B3-083 Big Case: Anemia Flashcards
1
Q
anemia is defined as
A
decreased RBC mass
2
Q
anemia is associated with decreased
A
hematocrit
hemoglobin
RBCs
3
Q
Two exceptions to the definition of anemia
A
- acute blood loss
- hemodilution
4
Q
leading cause of anemia worldwide
A
iron deficiency
5
Q
symptoms of anemia
A
pale conjunctiva
fatigue
pale palms
6
Q
severe anemia can lead to
A
cardiac insufficiency
7
Q
3 causes of anemia
A
- decreased RBC production
- increased RBC destruction
- bleeding
8
Q
what is the best indicator of RBC production?
A
reticulocyte count
9
Q
RBC lifespan
A
120 days
10
Q
RBCs are identifiable as reticulocytes for
A
about 1 day
11
Q
a normal reticulocyte count should be approx.
A
1% of circulating RBCs
about 50,000
12
Q
an anemia patient’s reticulocyte count would be
A
about 200,000 recticulocytes
13
Q
a reticulocyte count _______________ indicates a problem with RBC destruction
A
over 200,000
14
Q
a reticulocyte count _________ indicates a problem with RBC production
A
less than 100,000
15
Q
in a patient with normal Hct, an absolute reticulocyte count greater than 100,000 suggests
A
ongoing hemolysis or blood loss
16
Q
RPI
A
reticulocyte production index
corrects for the crit and reticulocyte lifespan
17
Q
MCV > 100
A
macrolytic
18
Q
MCV <80
A
microcytic
19
Q
MCV 80-100
A
normocytic
20
Q
variation in RBC shape
A
poikilocytosis
21
Q
variation in RBC size
A
anisocytosis
22
Q
cells with large, pale centers
A
hyprochromia
23
Q
iron from [plant or animal sources] is absorbed best
A
animal
24
Q
most iron comes from
A
diet
5-10% absorbed in proximal intestine
25
iron is absorbed and oxidized to
Fe3+ form
26
Fe3+ is bound tightly to __________ in blood
transferrin
27
iron is transferred to cells and reduced to Fe2+ form, then inserted into
heme or stored
28
stored iron (Fe3+) is bound to
ferritin
29
is ferritin in plasma?
yes some, mostly intracellular
30
hemosiderin
insoluble form of ferritin
31
peptide produced in the liver
hepcidin
32
hepcidin interacts with _________ to inhibit iron release for villus enterocytes and macrophages
ferroportin
33
hepcidin is upregulated by [high/low] plasma iron levels or inflammation
high
34
low iron levels [decrease/increase] hepcidin, which stimulates iron absorption and release into the blood
decrease
35
mutations in HFE can cause diminished hepcidin release, leading to
hereditary hemochromatosis
36
bound iron is transported in the blood by what?
transferrin
37
the total amount of transferrin in blood
total iron binding capacity (TIBC)
38
reflects body iron stores
serum ferritin
39
serum ferrtin is ________in iron deficiency, and _________ in inflammation
low; increases
40
TIBC is _______ in iron deficiency and ________ in inflammation
high; normal/low
41
serum iron is ________ in iron deficiency and inflammation
low
42
circulating protein derived from the cleavage of the membrane transferrin receptor on erythroid precursor cells
sTfR
43
what is the advantage of sTfR?
reflects overall erythropoiesis, which is increased in iron deficiency
distinguishes from ACD
44
________mg of iron per day is required for erythropoiesis
20
45
most iron is recycled from
old RBCs after they are eaten by macrophages
46
excess iron is stored in the
liver
47
3 causes of iron deficiency
1. blood loss
2. failure to meet increased requirements (pregnancy, infancy, etc.)
3. inadequate absorption
48
symptoms of iron deficiency
koilonychia: spoon shaped nails
angular cheilosis: fissuring at corners of mouth
Pummer-Vinson: narrowing of esophagus
49
treatment of iron deficient anemia
dietary iron supplement
last resort: transplant
50
most common cause for noncompliance of iron supplements
constipation/GI distress
51
indications for IV iron
severe symptomatic anemia
failure of oral iron d/t GI intolerance or absorption issues
cancer/chemo
anemia with chronic renal disease
heavy ongoing GI or menstrual blood loss
52
response to oral iron therapy: peak reticulocyte count
7-10 days
53
response to oral iron therapy: increased Hb and Hct
14-21 days
54
response to oral iron therapy: normal Hb and Hct
2 months
55
response to oral iron therapy: normal iron stores
4-5 months
56
most common cause of anemia in hospitalized patients
anemia of inflammation/chronic disease
57
sfTF Ferritin in ACD
decreased
58
transferritin in ACD
decreased
59
ferritin in ACD
increased
60
marrow iron in ACD
no changes
61
ferritin in IDA
decreased
62
serum iron in IDA
decreased
63
transferrin sat in IDA
decreased
64
sfTF in IDA
increased
65
marrow iron in IDA
decreased
66
thalassemeia is an ________ disorder of hemoglobin production
inherited
67
thalassemia is caused by a defect in
alpha or beta proteins
68
thalassemia major causes
severe microcytic anemia requiring transfusions
69
thalassemia minor causes
mild or moderated anemia
70
most important part of diagnosing iron deficient anemia
find the etiology
71
preferred site of bone marrow aspiration and biopsy in adults
iliac crest
72
can a bone marrow biopsy be taken at the sternum?
no, too close to vital organs
| only aspiration
73
can a bone marrow biopsy be taken at the sternum?
no, too close to vital organs
| only aspiration
74
contain RNA in cytoplasm
reticulocytes
75
low MCV, low MCHC, high RDW
iron deficiency
76
amount of iron absorbed by a normal adult male per day
1 mg
77
iron bioavailibilty ranked
attached to hemoglobin> Fe2>Fe3
78
inflammatory anemia typically results in a Hgb of
.>8 g/dL
mild to moderate anemia
79
in ACD, reticulocyte count is
low
80
result of elevated hepcidin levels that develop in response to IL-1, IL-6, INF-a
ACD
81
hepcidin decreases iron absorption by causing
internalization and proteolysis of ferroportin
82
normal/low serum iron levels
ACD
83
low TIBC
ACD
84
elevated serum ferritin
ACD
85
ACD is initially normocytic, normochromic but can progress to
hypochromic, microcytic
86
blood smear for Warm AIHA would show
spherocytes
87
blood smear for MAHA would show
shistocytes
88
high TIBC
IDA
89
high serum transferrin
IDA
90
low transferrin saturation
IDA
91
normal transferrin saturation
25-45%
92
transferrin saturation below 16%
IDA
93
low hepcidin
IDA
94
high hepcidin
ACD
95
iron excretion cannot be
physiologically modulated
96
iron absorption takes places in
first part of small intestine
97
Hgb should improve within
30 days of starting iron replacement therapy
