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Hematology and Oncology > EXAM #1: PATHOLOGY OF ANEMIA > Flashcards

EXAM #1: PATHOLOGY OF ANEMIA Flashcards

1
Q

What is anemia?

A

Decreased RBC mass leading to decrease tissue oxygenation

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2
Q

Practically, what is anemia?

A
  • Low Hb

- Low Hematocrit

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3
Q

What is important to remember when you come to the diagnosis of “anemia?”

A

This is an intermediate diagnosis and you need to find the UNDERLYING CAUSE

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4
Q

How do you classify anemia?

A

MCV

  • Microcytic
  • Normocytic
  • Macrocytic

Etiology

  • Increased blood loss
  • Impaired production
  • Increased destruction
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5
Q

What are the acute causes of blood loss?

A

Trauma

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6
Q

What are the chronic causes of blood loss?

A
  • Lesion of GI tract i.e. ulcer, colonic tumor…etc.

- Gynecological disturbance e.g. uterine leiomyoma

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7
Q

What is the cause of Fanconi anemia?

A

Defect in RBC stem cells

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8
Q

What is the cause of Thalassemia?

A

Defect in erythroblast maturation

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9
Q

What does Vitamin B12/Folate deficiency result in?

A

Defective DNA synthesis

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10
Q

What does iron deficiency result in?

A

Defective Hb synthesis

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11
Q

How does renal failure result in anemia?

A

Decrease EPO production

EPO is produced in the kidneys

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12
Q

Describe the basic etiology of ACD.

A

Inflammation induced iron sequestration

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13
Q

What are the primary hepatpoietic neoplasms?

A

Acute leukemia
Myelodysplasia
Myeloproliferative disorder

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14
Q

What virus is associated with anemia?

A

Parvovirus B12 infection

This results in an infection of RBC progenitors

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15
Q

What are the inherited RBC membrane disorders?

A

Hereditary spherocytosis

Hereditary elliptocytosis

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16
Q

What are the inherited enzymes deficiencies that result in anemia?

A
  • HMP shunt (G6PD)

- Glyoclytic (pyruvate kinase)

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17
Q

What are the inherited Hb abnormalities that result in anemia?

A
  • Thalassemia= defective globin synthesis

- Hemoglobinopathies

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18
Q

What are the acquired causes of increased RBC destruction?

A
  • PIGA deficiency
  • Autoimmune causes
  • Mechanical trauma
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19
Q

What are the autoimmune disorders that can lead to anemia?

A

1) Transfusion reaction
2) Hemoluytic disease of the newborn
3) Drugs
4) Auto-immune disorders

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20
Q

What are the causes of mechanical trauma to RBCs?

A

1) DIC
2) Cardiac trauma (valve disorders)
3) Infection– malaria, babesiosis
4) Chemical injury– lead poisoning
5) Sequestration of monoculear phagocyte system–hypersplenism

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21
Q

What is the normal size of a RBC on microscopy?

A

6-8 um

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22
Q

List the characteristics of a normal PBS (Peripheral Blood Smear).

A

1) Normochromic= normal Hb
2) Minimal poikilocytosis= irregular shape
3) Minimal anisocytosis= different sizes
4) Nothing “weird”

“Weird” things include nucleated RBCs, infectious organisms, iron aggregates, Howell-Jolly bodies.

23
Q

Where do you read the PBS?

A

Near to the tail, but not at the tail

24
Q

How can you tell a RBC is normochromic?

A

Central portion is 1/3 of the total diameter

25
Q

What are the features of a hypochromic RBC? Hyperchromic?

A

Hypo= central protion is greater than 1/3 of the RBC

Hyper= central portion is less than 1/3 of the RBC

26
Q

See ppt examples to distinguish anisocytosis and poikilocytosis.

A

N/A

27
Q

See ppt. examples to distinguish between hyperchromic and hypochromic.

A

N/A

28
Q

What is “polychromasia?”

A

RBCs with more than one color

  • Pink
  • Blue
  • Blue-gray

This is a sign of anemia?

29
Q

What are immature RBCs blue or blue-gray?

A
  • H & E staining of retics with RNA

- Straining of the RNA with acid is BLUE

30
Q

See ppt. example of polychromasia.

A

N/A

31
Q

What is normoblastemia? What is this an indication of?

A
  • Presence of nucleated RBCs in PBS

- Hemolytic anemia

32
Q

See ppt example of normoblastemia.

A

N/A

33
Q

What are the characteristics of a spherocyte?

A
  • Spherical
  • Small
  • Darker in color
34
Q

What are the the underlying causes of spherocytes on PBS?

A
  • Hereditary spherocytosis

- Autoimmune hemolytic anemia

35
Q

See ppt. example of spherocytes.

A

N/A

36
Q

What is a schistocyte?

A

“Broken” or fragmented RBC

37
Q

What are the causes of schistocytes?

A
  • Microangiopathic hemolytic anemia (DIC, TTP, HUS)
  • Other hemolytic anemia

Any situation of hemolytic anemia may cause schistocytes.

38
Q

See ppt. example of a schistocyte.

A

N/A

39
Q

What is punctate basophilia/ basophilic stippling?

A

Tiny blue dots in the periphery of the RBC

40
Q

What are the causes of punctate basophilia?

A
  • Lead poisoning
  • Severe anemia
  • Severe infection
  • Drugs
  • Alcoholism
41
Q

See ppt slide example of basophilic stippling.

A

N/A

42
Q

What is a Howell-Jolly body or H-J body?

A
  • RBC with a purple dot

- Purple nuclear remnant that are LARGER than basophilic stippling

43
Q

What causes Howell-Jolly bodies?

A
  • S/p splentectomy
  • Hemolysis

Spleen cannot rid the body of abnormal RBCs.

44
Q

See ppt example of H-J body.

A

N/A

45
Q

What are the features of reticulocytes?

A

Blue staining cell with blue staining darker central features

46
Q

See ppt. examples of reticulocytes.

A

N/A

47
Q

List the causes of microcytic anemia.

A

1) Iron deficiency
2) ACD
3) Thalassemia
4) Siderblastic anemia

48
Q

What are the causes of defects in heme synthesis?

A

1) Iron deficiency anemia
2) ACD
3) Sideroblastic anemia

49
Q

What causes defects in the synthesis of globin chains (alpha or beta)?

A

Thalassemia

50
Q

See ppt example of microcytic anemia.

A

N/A

51
Q

What is a typical reference for RBC size in a PBS?

A

Lymphocyte–the RBC should be the same size as the NUCLEUS of the lymphocyte

52
Q

What are the common causes of macrocytic anemia?

A

1) Vitamin B12/ Folate deficiency–>decreased DNA synthesis
2) Alcohol use–>increased RBC membrane
3) Liver disease
4) Reticulocytosis
5) Myelodysplastic syndrome*
6) Hypothyroidism*

*uncommon causes

53
Q

What is the common cause of normocytic anemia?

A

Blood loss

54
Q

Describe the physiologic response to acute blood loss.

A

1) Intravascular shift of water
2) Hemodilution
3) EPO stimulation

Reticulocytes appear in peripheral blood after 5 days.

Hematology and Oncology (38 decks)

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