FINALS - ANEMIA P1 Flashcards
According to WHO ______ is a condition in which number of RBC or Hgb concentration is lower than the normal.
ANEMIA
is a manifestation of a certain disease associated with a
decrease in the red blood cell, decrease in hematocrit and
a decrease in hemoglobin.
anemia
is anemia a primary disease?
no
Anaimia
an =
haima =
an = lack
haima = blood
Functional def of anemia
decrease in the oxygen carrying capacity of the blood.
Operational definition of anemia
reduction from the baseline value for the total
number of RBCs, amount of circulating hemoglobin,
and RBC mass for a particular patient.
Conventional definition of rbc
decrease in RBCs, Hb and Hct below the previously established reference values for healthy individuals of the same age, gender, and race and under similar environmental conditions.
Clinical Findings of Anemia
- History
- Physical examination
- Signs and symptoms
- Laboratory procedures
most common symptoms of anemia
Shortness of breath
Fatique
Weakness
clinical findings that are not covered by medtechs
- History
- Physical examination
- Signs and symptoms
Laboratory procedures for anemia
CBC, iron studies, hemoglobin electrophoresis
backbone of anemia
iron studies
In History of Patient, we check for the _
Diet
Bleeding history
Drug ingestion
Occupation
Exposure to chemicals
Travel
Previous medication
Ethnic group
Family history of disease
Hobbies
Neurologic symptoms
how many iron we lose every day
1mg of iron per day
In physical examination, we check for the ___
Skin: pallor
Eyes (hemorrhage)
Mouth (mucosal bleeding)
Sternal tenderness
Lymphadenopathy
Cardiac murmurs
Splenomegaly- enlargement of spleen
Hepatomegaly- enlargement of liver
Vital signs-
pallor in skin means
decrease in oxyhemoglobin
jaundice is an indicator of___
hemolysis
a skin symptoms which means there’s a breakage of capillaries
petechia/petique
vital signs includes
temperature, blood pressure, heart rate
General causes of Anemia
- Decreased red blood cell production (BONE MARROW FAILURE)
- Increased red blood cell destruction (extrinsic or intrinsic)
- Blood loss (acute or chronic)
Anemia due to decreased production of RBC
- Iron Deficiency Anemia, IDA
- Anemia due to Chronic Inflammation/ chronic disease, ACI or ACD
- Sideroblastic Anemia (blockage in heme synthesis)
- Megaloblastic Anemia (deficiency in vitamin B12)
- Aplastic Anemia (sa bone marrow)
- Thalassemia (walang alpha or beta)
- Anemia due to Chronic Renal Failure
- Anemia due to Endocrine Disorder (cushing syndrome, addison’s disease)
- Anemia due to Marrow Infiltration (myelophthisic anemia)
(most common type and easiest to treat)
iron deficiency anemia, IDA
decrease production of WBC, RBC and platelets
Pancytopenia-
diseases under endocrine disorder
cushing syndrome, addison’s disease
example of anemia due to marrow infiltration
(myelophthisic anemia)
classification of Anemia due to increased destruction of RBC
A. Intracorpuscular Abnormality (Intrinsic)
B. Extracorpuscular Abnormality (Extrinsic)
Intracorpuscular Abnormality (Intrinsic)
has 2 classifications as well, what are they/
Membrane Defect (problem sa membrane ng RBC, sa lipid, carbohydrate and protein)
Enzyme deficiency
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Globin abnormality
Extracorpuscular Abnormality (Extrinsic)
has 2 classifications as well, what are they?
- Mechanical
- Infection
- Chemical and Physical Agents
- Antibody-mediated Anemia (AMA)
conditions under membrane defect (intrinsic)
a) hereditary spherocytosis
b) hereditary elliptocytosis
c) hereditary pyropoikilocytosis
d) hereditary stomatocytosis
e) hereditary acanthocytosis
f) hereditary Rh null disease
conditions under enzyme deficiency (intrinsic)
a) G6PD deficiency
b) Pyruvate kinase deficiency
c) Porphyria
conditions under the globin abnormality (intrinsic)
Hemoglobinopathies (Hb SS, CC, SC)
Sgal, Cgal, Egal
conditions under the mechanical (extrinsic)
a) Microangiopathic hemolytic anemia (MAHA)
b) Traumatic cardiac hemolytic anemia
if there’s MAHA, other conditions are can be associated as well such as
thrombotic thrombocytopenic purpura
(TTP)
hemolytic uremic syndrome (HUS)
Disseminated intravascular coagulation
(DIC)
additional
Hemolysis, Elevated Liver enzymes and
Low Platelets count (HELLP)- seen in
pregnant patient
a mechanical extrinsic condition seen in pregnant women
Hemolysis, Elevated Liver enzymes and
Low Platelets count (HELLP)
conditions associated in INFECTION - EXTRINSIC
hemolytic anemia
- malaria
- babesia
- bartonella
- ehrlicia
causes of chemical and physical agents under the EXTRINSIC factors
caused by drugs, toxins, and burns
condition associated to antibody-mediated anemia (ANEMIA) - EXTRINSIC
acquired hemolytic anemia
examples of anemia due to blood loss
acute post hemorrhagic anemia
chronic post hemorrhagic anemia
laboratory test for anemia
- CBC (Manual: Hgb, Hct, RBC, WBC, DC)
- Reticulocyte count (checking of electrophoretic activity ng bone marrow)
- Peripheral smear (for morphology ng cells kung abnormal or normal cells)
- Bone marrow examination
- Iron studies (ang backbone which includes serum, iron, ferritin, total iron binding capacity/TIBC)
- Blood Chemistry (KFT/kidney function test, LFT/liver function test)
- Urinalysis
- Fecalysis
- Hematological special test procedures (Hgb electrophoresis)
iron studies is the backbone of anemia which includes the study of ___
serum, iron,
ferritin, total iron binding capacity/TIBC
a laboratory test that is for morphology ng cells kung abnormal or normal cells
peripheral smear
checking of electrophoetic activity ng
bone marrow
reticulocyte
Blood Chemistry done in anemia such as __
(KFT/kidney function test, LFT/liver
function test)
Morphological Classification of Anemia
1 Microcytic hypochromic anemia (found in SIGA)
2. Macrocytic normochromic anemia
3. Normocytic normochromic anemia
best anemia example of normocytic normochromic anemia
aplastic anemia
small rbc and low concentration of hgb
microcytic hypochromic anemia
big rbc and normal concentration of anemia
macrocytic normochromic anemia
based on the morphological classification of anemia (mcv based)
what is under the microcytic anemia
SIGA
Sideroblastic anemia
iron deficiency
anemia, chronic diseases
globin deficiency (thalassemia)
based on the morphological classification of anemia (mcv based)
what is under the macrocytic anemia
Non megaloblastic anemia
megaloblastic anemia
based on the morphological classification of anemia (mcv based)
what is under the normocytic anemia
in increased retics:
hemolytic anemia
in normal or low retics:
aplastic anemia
hypercellular (myeloma, myelofibrosis, 1st refractory anemia)
normal cellular (neoplasm, uremia)
Non megaloblastic anemia has a disease under called
chronic liver disease
megaloblastic anemia has a disease under called
vitamin b12 deficiency
folic acid deficiency
neither * malignant growth
hemolytic anemia has 2 factors involved
intrinsic or extrinsic
intrinsic factors of hemolytic anemia are
membrane
enzyme
hemoglobin
PNH
EXTRINSIC factors of hemolytic anemia are
antibody mediated
infection (malaria)
chemical and physical agents (drugs, toxins, burns)
mechanical (MAHA, TTP, DIC, HUS)
- cardiac valve prosthesis
- march hemoglobinuria
microcytic hypochromic has decrease of ___
all erythrocyte indices: mcv, mchc, mch
microcytic hypochromic is found in what conditions
thalassemia and severe iron deficiency anemia
it determine the different type of anemia
rbc indices : mcv, mchc, mch
microcytic hypchromic is found in
SIGA
the most common type of anemia
iron deficiency anemia
easiest anemia to treat
IRON DEFICIENCY ANEMIA
what are the causes of IDA
- inadequate intake of iron
- Increased need of iron
- Chronic blood loss
how many mg of iron is lost everyday
1 mg
conditions that will increased the need of iron in Iron deficiency anemia
infancy, childhood, adolescence, and pregnancy
chronic blood loss in IDA are caused by
- heavy menstrual bleeding
- GI bleeding from ulcers or tumors.
- urinary trach with kidney stones
- Iatrogenic cause
In IDA, the 3 cause which is the chronic blood loss, what is an example of Iatrogenic cause
ikaw at ikaw ang nagvovolunteer for sample
In pathogenesis of Iron deficiency anemia
what are the 3 stages
- Stage I- Iron Depletion
- Stage II – Exhaustion of the storage pool of iron
- Stage III – Frank Anemia
In stage 1 iron deficiency
Hgb =
serum iron =
total binding capacity =
ferritin =
Hgb = normal
serum iron = normal
total binding capacity = normal
ferritin = low
what is the one affected in stage 1 Iro depletion of IDA
Ferritin - the value is low
will measure the circulating iron that is bound to transferring
serum iron
measure the capacity of
iron to bind transferrin
Total Iron Binding Capacity
protein that are used for storge of iron
ferritin
Stage II of IDA– Exhaustion of the storage pool of iron
Normal =
Decreased =
Increased =
Decreased =
RBC development still normal
Normal = Hb
Decreased = serum iron
Increased = TIBC
Decreased = ferritin
RBC development still normal
Stage III of IDA– Frank Anemia
Decreased =
Decreased=
Decreased =
Increased =
Decreased = Hb
Decreased= iron
Decreased = ferritin
Increased = TIBC
Blood Features of IDA
↓ to normal retic
↓ serum iron
↓ serum ferritin
↑ total iron-binding capacity (TIBC)
Microcytic hypochromic type of Anemia
Anisocytosis (size of RBC) /Poikilocytosis (shape of RBC)
Decrease in OFI (osmotic fragility test)
supplement or treatment for IDA
avoid puyat and eat nutritious food
FERROUS sulfate, plus Vitamin C
purpose of vit c with ferrous sulfate
increase absorbtion
CATEGORIES OF LAB DIAGNOSIS FOR ANEMIA
screening
cbc and rbc indices
CATEGORIES OF LAB DIAGNOSIS FOR ANEMIA
specialize
Hb electrophoresis
—–Look for underlying cause
— treatment ferrous sulfate and vt x
CATEGORIES OF LAB DIAGNOSIS FOR ANEMIA
diagnostic
Backbones of anemia
— Iron studies
SEVERE TYPE OF IRON DEFICIENCY has a presence of
koilonychia and Smooth tongue adn PICA
, a condition also referred to as
“spoon-shaped nails,” is associated with iron
deficiency in which the fingernails are thin, brittle,
and concave with raised edges.
Koilonychia
Condition where there’s a craving for uncertain food.
Ex: dirt, clay, chalk - non certain food
PICA
_ can result in a painless, smooth,
shiny, and reddened tongue
Iron deficiency - smooth tongue
Mahilig ngumata ng yelo
PAGOPHAGIA
morphology or appearances we can see in a blood film of a patient with IDA
pencil cells, target
cells, teardrops, and rare fragments.
Early iron deficiency may be normocytic with no significant morphologic changes.
true or false
true
develop when the incorporation of iron into heme is blocked.
SIDEROBLASTIC ANEMIA
Blocked during heme synthesis
SIDEROBLASTIC ANEMIA
Diseases that interfere with the production of adequate amounts of protoporphyrin ring
SIDEROBLASTIC ANEMIA
Primary caused of sideroblastic anemia is ___
genetic
secondary caused of sideroblastic anemia is ___
o Certain therapeutic drugs
o Chronic transfusion (Aplastic)
o Alcoholism and food fads
o Use of iron utensils & iron in water
Diagnostic lab finding (hallmark) of sideroblastic anemia
is ringed sideroblasts in the bone marrow
Pappenheimer bodies in peripheral blood
the excess iron in sideroblastic anemia shows as a blue dots around the cell and can be seen only using a stain
Perl’s Prussian blue
lead poisoning is another type of a condition wherein there’s problem with __
heme sysnthesis
lead interferes with ___ in the mitochondria
iron storage
lead damages the activity of the enzyme used for synthesis (__)
basophilic stippling
all under heme synthesis
sidroblastica anemia
lead poisoning
porphyria
rare diseased caused by acumulation of porphyrin in developing rbc
porphyria
characterized by dermal photosensitivity and raused caused by the sun
porphyria
the original werewolf is the one with
erythropoietic porphyria
ANEMIA DUE TO CHRONIC INFLAMMATION
anemia associated with systemic diseases:
o arthritis
o tuberculosis
o HIV
o malignancies
- leukemia, lymphoma, myeloma
second most common type of anemia
ACI or ACD
Lab features of ACI or ACD
o Decreased= TIBC
o Mild anemia – HB = 7-11 g/dL
o Increased= WBC (because there’s inflammation)
inherited disorders caused by genetic alterations that reduce
or preclude the synthesis of the globin chains of hemoglobin tetramer.
THALASSEMIA
anemia that is Maaaring wala ang alpha or beta, or baka mahina o kuang
yung alpha or beta
THALASSEMIA
For as to have Hb normal= what are the globins
2 pairs alpha & 2 pairs beta
THALASSEMIA predominant in ____
Mediterranean, African and Asian ancestry.
THALASSEMIA First described by ___
COOLEY and LEE in 1925
Types of Thalassemia
- Beta (β) Thalassemia
- Alpha (α) Thalassemia
- Hereditary Persistence of Hb F (HPHF)
- Hemoglobin Lepore
- Hemoglobinopathy + Thalassemia
a. Hemoglobin S- Thalassemia
b. Hemoglobin C-Thalassemia
c. Hemoglobin E-Thalassemia
Sa thalassemia may ___ na nangyayari
hemolysis
in thalassemia, all the lab test is normal except
reticulocyte count
. Beta (β) Thalassemia
beta chain is on
chromosome 11
Thalassemia minor
- Hb= ___
10-13 mg/dL
Thalassemia minor
Other names
Heterozygous
thalassemia
Cooley’s trait
results when one of
the 2 genes that
produce beta globin
is defective
Thalassemia
minor
a thalassemia that usually presents a
mild, asymptomatic
anemia
Thalassemia
minor
Intermediate B
thalassemia -
Hb= ___
7 daw sa rec lec
9 mg/dL
other name of intermediate b thalassemia
Thalassemia
Intermedia
more severe
anemia than minor
B-thalassemia but
do not require
regular transfusion
Intermediate B
thalassemia
occasional
transfusions but do
not require them on
a regular basis.
. Intermediate B
thalassemia
Thalassemia
major
Homozygous
thalassemia
Cooley’s anemia
Mediterranean
anemia
Target cell anemia
Thalassemia
major
- Hb= ___
3-4 mg/dL
-decrease or
complete lack of
beta globin
production
Thalassemia
major
Thalassemia
major
Diagnosed between
___because
increase at
tumataas yung Hb A
6 months old to 2
yrs. old
Characteristics of thalassemia major
death is due to circulating iron
overload (patient- mga bata) because
they are transfusion dependent
patient appearance for thalassemia major
stunted growth (hindi
masyadong lumalaki)
frontal bossing
(protrude yung noo,
cheekbone is
highlighted/prominent,
gums and teeth are
protrude)
Alpha (α) Thalassemia is coded on
chromosome 16
. Alpha (α) Thalassemia
predominates
hemolysis
an alpha thalasemia that there’s a deletion of one alpha globin leaving 3 functional a globin
silent carrier
an alpha thalasemia that there’s a deletion of two alpha globin leaving 2 functional a globin
a thalassemia trait (homozygoud or heterozygous)
an alpha thalasemia that there’s a only one gene producing gene producing chain
hemoglobin H disease
results in the absence of all a chain synthesis
hydrops fetalis
an alpha thalassemia that is incompatible to life
hydrops fetalis
counterpart of the beta thalassemia major because
of the absence of all alpha chain
hydrops fetalis
globin chains are important para sapag carry ng ___
O2
appearance of hydrops fetalis patients
enlargement of spleen, liver and the baby are color
yellow
thalassemia with increased levels of fetal hemoglobin
. Hereditary Persistence of Hb F (HPHF)
partial or total suppression of beta and delta chains and HB F increased to compensate
Hereditary Persistence of Hb F (HPHF)
a rare class of thalassemia caused by crossing over of beta and delta gene
Hemoglobin Lepore
is a double heterozygous abnormality
Hemoglobin S- Thalassemia
the abnormal genes for Hb S and thalassemia are coinherited
Hemoglobin S- Thalassemia
β thalassemia with inherited Hb C
Hemoglobin C-Thalassemia
minimal amount of or no Beta chain
Hemoglobin C-Thalassemia
co-inherited of Hemoglobin E and β thalassemia that results
to a marked reduction of β chain production.
Hemoglobin E-Thalassemia
a hemoglobiophaties that is Similar to beta thalassemia major
Hemoglobin E-Thalassemia
Hemoglobin E-Thalassemia
Common in __
Cambodia, Thailand, part of India
LABORATORY FINDINGS OF THALASSEMIA
- CBC
- Peripheral smear
- increased reticulocyte count
- bone marrow examination
- decreased OFT
- supravital stain
- electrophoresis
- Mass spectrophotometry
- DNA analysis (sophisticated test)
- increased indirect bilirubin.
(sophisticated test) for thalassemia
DNA analysis
a. PCR
b. signal amplification system
disorder in the DNA synthesis of RBC
Megaloblastic anemia
the maturation of nucleus is delayed relative to that of cytoplasm
Megaloblastic anemia
Types of megaloblastic anemia
Pernicious anemia - VitB12
Decrease level of Folic Acid
Decrease level of Vitamin B₁₂ = Vitamin
B12 (cobalamin) deficiency
Pernicious anemia
Folic Acid:
Important ito kapag buntis, so dapat so dapat meron ka nito baka
mauwi sa tinatawag na ___ (
Spina Bifida
Vitamin B12 deficiency effects
Neurologic symptoms:
Memory loss
Numbness
Tingling in toes and fingers
Impairment of walking by loss of vibrator sense.
Causes of Megaloblastic Anemia
- Inadequate intake sources of folic acid
- Increased need
- Impaired absorption in the intestine
- Impaired use due to drugs such as antiepileptic drugs
- Excessive loss during renal dialysis
TEST for megaloblastic anemia
Shilling test
This test will determine or distinguish whether the problem is impaired absorption or malabsorption of B12 from other causes.
Laboratory Findings of Megaloblastic Anemia:
- CBC
- Decreased in absolute reticulocyte count
- Peripheral smear
- Hypersegmented neutrophil(5 or more lobes)
Laboratory Findings of Megaloblastic Anemia:
cbc
Pancytopenia = Low/decreased formed elements
Hb and Hct: decreased
MCV: increased (>120 fL)
MCH and RDW: increased
MCHC: normal
Peripheral smear of Megaloblastic Anemia:
a. oval macrocytes/megalocytes
b. poikilocytosis - dacryocytes, fragments, microspherocytes
c. NRBCs
d. Howell-Jolly bodies
e. Basophilic stippling
f. Cabot rings
This is one of the hallmark of the condition
megaloblastic anemia
Hypersegmented neutrophil(5 or more lobes)
- Chemistry Analysis of megaloblastic anemia
decreased serum Folate level
decreased serum Vitamin B₁₂ level
increased Homocysteine – Folate def.
increased Methylmalonic acid – B12 def.
increased LDH
increased total and indirect bilirubin
increased LDH i megaloblastic anemia
lysis or destruction dun
palang sa bone marrow
used to distinguish malabsorption of vitamin B12 from
other causes of malabsorption
Schilling Test
uses oral dose of radioactive vitamin B12
Schilling Test
Non-megaloblastic anemia causes
anemia caused by conditions such as alcoholism and chronic liver disease (CLD)
no hypersegmentation
no increase in MCV (di na umaabot more than 120)
Di namimeet 120 days lifespan (RBC)
characterized by premature RBC destruction caused by autoantibodies that bind the RBC surface
- Autoimmune Hemolytic Anemia
A. Extrinsic Hemolytic Anemia
- Antibody Mediated Anemia
a) Autoimmune Hemolytic Anemia
what are the types of Autoimmune Hemolytic Anemia
a. Warm-Reactive Autoimmune Hemolytic Anemia
b. Cold-Reactive Autoimmune Hemolytic Anemia
c. Paroxysmal Cold Hemoglobinuria (PCH)
a type of autoimmune hemolytic anemia
responsible for approximately 70% of Immune
hemolytic cases - mediated by antibody with maximum binding
affinity
at 37°C
a. Warm-Reactive Autoimmune Hemolytic Anemia - responsible for approximately 70% of Immun
a type of autoimmune hemolytic anemia
mediated by antibody with maximum binding
affinity at 4°C or below 32°C
Cold-Reactive Autoimmune Hemolytic Anemia
a type of autoimmune hemolytic anemia
a rare acute form of cold-generated hemolysis - hemolysis occurs when blood is warmed after
previous exposure to chilling - caused by an antibody (Donath-Landsteiner
antibody) present in the plasma
Paroxysmal Cold Hemoglobinuria (PCH)
- self-limiting, but severe even fatal following the administration of
drug that can cause immune hemolytic anemia
Drug-Induced Immune Hemolytic Anemia
example of drugs in Drug-Induced Immune Hemolytic Anemia
a. Penicillin
b. Stibophen
c. Alpha methyldopa
usually occurs in newborns following the transplacental passage
of maternal anti-fetal red cells antibody.
Alloimune Hemolytic Anemia
2 causes of Alloimune Hemolytic Anemia
- Erythroblastosis fetalis - Isoimmune HDN due to Rh incompatibility
- Isoimmune HDN due to ABO incompatibility
