Gen Path Exam 3 - Anemia and RBC Disorders Flashcards
Decrease in the number of erythrocytes (RBCs) or hemoglobin (Hgb) content per unit volume of peripheral blood
Anemia
Anemia hemoglobin level in men vs women
Men: < 13 g/dL
Women: < 12 g/dL
Increase in number of RBCs per unit volume of peripheral blood
Polycythemia
Myeloproliferative neoplasm of the bone marrow characterized by abnormal hematopoietic stem/progenitor cells and overproduction of RBCs
Primary polycythemia
Another name for primary polycythemia
Polycythemia vera
Occurs from increased erythropoietin (EPO) levels, chronic lung disease (e.g., emphysema), high-altitude living, obstructive sleep apnea, and cyanotic heart disease
Secondary polycythemia
Anemia results from one or more combinations of what 3 basic mechanisms?
Reduced/ineffective erythropoiesis
Increased RBC loss/reduced RBC life span
Dilutional anemia
Which basic mechanism?
Decreased marrow erythropoiesis
Reduced/ineffective erythropoiesis
Which basic mechanism?
Inadequately increased total erythropoiesis
Reduced/ineffective erythropoiesis
Which basic mechanism?
Increased ineffective erythropoiesis
Reduced/ineffective erythropoiesis
Which basic mechanism?
Acute or chronic blood loss
Increased RBC loss/reduced RBC life span
Which basic mechanism?
Increased RBC destruction
Increased RBC loss/reduced RBC life span
Which basic mechanism?
Splenic pooling and sequestration
Increased RBC loss/reduced RBC life span
Which basic mechanism?
Plasma volume expansion
Dilutional anemia
How long does each RBC live?
120 days
To maintain steady populations of RBCs, how many RBCs must be renewed each day?
1/120
What does the clinical expression of anemia result from?
Tissue hypoxia
The specific signs/symptoms of anemia represent __________________ compensatory responses to the severity/duration of tissue hypoxia
cardiovascular-pulonary
Anemia is asymptomatic when hematocrit is….
> 30%
Moderate anemia
Hematocrit < 30%
Severe anemia
Hematocrit < 20%
What type of anemia is associated with:
Weakness
Vertigo
Headache
Tinnitus
Spots before eyes
Fatigue easily
Drowsy
Irritable
Bizzare behavior
Moderate to severe anemia
What type of anemia is associated with:
Splenomegaly
Amenorrhea
Loss of libido
GI problems
Jaundice
Heart failure
Shock
Moderate to severe anemia
A convenient classification for most anemias that result from RBC production defects is based on what?
Changes in RBC size and MCHC
What type of RBCs in this anemia?
Production defect results from alterations in heme or globin synthesis (e.g., iron deficiency or iron malabsorption, thalassemia and related hemoglobin synthesis defects)
Microcytic-hypochromic RBCs
What type of RBCs in this anemia?
Hypoproliferative or hypoplastic mechanism (e.g., leukemia, metastatic cancer, cytoreductive drugs)
Normochromic-normocytic RBCs w/ defective production
What type of RBCs in this anemia?
Defect in DNA synthesis; usually due to defective vitamin B12, folate, or folic acid metabolism or dietary intake, or to an interference with DNA synthesis by cytoreductive drugs
Macrocytic RBCs
Adequate marrow response to anemia is evidenced by _______________ or _______________________
reticulocytosis; polychromatophilia
table 1 (stuff under, I don’t think we have to know the #s)
Name the 4 anemias due to reduced/ineffective erythropoiesis
Iron deficiency anemia
Anemia of chronic disease/inflammation
Vitamin B12 deficiency/pernicious anemia
Folate deficiency anemia
What type of anemia?
Due to decreased iron stores
Iron deficiency anemia
What type of anemia?
The MOST COMMON cause of anemia in the US
Iron deficiency anemia
What type of anemia?
Affects toddlers 1-2 yrs old
Affects females 12-49 yrs old
Iron deficiency anemia
Why are toddlers affected by iron deficiency anemia?
Inadequate intake of iron
Why are females affected by iron deficiency anemia?
Menstrual loss
What are the 4 causes of iron deficiency anemia?
Chronic blood loss
Poor iron intake
Poor iron absorption
Increased demand for iron
What are the reasons for chronic blood loss, which causes iron deficiency anemia?
GI bleeding
Menstrual bleeding
Cancers
What 3 things can cause GI bleeding and chronic blood loss, leading to iron deficiency anemia?
Ulcers
Aspirin
NSAIDs
What 3 types of cancers cause chronic blood loss, leading to iron deficiency anemia?
Esophagus
Stomach
Colon
What do the following cause? What does this lead to?
Gastrectomy
Gastric bypass
Resection of proximal intestine
IBD
Sprue
Poor iron absorption
Leads to iron deficiency anemia
What are 3 reasons for increased demand for iron, leading to iron deficiency anemia?
Infancy
Adolescence
Pregnancy
What type of anemia?
Onset may be acute with rapid blood loss, or chronic with poor diet or slow (chronic) blood loss
Iron deficiency anemia
T/F: Patients with mild iron deficiency anemia (HCT > ~30%) are usually asymptomatic
True
What type of anemia?
Signs/symptoms include:
Skin, mucosal, conjunctival pallor
Fatigue
Irritable
Decreased concentration
Weakness
SOB
Brittle, fragile nails and koilonychia
Headache
Decreased appetite
Pica
Dysphagia
Tachycardia
Wide pulse pressure
Severe iron deficiency anemia
What does koilonychia mean?
Spooning of nails
Clinical manifestation unique to iron deficiency
Pica
Unusual craving for certain non-nutritional substances like ice, clay, or starch
Pica
What does pagophagia mean?
Ice craving (pica)
What does geophagia mean?
Clay craving (pica)
What does amylophagia mean?
Starch craving (pica)
May rarely occur in patients due to the development of upper esophageal webs (membrane-like growths); occurs most frequently in elderly women with iron deficiency
Dysphagia
The triad of iron deficiency anemia, dysphagia, and upper esophageal webs is called what?
Plummer-Vinson syndrome
What is Plummer-Vinson syndrome a triad of?
Iron deficiency anemia
Dysphagia
Upper esophageal webs
What is associated with an increased risk for the later development of esophageal carcinoma?
Plummer-Vinson syndrome
What is Plummer-Vinson syndrome associated with an increased of developing?
Esophageal carcinoma
What are the 3 oral presentations of iron deficiency anemia?
Angular cheilitis
Atrophic glossitis
Generalized mucosal atrophy
What type of anemia has the following oral manifestations?
Angular cheilitis
Atrophic glossitis
Generalized mucosal atrophy
Iron deficiency anemia
What type of anemia?
Decreased serum ferritin
Iron deficiency anemia
Why is there decreased serum ferritin in iron deficiency anemia?
Iron stored in bone marrow is depleted
What type of anemia?
Decreased serum iron
Increased TIBC + serum transferrin
Iron deficiency anemia
What type of anemia?
Decreased ability to make Hgb
Leads to microcytic hypochromic anemia
Iron deficiency anemia
What type of anemia?
Microcytic hypochromic anemia w/ wide area of central pallor, anisocytosis, and poikilocytosis
Iron deficiency anemia
What type of anemia?
Low RBC, Hgb, HCT, MCV, MCH, MCHC
Iron deficiency anemia
What type of anemia?
Increased RDW + platelet count
Iron deficiency anemia
Why is the platelet count elevated in iron deficiency anemia?
Reactive thrombocytosis
What type of anemia?
Low serum ferritin, serum iron, MCV, MCHC
High TIBC + RDW
Iron deficiency anemia
What specific lab findings help differentiate iron deficiency anemia from other anemias?
Low ferritin, iron, MCV, MCHC
High TIBC + RDW
How is iron deficiency anemia treated?
Iron supplements (ferrous sulfate)
What type of anemia?
2nd most common anemia in the US
Anemia of chronic disease/inflammation
What type of anemia?
The MOST COMMON type of anemia in hospitalized patients
Anemia of chronic disease/inflammation
What type of anemia?
Associated with many underlying diseases w/ sustained inflammation
Anemia of chronic disease/inflammation
What are 3 categories of diseases w/ sustained inflammation that are associated with anemia of chronic disease/inflammation?
Neoplasms
Microbial infections
Autoimmune diseases
Name 2 neoplasms associated with anemia of chronic disease/inflammation
Hodgkin lymphoma
Carcinoma (lung/breast)
Name 3 microbial infections associated with anemia of chronic disease/inflammation
Osteomyelitis
Bacterial endocarditis
Lung abscess
Name 4 autoimmune diseases associated with anemia of chronic disease/inflammation
RA
Systemic lupus
Sarcoidosis
IBD
Inflammatory _____________ are associated with neoplasms/microbial infections/autoimmune diseases that stimulate the ________ synthesis and release of __________.
This sequesters iron in ____________ and suppresses the production of _____________.
What type of anemia is involved in this process?
cytokines; hepatic; hepcidin
macrophages; erythropoietin
Anemia of chronic disease/inflammation
What type of anemia?
The low availability of serum iron causes iron deficiency in the bone marrow compartment, resulting in decreased RBC production
Anemia of chronic disease/inflammation
Circulating protein that blocks ferroportin
Hepcidin
An iron channel responsible for the exit of iron from enterocytes (and GI absorption) and macrophages (which accumulate iron from engulfed senescent blood cells)
Ferroportin
T/F: The clinical presentations of anemia of chronic disease/inflammation has similarities to iron deficiency anemia including fatigue, shortness of breath, weakness, pallor and headaches
True
What type of anemia?
Normocytic, normochromic, mild to moderate anemia
Anemia of chronic disease/inflammation
What type of anemia?
Abnormally low reticulocyte count
Anemia of chronic disease/inflammation
How is anemia of chronic disease/inflammation treated?
Treat causative condition
What type of anemia?
Megaloblastic, macrocytic anemia resulting from cobalamin deficiency characterized by atrophic gastritis and achlorhydria.
Vitamin B12 deficiency/pernicious anemia
What is cobalamin?
Vitamin B12
What is Vitamin B12 deficiency/pernicious anemia associated with?
Autoimmune disease
H. pylori infection
Name 3 autoimmune diseases associated with Vitamin B12 deficiency/pernicious anemia
Type 1 DM
Graves disease
Addison disease
What age group is affected by Vitamin B12 deficiency/pernicious anemia?
Older (40-70 yrs)
What sex/race is affected more by Vitamin B12 deficiency/pernicious anemia?
Women, particularly black
T/F: A rare form of Vitamin B12 deficiency/pernicious anemia is hereditary and more frequent in patients of northern European ancestry, especially Scandinavia
True
What is the most common cause of Vitamin B12 deficiency/pernicious anemia?
Autoimmune destruction of gastric mucosa -> suppresses intrinsic factor
What antibodies are present in patients with Vitamin B12 deficiency/pernicious anemia?
Parietal cell ABs
Intrinsic factor ABs
What type of anemia is associated with the following histologic features?
Atrophy of gastric glands
Achlorhydria
Intestinal metaplasia w/ goblet cells
Loss of parietal cells
Vitamin B12 deficiency/pernicious anemia
What type of anemia?
Onset is insidious and vague; pts may be asymptomatic initially
Vitamin B12 deficiency/pernicious anemia
What is the classic triad of symptoms for Vitamin B12 deficiency/pernicious anemia?
Weakness
Glossitis
Paresthesias