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PATHOANATOMY > BLOOD > Flashcards

BLOOD Flashcards

1
Q

DEFINE ANAEMIA

A

Decreased:
> erythrocytes
> hemoglobin
> hematocrits

all below their normal ranges

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2
Q

ETIOLOGY OF ANAEMIA

A

> haemorrhage
destruction of RBC
decreased production in bone marrow > hematopoeisis is low

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3
Q

WHAT CAUSES LOW HEMOGLOBIN?

A

> Low diet of IRON

> genetic + acquired conditions that affect production + function/ structure of Hb

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4
Q

CLASSIFICATION OF ANAEMIA DUE TO HAEMORRHAGE?

A

> Acute blood loss > acute post hemorrhagic anaemia

> chronic blood loss

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5
Q

CLASSIFICATION OF ANAEMIA DUE TO RBC DESTRUCTION?

A

> inherited genetic defects

> acquired genetic defects
> Ab mediated destruction
> mechanical trauma

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6
Q

CLASSIFICATION OF ANAEMIA DUE TO DECREASED RBC PRODCUTION IN BONE MARROW?

A

> inherited genetic defects
> defects leading to stem cell depletion (aplastic anaemia)
> defects affecting maturation of RBC (thalassemia)

> nutritional deficiencies
> deficiencies affecting synthesis of DNA (via B12 deficiency anaemia)
> deficiencies affecting Hb production (iron deficiency anaemia)

> bone marrow failure due to systemic disease
> inflammatory, infectious disease, renal failure, cancer)

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7
Q

WHAT ARE THE RESULTS OF ANAEMIA?

A

TISSUE HYPOXIA

> RBC carry O2 to tissue cells so reduces RBC&raquo_space; low O2 supply to tissue cells > hypoxia

> prolonged anaemia > CHRONIC HYPOXIA

> CHRONIC HYPOXIA
> tissue + organ damage 
> FATTY LIVER 
> FATTY HEART 
> FATTY BONE MARROW
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8
Q

WHICH ORGANS ARE AFFECTED IN ANEMIA + HOW?

A

> FATTY LIVER

> FATTY HEART

> FATTY BONE MARROW

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9
Q

DESCRIBE FATTY LIVER IN ANEMIA?

A

FATTY LIVER = STEATOSIS
> too much fat build up in liver
> hypoxia in liver tissue due to anemia > unable to break down fat build up

MACRO:
> ENLARGED
> YELLOW
> SOFT + GREASY

MICRO:
> fat as vacuoles
> displaces nucleus to periphery of hepatocytes

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10
Q

DESCRIBE FATTY HEART IN ANEMIA?

A

TIGER HEART
> bands of yellow affected myocardium + bands of darker red brown unaffected myocardium

> papillary muscles affected in right ventricles
intracellular deposits of fat along small venues

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11
Q

DESCRIBE FATTY BONE MARROW IN ANEMIA?

A

INACTIVE FAT BONE MARROW replaces by red, hematopeotic bone marrow

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12
Q

OUTLINE CLINCIAL FEATURES OF ANEMIA

A 
> cyanosis 
> pallor 
> tachycardia 
> palpitation
> dyspnoea 
> dizziness 
> weakness + fatigue 
> glossitis

ALL DUE TO LOW OXYGEN > HYPOXIA

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13
Q

ETIOLOGY OF ANAEMIA DUE TO BLOOD LOSS?

A 
> trauma + rupture to blood vessels 
> increased menstruation 
> GI bleeding 
> gastric/ duodenal ulcer 
> varices of esophagus 
> genital system disease 
> childbirth trauma
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14
Q

MORPHOLOGY OF ANEMIA DUE TO HEMORRHAGE?

A

> blood loss
low erythrocytes
increased erythropoeisis in bone marrow after 48-72h

CHRONIC BLOOD LOSS
> development of IRON deficiency anaemia

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15
Q

WHAT TYPE OF ANEMIA DOES HEMORRHAGE CAUSE?

A

IRON DEFICIENCY ANAEMIA

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16
Q

OUTLINE CHARACTERISTICS OF IRON DEFICIENCY ANEMIA?

A

> smaller erythrocytes > microcytic
hypo chromic
bone marrow regeneration > red bone marrow replaces yellow inactive bone marrow

17
Q

WHAT IS MEGALOBLASTIC ANAEMIA?

A

ERYTHROCYTES EXTREMELY LARGE BUT LOW IN NUMBERS
> macrocytic
> due to defective DNA synthesis leading to delayed maturation of RBC nucleus

18
Q

ETIOLOGY OF MEGALOBLASTIC ANAEMIA?

A

> Vitamin B12 deficiency - cobalamin
Vitamin B9 deficiency - Folate
pernicious anaemia

19
Q

WHAT IS PERNICIOUS ANAEMIA?

A

> autoimmune disorder
inability of gastric mucosa to produce intrinsic factor (IF)
antibodies:
> anti-parietal antibodies against parietal cells of stomach mucosa
> anti-intrinsic factor antibodies
intrinsic factor = important for absorbing + transferring vitamin B12 across intestinal mucosa
vitamin B12 - important for healthy RBC

20
Q

CLINICAL FEATURES OF PERNICIOUS ANEMIA?

A

> fatigue
dyspnoea
tachycardia

> NEUROLOGICAL > Vit.B12 maintains integrity of myelin sheaths
> NERVOUS SYSTEM DYSFUNCTION
parathesia (burning, prickling sensation)
loss of proprioceptive ability
ataxia ( no coordination)
hunters glossitis (painful, tender, glossy tongue)

21
Q

MORPHOLOGY OF MEGALOBLASTIC ANEMIA?

A

Blood: macrocytic + oval shaped

Bone marrow: hyper cellular due to increased erythropoiesis > producing abnormal large RBC cells with mature cytoplasm + less mature nuclei

Stomach
> chronic gastritis 
> atrophy of fundic glands stomach 
> affected chief + parietal cells 
>> producing low intrinsic factors > affecting with Vit. B12 absorption

Nervous system:
> central nervous system lesion
> demyelination of dorsal + lateral tracts sometimes with loss of axons

22
Q

ETIOLOGY OF IRON DEFICIENCY ANAEMIA?

A
  1. Increased blood loss - haemorrhage
  2. Increased demand during periods of increased growth
    - infancy
    - childhood
    - adolescence
    - premature children
    - pregnancy + lactation
  3. Inadequate dietary intake
    - poor economic status
    - anorexia
    - elderly due to poor dentition
    - apathy
  4. Decreased absorption
    - partial/ total gastectomy
    - achlorhydria
    - intestinal malabsorption
23
Q

OUTLINE WHAT CAUSES INCREASED BLOOD LOSS FOR IRON DEFICIENCY ANEMIA?

A

> UTERINE

  • menstruation
  • repeated miscarriages
  • post menopausal uterine bleeding

> GIT

  • peptic ulcer
  • haemorrhoids
  • hookworm infestation
  • cancer of stomach + large bowel
  • oesophageal varices
  • hiatus hernia
  • chronic aspirin ingestion
  • ulcerative colitis
  • diverticulosis

> RENAL

  • hematouria
  • hemoglobinuria

> NASAL
- epistaxis

> LUNGS
- hemoptysis

24
Q

EXPLAIN PATHOGENISIS OF IRON DEFICIENCY ANAEMIA?

A

> Inadequate supply of iron for required Hb synthesis

> negative iron balance > compensated by mobilisation of iron from tissue deposits > maintains Hb synthesis

> depletion of iron deposits in tissue > IRON DEFICIENCY ANEMIA

25
Q

OUTLINE CLINICAL FEATURES OF IRON DEFICIENCY ANAEMIA

A 
> WEAKNESS 
> FATIGUE 
> DYSPNEA 
> PALPITATIONS 
> PALLOR 
> ANGINA 
> CONGESTIVE CARDIAC FAILURE 
> MENORRHAGIA
26
Q

DESCRIBE EPITHELIAL CHANGES FOR CHRONIC IRON DEFICIENCY ANAEMIA?

A

> KOILONYCHIA - soft, spoon looking nails with depressions

> ATROPHIC GLOSSITIS - partial/ complete absence of filiform papillae of tongue surface

> ANGULAR STOMATITIS - inflammation of corners of mouth

> DYSPHAGIA - difficulty swallowing

> PLUMMER-VINSON SYNDROME - triad of:
dysphagia
iron deficiency
oesophageal webs

27
Q

OUTLINE THE DEVELOPMENT STAGES OF ANAEMIA?

A
  1. storage of iron depletion but no anaemia at this stage
  2. iron deficient erythropoiesis > no development of anaemia
  3. iron deficiency anaemia developed when RBC becomes microcytic + hypo chromic
28
Q

OUTLINE LAB FINDINGS FOR IRON DEFICIENCY ANEMIA?

A 
> BLOOD PICTURE - mild - moderate anaemia 
> Fall in Hb 
> RBC - hypochromic + microcytic 
> Anisocytosis + poikilocytosis 
> low RBC count 
> low reticulocyte count 
> low MCV 
> low MHC 
> low MCHC

> BONE MARROW

  • hyper cellular due to erythroid hyperplasia
  • normoblastic erythropoiesis > small polychromatic normoblasts (micronormoblasts)
  • prussian blue reaction > shows deficiency of reticuloendothelial iron storage

BIOCHEMICAL FINDINGS:

  • low serum iron
  • increased TIBC (total iron binding capacity)
  • low serum ferritin
  • increased transferring
29
Q

WHAT IS APLASTIC ANAEMIA?

A

aka PANCYTOPENIA
> anaemia
> leucopenia
> thrombocytopenia

Due to aplasia of bone marrow + reduction of hematopeotic pluripotent stem cells

30
Q

TYPES OF APLASTIC ANAEMIA + ITS ETIOLOGY

A

MOST CASES = IDIOPATHIC

CASES WITH ETIOLOGY:

  1. PRIMARY APLASTIC ANAEMIA
    > Fanconi’s anaemia: autosomal recessive genetic disorder resulting in failure of bone marrow

> Immunologically mediated acquired form (immunosuppressive therapy)

  1. SECONDARY APLASTIC ANAEMIA
    > DRUGS
    - antimetabolites (methotrexate) = anticancer drugs
    - mitotic inhibitors (daunorubicin) = prevents cancerous growth by stopping mitosis
    - alkylating agents (busulifan) - prevents DNA synthesis - preventing cancer cell growth

> TOXIC CHEMICALS

  • industrial
  • domestic
  • benzene derivatives
  • insecticides
  • arsenicals

> INFECTIONS

  • viral hepatits
  • epstein-barr virus infection
  • AIDS

> MISCELLANAOUS

  • SLE
  • therapeutic X-rays
31
Q

CLINICAL FEATURES OF APLASTIC ANEMIA

A

> WEAKNESS

> FATIGUE

> HEMORRHAGE - thrombocytopenia

> MOUTH + THROAT INFECTION

32
Q

LAB FINDINGS OF APLASTIC ANEMIA

A

> low Hb
low/ 0 reticulocyte count

> blood picture - normocytic, normochromic anmeia

> Leucopenia - low granulocyte count with relative lymphocytosis

> thrombocytopenia
bone marrow aspirate = yields dry tap

> Trephine biopsy used for diagnosis - patchy cellular areas in hypocellular or aplastic marrow due to replacement by fat

> Depression of myeloid cells, megakaryocytic + erythroid cells

PATHOANATOMY (7 decks)

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