Chapter 7: Anemias Flashcards
How can we calculate hematocrit?
RBC mass/blood volume
What value defines severe anemia?
Hg less than 7
How will the body respond to chronic hypoxia?
EPO up; mitochondria up; angiogenesis up
What is the oxygen saturation with central cyanosis?
less than 85%
How do we measure oxygen saturation?
pulse oximetry
How do we measure pO2?
Arterial blood gas (ABG)
If reticulocyte count on CBC is more than 1% what kind of anemia is it?
suspect hemolysis
If reticulocyte count on CBC is less than 1%?
bone marrow problem (renal failure to produce EPO, hypothyroidism, aplastic anemia, fanconi anemia, Diamond Blackfan anemia (triphalangeal thumb)
If reticulocyte count is normal (1%)?
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
Where does extravascular hemolysis occur?
spleen and liver
Where does intravascular hemolysis occur?
In blood vessels
What are signs of extravascular hemolysis?
splenomegaly, jaundice and high unconjugated bilirubin
What are some causes of extravascular hemolysis?
hereditary spherocytosis, G6PD deficiency, sickle cell, pyruvate kinase deficiency
What are some signs of intravascular hemolysis?
schistocytes, helmet cells, haptoglobin down; hemoglobinuria
What are some causes of intravascular hemolysis?
autoimmune hemolytic anemia,paroxysmal nocturnal hemoglobinuria, microangiopathic hemolytic anemia, malaria, infections, neoplasms
What does a warm agglutin test for?
autoimmune hemolytic anemia
What does a cold agglutin test for?
infection (mycoplasma) or neoplasm; RBCs clump together on exposure to cold air (IgM against RBC)
Drugs that cause hemolytic anemia?
Penicillins, Cephalosporins, Sulfa drugs, Alpha-methyldopa, PTU, antimalarials, dapsone
drugs that could cause lupus
HIPPPE
hydralazine
INH
Procainamide
Penicillamine
Phenytoin
Ethosuximide
A drug that blocks C5 MAC complex?
Eculuzimab (cannot destroy encapsulated organisms, so check for vaccinations against encapsulated organisms (SHINeSKi) Strep Pneumo, Hib, Neissiera, Salmonella,
If pt RET down what should you do?
Prescribe folate and B12 and see back in a week.
If you see Howell-Jolly bodies?
think hemolytic anemia and splenectomy (sickle cell)
MCC of spherocytosis
old age; #2 hereditary
MCC of tear drop cell?
hemolytic anemia and cancer of BM
MCC of target cell?
iron deficiency anemia and thalassemia
MCC of Heinz body?
G6PD deficiency (precipitaated or oxidized protein like hemoglobin stuck to the sides)
MCC of basophilic stippling?
lead poisoning
MCC of acanthocytes (RBC coated with lipid)?
hyperlipidemias, obesity, nephrotic syndrome (loss of albumin so liver makes apolipoproteins instead); renal failure; pregnancy
What if you see anisocytosis (different cell sizes) or poikolocytosis (different shapes)?
2 or more anemias or treating an anemia and part of the cell population is anemic and part is normal
MCC of malabsorption in children?
cystic fibrosis and celiac sprue
MCC of malabsorption in adults?
Crohn’s
What are the lab values for Iron deficiency anemia?
Serum Fe low, Ferritin low, TIBC is HIGH (because looking to bind more Fe)
MCC for IDA in children and teenagers?
low intake; poor diet
MCC for IDA in adults over 40?
mucosal bleeding males–colon; females–endometrial
Tx for IDA?
Ferrous Iron with Vitamin C!
What acute phase reactant causes anemia of chronic disease?
hepcidin (body stores away iron because doesn’t want bacteria to use it)
What are the lab values of anemia of chronic disease?
Serum Fe low, ferritin normal or increased; TIBC down (doesn’t want to bind iron)
How does lead poisoning cause anemia?
blocks D-Ala dehydratase and ferrochetolase in heme production
How many alpha genes are there on hemoglobin?
4
How many beta genes are there on hemoglobin?2
2
If one alpha gene is missing what is that called?
alpha thalassemia minor (asymptomatic)
If two or more alpha genes are missing what is that called?
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)
If one beta gene is missing what is that called?
beta thalassemia minor (with/without symptoms)
If 2 beta genes are missing?
beta thalassemia major cannot make HbA, can make HbF and HbA2 therefore symptomatic at 6 mo. when HbF diminishes; requires transfusions
What drug is given to sickle cell pts to produce more HbF?
hydroxurea
What is normocytic normochromic anemia?
Nothing is wrong with RBCs; just don’t have enough of them!
What are some causes of normocytic normochromic anemia?
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)
What is macrocytic anemia?
MCV increase; defective nuclear division
What causes macrocytic anemia?
B12 deficiency; folate deficiency; hypothyroidism; alcohol; chemotherapy; anti-convulsve drugs (block Ca or folate–microtubules need Ca )
Vitamin B12 is a cofactor of which 2 enzymes?
malonyl-CoA Mutase; Homocysteine Methyl transferase;
MCC of B12 deficiency
Type A gastritis (pernicious anemia)
MCC of folate deficiency?
overcooked veggies
How does alcohol cause macrocytic anemia?
Alcoholics have poor diet; also alcohol denatures proteins and impairs nuclear division
What is the cause of Paroxysmal Nocturnal hemoglobinuria?
gene mutatoin causes an anchor for GPI (glycosyl-phosphatidylinositol protein to be missing; without GPI, complement tags cell for destruction
What is usually the cause of death in PNH?
overtime complement fixation causes thrombosis; pts may die of MI or strokes
What test is used to detect PNH?
flow cytometry (CD55 and CD59 on surface)
