anemias - Sheet1

Question 1

What is anemia?

Answer 1

Anemia is defined as a reduction in the total number of erythrocytes (RBCs) in circulating blood or a decrease in the quality or quantity of hemoglobin.

Question 2

What are the main etiologies of anemia?

Answer 2

The main causes of anemia include impaired erythrocyte production, acute or chronic blood loss, increased erythrocyte destruction, or a combination of these factors.

Question 3

What is the impact of anemia on oxygen transport?

Answer 3

Anemia leads to reduced oxygen-carrying capacity of the blood, resulting in hypoxia (lack of oxygen in tissues) and hypoxemia (low oxygen levels in the blood).

Question 4

What are common manifestations of anemia?

Answer 4

Common manifestations include dyspnea (shortness of breath), palpitations, dizziness, fatigue, and pallor. Anemia can also cause neurological and gastrointestinal changes.

Question 5

How is anemia classified?

Answer 5

Anemia can be classified by the etiologic factor, size, and hemoglobin content.

Question 6

What are the terms used to classify anemia by size?

Answer 6

Anemia classified by size uses terms that end in “-cytic,” such as microcytic (small RBCs) or macrocytic (large RBCs).

Question 7

What are the terms used to classify anemia by hemoglobin content?

Answer 7

Anemia classified by hemoglobin content uses terms that end in “-chromic,” such as hypochromic (less color due to low hemoglobin) or normochromic (normal hemoglobin content).

Question 8

What are normocytic-normochromic anemias?

Answer 8

Normocytic-normochromic anemias are characterized by RBCs that are of normal size (normocytic) and have normal hemoglobin content (normochromic).

Question 9

What is the primary characteristic of post-hemorrhagic anemia?

Answer 9

Post-hemorrhagic anemia is characterized by acute blood loss from the vascular space, resulting in a sudden decrease in circulating erythrocytes.

Question 10

What are common etiologies of normocytic-normochromic anemias?

Answer 10

Common causes include trauma, gastrointestinal (GI) bleeding, retroperitoneal bleeding, and bleeding from other sites.

Question 11

How do risk factors for normocytic-normochromic anemias vary?

Answer 11

Risk factors vary depending on the underlying etiology, such as age, gender, medical history, and lifestyle factors (e.g., high-risk activities leading to trauma).

Question 12

What manifestations depend on the severity of blood loss in normocytic-normochromic anemias?

Answer 12

Manifestations can include lightheadedness or dizziness, pallor (pale skin), dyspnea on exertion (DOE), and signs of organ dysfunction, which may vary based on the degree of anemia.

Question 13

How is normocytic-normochromic anemia diagnosed?

Answer 13

Diagnosis typically involves a thorough history and physical examination (H&P), complete blood count (CBC), radiographic scans to determine the etiology of bleeding, and GI studies to rule out gastrointestinal loss.

Question 14

What are megaloblastic anemias?

Answer 14

Megaloblastic anemias, also termed macrocytic anemias, are characterized by unusually large red blood cells (RBCs) due to defective DNA synthesis, often caused by deficiencies in vitamin B12 or folate (vitamin B9).

Question 15

What is the role of vitamin B12 and folate in erythropoiesis?

Answer 15

Vitamin B12 and folate are co-enzymes required for nuclear maturation and DNA synthesis during erythropoiesis. Deficiencies in either vitamin lead to impaired maturation of erythrocytes.

Question 16

What occurs to RNA processes in megaloblastic anemia?

Answer 16

Ribonucleic acid (RNA) processes occur at a normal rate, which leads to unequal growth of the nucleus and cytoplasm in erythrocytes.

Question 17

What happens to defective erythrocytes in megaloblastic anemia?

Answer 17

Defective erythrocytes die prematurely, leading to anemia. These damaged cells undergo shrinkage, membrane changes (blebbing), and rearrangement of plasma membrane components before being removed from circulation by macrophages.

Question 18

What is pernicious anemia, and how is it related to vitamin B12 deficiency?

Answer 18

Pernicious anemia is the most common type of macrocytic anemia and is related to vitamin B12 deficiency, often due to a lack of intrinsic factor (IF), which is necessary for vitamin B12 absorption in the intestine.

Question 19

Describe the pathophysiologic mechanism of pernicious anemia.

Answer 19

Intrinsic factor, secreted by gastric parietal cells, binds dietary vitamin B12 in the small intestine. The IF-B12 complex then binds to receptors in the intestinal lining and is absorbed into the bloodstream. A deficiency of IF or vitamin B12 reduces absorption, impacting erythrocyte maturation.

Question 20

What are some etiologies of pernicious anemia?

Answer 20

Etiologies may include congenital or autoimmune disorders (autoantibodies against intrinsic factor), chronic gastritis (e.g., H. pylori infection), gastrectomy, ileal resection, and certain endocrine disorders.

Question 21

What are the risk factors for developing pernicious anemia?

Answer 21

Risk factors include being over 30 years old, Northern European descent, genetic predisposition, certain medical conditions, and poor dietary intake of vitamin B12.

Question 22

What are the key manifestations of pernicious anemia?

Answer 22

Key manifestations include weakness, fatigue, paresthesias (tingling) in feet and fingers, loss of appetite, abdominal pain, weight loss, a smooth and beefy red sore tongue (atrophic glossitis), “lemon yellow” skin (pallor combined with icterus), hepatomegaly, splenomegaly, and neurologic symptoms due to nerve demyelination.

Question 23

How is pernicious anemia diagnosed?

Answer 23

Diagnosis involves history and physical examination (H&P), complete blood count (CBC), bone marrow aspiration, serologic studies for vitamin B12 levels and intrinsic factor antibodies, and gastric biopsies.

Question 24

What is folate deficiency anemia?

Answer 24

Folate deficiency anemia is caused by a deficiency in folate (vitamin B9), which is essential for RNA and DNA synthesis in maturing erythrocytes.

Question 25

What is the pathophysiologic mechanism behind folate deficiency anemia?

Answer 25

Absorption of folate occurs in the upper small intestine and is not dependent on other factors. Poor absorption leads to the development of megaloblastic cells with clumped nuclear chromatin, resulting in apoptosis of erythroblasts in the later stages of erythropoiesis.

Question 26

What risk factors are associated with folate deficiency anemia?

Answer 26

Risk factors include alcoholism, chronic malnourishment, and diets low in vegetables.

Question 27

What are the key manifestations of folate deficiency anemia?

Answer 27

Key manifestations include severe cheilosis (scales and fissures of the lips and mouth corners), stomatitis (mouth inflammation), painful ulcerations of the buccal mucosa and tongue (characteristic of burning mouth syndrome), dysphagia (difficulty swallowing), flatulence, and watery diarrhea.

Question 28

What are microcytic-hypochromic anemias?

Answer 28

Microcytic-hypochromic anemias are characterized by red blood cells (RBCs) that are abnormally small (microcytic) and contain reduced amounts of hemoglobin (hypochromic).

Question 29

What is the most common cause of microcytic anemia?

Answer 29

The most common cause of microcytic anemia is iron deficiency, which can result from poor dietary intake, poor absorption, or bleeding.

Question 30

What does “hypochromic” mean in the context of anemia?

Answer 30

“Hypochromic” indicates that RBCs have less color, which is usually related to low hemoglobin content; this condition is most commonly caused by iron deficiency.

Question 31

What is iron deficiency anemia?

Answer 31

Iron deficiency anemia is the most common type of anemia worldwide, related to a deficiency in iron, impaired absorption, or loss of iron.

Question 32

Who are the highest risk groups for iron deficiency anemia?

Answer 32

High-risk groups include toddlers, adolescent girls, women of childbearing age, those living in poverty, infants consuming cow’s milk, older adults on restrictive diets, and teenagers on junk food diets.

Question 33

Why is cow’s milk a concern for infants regarding iron deficiency?

Answer 33

Cow’s milk is low in iron, and its iron is poorly absorbed. Additionally, it can decrease the absorption of iron from other dietary sources, increasing the risk of deficiency.

Question 34

What are some common etiologies of microcytic-hypochromic anemia?

Answer 34

Common etiologies include dietary lack and eating disorders, impaired absorption, increased iron requirements, chronic blood loss, medications that cause gastrointestinal bleeding, and certain surgeries.

Question 35

What is the pathophysiologic mechanism of iron deficiency anemia?

Answer 35

Iron is essential for hemoglobin synthesis. Inadequate dietary intake or excessive blood loss depletes iron stores in the bone marrow, leading to impaired hemoglobin production and resultant anemia.

Question 36

What are the key manifestations of iron deficiency anemia?

Answer 36

Key manifestations include fatigue, weakness, shortness of breath, pale earlobes, palms, and conjunctivae, brittle and spoon-shaped nails (classic sign), burning mouth, and angular cheilitis/stomatitis (dryness and soreness at the corners of the mouth).

Question 37

When do symptoms typically become apparent in iron deficiency anemia?

Answer 37

Symptoms usually become symptomatic when hemoglobin levels drop to 7–8 g/dL.

Question 38

How is iron deficiency anemia diagnosed?

Answer 38

Diagnosis involves a thorough history and physical examination (H&P), complete blood count (CBC), and evaluation of iron levels in the blood.

Question 39

What is anemia of chronic disease?

Answer 39

Anemia of chronic disease is a mild-to-moderate anemia resulting from decreased erythropoiesis and impaired iron utilization in individuals with chronic systemic diseases or inflammation.

Question 40

What are some conditions associated with anemia of chronic disease?

Answer 40

Conditions include infections, cancer, and inflammatory or autoimmune diseases.

Question 41

What are the pathologic mechanisms of anemia of chronic disease?

Answer 41

Key mechanisms include decreased erythrocyte lifespan, suppressed production of erythropoietin, kidney failure affecting erythropoietin production, ineffective bone marrow response to erythropoietin, and altered iron metabolism.

Question 42

How does kidney failure relate to anemia of chronic disease?

Answer 42

Kidney failure can suppress the production of erythropoietin, the hormone essential for erythrocyte production, contributing to anemia.

Question 43

What are common manifestations of anemia of chronic disease?

Answer 43

Symptoms are similar to those of iron deficiency anemia, including fatigue, weakness, and pallor.

Question 44

How does iron storage differ in anemia of chronic disease compared to iron deficiency anemia?

Answer 44

In anemia of chronic disease, there is typically a very high total body iron storage level, unlike in iron deficiency anemia, where iron stores are depleted.

Question 45

How is anemia of chronic disease diagnosed?

Answer 45

Diagnosis is made through history and physical examination (H&P), low levels of circulating iron and transferrin, and failure to respond to conventional iron replacement therapy.

Question 46

What is aplastic anemia?

Answer 46

Aplastic anemia is a condition characterized by pancytopenia, which is a reduction or absence of all three types of blood cells: red blood cells (RBCs), white blood cells (WBCs), and platelets.

Question 47

What are common etiologies of aplastic anemia?

Answer 47

Most aplastic anemias are related to autoimmune disorders, but they can also be due to chemicals, drugs, physical agents, unpredictable exposures, or inherited/idiopathic factors.

Question 48

What is the pathophysiologic mechanism of aplastic anemia?

Answer 48

Aplastic anemia involves hypocellular bone marrow that has been replaced with fat, leading to insufficient production of blood cells.

Question 49

What are the common manifestations of aplastic anemia?

Answer 49

Symptoms include increased risk of infection, hypoxemia, bleeding, pallor, weakness, and dyspnea.

Question 50

How is aplastic anemia diagnosed?

Answer 50

Diagnosis involves history and physical examination (H&P), a complete blood count (CBC) with differential, and a bone marrow biopsy.

Question 51

What is hemolytic anemia?

Answer 51

Hemolytic anemia is a condition characterized by the accelerated destruction of red blood cells (RBCs).

Question 52

What are the etiologies of hemolytic anemia?

Answer 52

Hemolytic anemia can be classified as congenital or acquired. Acquired etiologies include wrong blood type transfusions and medication-induced hemolysis (e.g., penicillin, cephalosporins, hydrocortisone).

Question 53

What are common manifestations of hemolytic anemia?

Answer 53

Symptoms may include jaundice (icterus), aplastic crisis, splenomegaly, renal failure, hematuria, and it may also be asymptomatic in some cases.

Question 54

How is hemolytic anemia diagnosed?

Answer 54

Diagnosis involves history and physical examination (H&P), a complete blood count (CBC), and a bone marrow biopsy, which shows abnormally increased numbers of erythrocyte stem cells (erythroid hyperplasia).