOW ```

Question 35

Describe anemia of chronic disease levels of iron, ferritin, total iron binding capacity

Answer 35

``` Iron = LOW Ferritin = HIGH TIBC = LOW ```

Question 36

What is Anemia of chronic disease?

Answer 36

Impaired RBC production or iron utilization due to chronic illness

Question 37

Infection, immune diseases or malignancy cause the body to horde iron instead of utilize it

Answer 37

Anemia of chronic disease

Question 38

With Anemia of chronic disease, levels of iron are low, yet hepcidin is high. How is this possible?

Answer 38

Inflammatory cytokines cause an increase in hepcidin = decreased absorption

Question 39

What usually causes aplastic anemia?

Answer 39

Drugs Viral infection Irradiation

Question 40

What is the inherited form of aplastic anemia?

Answer 40

Fanconi anemia (dna repair defect)

Question 41

How does Aplastic anemia present?

Answer 41

PANCYTOPENIA

Question 42

Anemia, thrombocytopenia, leukopenia all present together. What does that indicate?

Answer 42

Aplastic Anemia

Question 43

What is pure red cell aplasia?

Answer 43

Bone marrow shows decreased or abnormal erythroid precursors

Question 44

Bone marrow shows decreased or abnormal erythroid precursors

Answer 44

Pure red cell aplasia

Question 45

Pure red cell aplasia is uncommon. What is it often seen with?

Answer 45

Autoimmune phenomena like thymoma

Question 46

What is Myelophthisic anemia?

Answer 46

Space occupation in the marrow replaces normal hematopoietic cells = Abnormal release of precursors (leukoerythroblastosis)

Question 47

Space occupation in the marrow that results in leukoerythroblastosis

Answer 47

Myelophthisic anemia

Question 48

What can occupy the space in the marrow that is normally where the hematopoietic cells would reside with Myelophthisic anemia?

Answer 48

Metastatic cancer

Question 49

Leukoerythroblastosis

Answer 49

Increased immature erythroid and myeloid cells

Question 50

Increased immature erythroid and myeloid cells

Answer 50

Leukoerythroblastosis | - result of myelophthisic anemia