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Pass Program > Chapter 7: Anemias > Flashcards

Chapter 7: Anemias Flashcards

1
Q

How can we calculate hematocrit?

A

RBC mass/blood volume

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2
Q

What value defines severe anemia?

A

Hg less than 7

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3
Q

How will the body respond to chronic hypoxia?

A

EPO up; mitochondria up; angiogenesis up

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4
Q

What is the oxygen saturation with central cyanosis?

A

less than 85%

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5
Q

How do we measure oxygen saturation?

A

pulse oximetry

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6
Q

How do we measure pO2?

A

Arterial blood gas (ABG)

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7
Q

If reticulocyte count on CBC is more than 1% what kind of anemia is it?

A

suspect hemolysis

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8
Q

If reticulocyte count on CBC is less than 1%?

A

bone marrow problem (renal failure to produce EPO, hypothyroidism, aplastic anemia, fanconi anemia, Diamond Blackfan anemia (triphalangeal thumb)

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9
Q

If reticulocyte count is normal (1%)?

A

check MCV and find size of RBC if it is less than 80 it is microcytic anemia (iron deficiency, anemia of chronic disease, lead poisoning, hemoglobinopathies i.e. thalassemia

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10
Q

Where does extravascular hemolysis occur?

A

spleen and liver

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11
Q

Where does intravascular hemolysis occur?

A

In blood vessels

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12
Q

What are signs of extravascular hemolysis?

A

splenomegaly, jaundice and high unconjugated bilirubin

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13
Q

What are some causes of extravascular hemolysis?

A

hereditary spherocytosis, G6PD deficiency, sickle cell, pyruvate kinase deficiency

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14
Q

What are some signs of intravascular hemolysis?

A

schistocytes, helmet cells, haptoglobin down; hemoglobinuria

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15
Q

What are some causes of intravascular hemolysis?

A

autoimmune hemolytic anemia,paroxysmal nocturnal hemoglobinuria, microangiopathic hemolytic anemia, malaria, infections, neoplasms

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16
Q

What does a warm agglutin test for?

A

autoimmune hemolytic anemia

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17
Q

What does a cold agglutin test for?

A

infection (mycoplasma) or neoplasm; RBCs clump together on exposure to cold air (IgM against RBC)

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18
Q

Drugs that cause hemolytic anemia?

A

Penicillins, Cephalosporins, Sulfa drugs, Alpha-methyldopa, PTU, antimalarials, dapsone

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19
Q

drugs that could cause lupus

A

HIPPPE
hydralazine
INH
Procainamide
Penicillamine
Phenytoin
Ethosuximide

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20
Q

A drug that blocks C5 MAC complex?

A

Eculuzimab (cannot destroy encapsulated organisms, so check for vaccinations against encapsulated organisms (SHINeSKi) Strep Pneumo, Hib, Neissiera, Salmonella,

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21
Q

If pt RET down what should you do?

A

Prescribe folate and B12 and see back in a week.

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22
Q

If you see Howell-Jolly bodies?

A

think hemolytic anemia and splenectomy (sickle cell)

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23
Q

MCC of spherocytosis

A

old age; #2 hereditary

24
Q

MCC of tear drop cell?

A

hemolytic anemia and cancer of BM

25
Q

MCC of target cell?

A

iron deficiency anemia and thalassemia

26
Q

MCC of Heinz body?

A

G6PD deficiency (precipitaated or oxidized protein like hemoglobin stuck to the sides)

27
Q

MCC of basophilic stippling?

A

lead poisoning

28
Q

MCC of acanthocytes (RBC coated with lipid)?

A

hyperlipidemias, obesity, nephrotic syndrome (loss of albumin so liver makes apolipoproteins instead); renal failure; pregnancy

29
Q

What if you see anisocytosis (different cell sizes) or poikolocytosis (different shapes)?

A

2 or more anemias or treating an anemia and part of the cell population is anemic and part is normal

30
Q

MCC of malabsorption in children?

A

cystic fibrosis and celiac sprue

31
Q

MCC of malabsorption in adults?

A

Crohn’s

32
Q

What are the lab values for Iron deficiency anemia?

A

Serum Fe low, Ferritin low, TIBC is HIGH (because looking to bind more Fe)

33
Q

MCC for IDA in children and teenagers?

A

low intake; poor diet

34
Q

MCC for IDA in adults over 40?

A

mucosal bleeding males–colon; females–endometrial

35
Q

Tx for IDA?

A

Ferrous Iron with Vitamin C!

36
Q

What acute phase reactant causes anemia of chronic disease?

A

hepcidin (body stores away iron because doesn’t want bacteria to use it)

37
Q

What are the lab values of anemia of chronic disease?

A

Serum Fe low, ferritin normal or increased; TIBC down (doesn’t want to bind iron)

38
Q

How does lead poisoning cause anemia?

A

blocks D-Ala dehydratase and ferrochetolase in heme production

39
Q

How many alpha genes are there on hemoglobin?

A

4

40
Q

How many beta genes are there on hemoglobin?2

A

2

41
Q

If one alpha gene is missing what is that called?

A

alpha thalassemia minor (asymptomatic)

42
Q

If two or more alpha genes are missing what is that called?

A

alpha thalassemia major 2 genes could be symptomatic (a-,a-) trans; (aa,–) cis ; 3 requires blood transfusions and 4 is incompatible with life (Hydrops Fetalis–Barts)

43
Q

If one beta gene is missing what is that called?

A

beta thalassemia minor (with/without symptoms)

44
Q

If 2 beta genes are missing?

A

beta thalassemia major cannot make HbA, can make HbF and HbA2 therefore symptomatic at 6 mo. when HbF diminishes; requires transfusions

45
Q

What drug is given to sickle cell pts to produce more HbF?

A

hydroxurea

46
Q

What is normocytic normochromic anemia?

A

Nothing is wrong with RBCs; just don’t have enough of them!

47
Q

What are some causes of normocytic normochromic anemia?

A

acute hemorrhage; renal failure; hypothyroidism (if thyroid hormone not present, EPO cannot work); aplastic anemia (parvovirus B19); drugs, myelofibrosis; Fanconi (RBC aplasia; hereditary or secondary to Thymoma); Diamond Blackfan Syndrome (RBC aplasia plus triphalangeal thumb)

48
Q

What is macrocytic anemia?

A

MCV increase; defective nuclear division

49
Q

What causes macrocytic anemia?

A

B12 deficiency; folate deficiency; hypothyroidism; alcohol; chemotherapy; anti-convulsve drugs (block Ca or folate–microtubules need Ca )

50
Q

Vitamin B12 is a cofactor of which 2 enzymes?

A

malonyl-CoA Mutase; Homocysteine Methyl transferase;

51
Q

MCC of B12 deficiency

A

Type A gastritis (pernicious anemia)

52
Q

MCC of folate deficiency?

A

overcooked veggies

53
Q

How does alcohol cause macrocytic anemia?

A

Alcoholics have poor diet; also alcohol denatures proteins and impairs nuclear division

54
Q

What is the cause of Paroxysmal Nocturnal hemoglobinuria?

A

gene mutatoin causes an anchor for GPI (glycosyl-phosphatidylinositol protein to be missing; without GPI, complement tags cell for destruction

55
Q

What is usually the cause of death in PNH?

A

overtime complement fixation causes thrombosis; pts may die of MI or strokes

56
Q

What test is used to detect PNH?

A

flow cytometry (CD55 and CD59 on surface)

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