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CSMLS > HEM Micro & Macro Anemia > Flashcards

HEM Micro & Macro Anemia Flashcards

1
Q

Type of anemia when MCV<80 fL

A

Microcytic

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2
Q

Type of anemia when MCV>100 fL

A

Macrocytic

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3
Q

M:E ratio is __ in Microcytic anemia

A

DECREASED; erythroid hyperplasia due to EPO trying to compensate

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4
Q

Causes of IDA

A

Lack of iron during heme formation:

  1. Increased requirements (pregnancy, growth)
  2. Decreased intake (poor diet, malabsorption)
  3. Increased loss (hemorrhage)
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5
Q

Lab results for IDA (HGB, HCT, RBC, PBS, BM, Indices, WBC, PLT, RETIC, serum iron, serum ferritin TIBC, transferrin sat.)

A

HGB/ MCH/ MCHC: decreased
HCT: decreased
MCV: <80 fL
RBC: decreased
PBS: hypo/micro
BM: decreased iron stores (prussian-blue)
WBC: decreased M:E ratio
RETIC: decreased
PLT: normal

serum iron: decreased
serum ferritin: decreased
TIBC: INCREASED
transferrin sat: decreased

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6
Q

Cause of sideroblastic anemia

A

Decreased protoporphyrin production OR inability to
incorporate iron into heme:

  1. Enzyme deficiency (ALA synthase)
  2. Lead poisoning
  3. Drugs (chloramphenicol, chemotherapy)
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7
Q

Why are ringed sideroblasts seen in sideroblastic anemia ?

A

abnormal deposition of iron in mitochondria due to defective incorporation into heme

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8
Q

RDW is high or low for sideroblastic anemia; why ?

A

HIGH RDW; defective incorporation of iron leads to inconsistent RBCs (dimorphic)

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9
Q

Lab results for Sideroblastic anemia (RDW, HGB, HCT, RBC, PBS, BM, Indices, WBC, PLT, RETIC, serum iron, serum ferritin, TIBC, transferrin sat.)

A

RDW: HIGH
HGB/ MCH/MCHC: decreased
MCV: <80 fL
HCT: decreased
RBC: decreased
PBS: hypo/micro + normo/normo (DIMORPHIC)
BM: increased iron stores (prussian-blue), ringed sideroblasts
RETIC: decreased

serum iron: INCREASED
serum ferritin: INCREASED
TIBC: decreased
transferrin sat: INCREASED

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10
Q

Cause of Anemia of Chronic Infection

A

Underlying infection/ inflammation, autoimmune diseases, malignant neoplasms:

  1. Impaired iron kinetics: sequestered iron from pathogen
  2. Impaired erythropoiesis: inflammatory cytokines hinder action of EPO on HSC
  3. Decreased RBC survival: reticuloendothelial cells increase removal of RBCs with small defects

NOTE: reticuloendothelial cells descend from monocytes = phagocytes

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11
Q

Lab results for Anemia of Chronic Infection (CRP, HGB, HCT, RBC, PBS, BM, Indices, WBC, PLT, RETIC, serum iron, serum ferritin, TIBC, transferrin sat.)

A

CRP: INCREASED
HGB/MCH/MCHC: decreased
HCT: decreased
RBC: decreased
PBS: micro/hypo
BM: normal to increased iron stores (prussian-blue)
RETIC: decreased

serum iron: decreased
serum ferritin: increased
TIBC: decreased
transferrin sat: increased

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12
Q

General cause of megaloblastic anemia

A
  • Impaired DNA synthesis
  • vit B12 and folate deficiency
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13
Q

Causes of vit B & folate deficiency

A
  1. Diet
  2. Malabsorption (surgical removal, inflammatory bowl, parasites)
  3. Increased requirement (pregnancy)
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14
Q

Megaloblastic anemia: CBC results (HGB, HCT, RBC, Indices, WBC, PLT, RETIC)

A

HGB: DECREASED
HCT: increased
RBC: decreased
MCV: increased
MCH: INCREASED
MCHC: NORMAL
WBC: HYPERSEG neuts
PLT: DECREASED
RETIC: DECREASED

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15
Q

Megaloblastic anemia: BM (M:E, iron stores, morph)

A
  • M:E decreased; erythroid hyperplasia
  • NORMAL iron stores
  • nuclear-cytoplasm asynchrony
  • enlarged precursors
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16
Q

Iron studies (serum iron, serum ferritin, TIBC, transferrin sat.) for both Megalo/Non-megaloblastic anemia

A

NORMAL iron studies in PBS

NOTE: BM may have increased iron stores

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17
Q

How is megaloblastic anemia differentiated from pernicious anemia ?

A

Patients with pernicious anemia will be DAT positive due to autoAb

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18
Q

Cause of pernicious anemia

A
  • autoAb destroy parietal cells that produce Intrinsic Factor
  • IF is required to absorb vit B12
19
Q

Causes of non-megaloblastic anemia

A
  • liver disease
  • chronic alcoholism
  • bone marrow failure (aplastic anemia or MDS)
  • post-splenectomy
20
Q

Non-Megaloblastic Anemia: CBC results (HGB, HCT, RBC, Indices, WBC, PLT, RETIC)

A

HGB: DECREASED
HCT: increased
RBC: decreased
MCV: increased
MCH: NORMAL
MCHC: NORMAL
WBC: NORMAL/ NO hyperseg neuts
PLT: DECREASED
RETIC: DECREASED

21
Q

Non-megaloblastic anemia: BM (M:E, iron stores, morph)

A
  • M:E decreased; erythroid hyperplasia
  • NORMAL iron stores
  • NO megaloblastic changes
22
Q

What are hemoglobinopathies ?

A
  • qualitative or quantitative
  • disorders involving hemoglobin
23
Q

What are heinz bodies ?

A
  • excess globin chains precipitated into cytoplasm
  • viewed by supravital stains
24
Q

Cause of Thalassemias

A
  • gene mutations leads to decreased normal Hgb
  • categorized based on the genes lost (alpha or beta)
25
Q

Hgb A chains

A

2 alpha + 2 beta

26
Q

No. of gene deletions for: Thalassemia A Minor vs Intermedia (“__”) vs Major (“__”)

A

Minor: 2/4 alpha gene deletions

Intermedia/ “Hgb H Disease”: 3/4 alpha gene deletions

Major/ “Hgb BARTS:” 4/4 alpha gene deletions

27
Q

Which Thalassemia is associated with Hydrops Fetalis ? Why ?

A

Alpha Thalassemia Major:
- NO ALPHA chains = gamma chains form tetrads

28
Q

Beta Thalassemia

A
  • deletion of one/ both beta genes
29
Q

Why may beta thalassemia be diagnosed later than alpha thalassemia ?

A

Beta chains are not synthesized until after fetal Hgb begins the switch to adult Hgb

30
Q

B Thal major

A
  • two altered genes
  • two null genes
  • one altered AND one null gene
31
Q

Why do patients with B Thal have ineffective erythropoiesis ?

A
  • decreased beta globin chain = excess alpha chain
  • excess alpha is precipitated (HEINZ BODIES)
  • premature cell death DUE TO INCLUSIONS
32
Q

Alpha and Beta Thal: CBC results (HGB, HCT, RBC, Indices, WBC, PLT, RETIC)

A

HGB decreased
HCT decreased
RBC decreased
WBC normal
PLT normal
RETIC decreased

MCV decreased
MCH decreased
MCHC decreased

33
Q

Alpha and Beta Thal PBS:

A

POIKILOCYTOSIS:
- micro/hypo
- target
- tears
- schisto
- sphero
- basophilic stippling
- HEINZ BODIES (supravital)

34
Q

Alpha and Beta Thal: BM (M:E, iron stores, characteristic morph)

A
  • M:E decreased; erythroid hyperplasia
  • iron stores INCREASED (cannot use)
35
Q

Alpha and Beta Thal: iron studies (serum iron, serum ferritin, TIBC, transferrin sat.)

A

serum iron= normal
serum ferritin= INCREASED
TIBC= normal
transferrin sat= normal

36
Q

Confirmatory tests to differentiate Thalassemias

A
  • Hgb HPLC and electrophoresis
  • Molecular genetics
37
Q

Describe the usual genetic abnormality found in Hemoglobin H Disease vs Beta Thalassemia Major

A

Hemoglobin H Disease (Hemoglobin α-thal intermedia):
- 3/4 α genes affected

β-thal Major:
- both genes mutated β°/β° OR β+/β° OR β+/β+

38
Q

Red cell morphology (color, size, shape(s), inclusions) seen in Hemoglobin H Disease vs Beta Thalassemia Major

A

Both are very similar with a junky picture: micro/hypo with poikilocytosis (ie. targets, schisto, baso stippling etc.)

39
Q

Oxidative denaturation of hemoglobin results in the formation of small particles that are visualized with supravital staining. What is the term for these particles?

A

Heinz bodies

40
Q

How may the macrocytosis caused by liver disease be differentiated from the macrocytosis caused by a B12 or folate deficiency Select all that apply:

a.
In liver disease the neutrophils are not hypersegmented

b.
In liver disease, the bone marrow does not show asynchrony

c.
In liver disease, the MCV will be much higher than in B12 deficiency

d.
In liver disease, the macrocytes are round not oval

A

a.
In liver disease the neutrophils are not hypersegmented

b.
In liver disease, the bone marrow does not show asynchrony

d.
In liver disease, the macrocytes are round not oval

41
Q

The hypochromic anemias represent a related group of disorders with:

a.
A quantitative defect in hemoglobin synthesis

b.
A qualitative defect in globin protein chains

c.
Excess hemoglobin synthesis

d.
Vitamin B12 and folate deficiency

A

a.
A quantitative defect in hemoglobin synthesis

42
Q

PBS: Hypochromia

BM: RBC with ragged cytoplasm, erythroid hyperplasia

A

Iron Deficiency anemia

43
Q

Select all conditions in which the iron stores would be increased in the marrow. Select all that apply:

a.
Megaloblastic anemia

b.
Hemolytic anemia

c.
Lead poisoning

d.
B thalassemia minor

A

a.
Megaloblastic anemia

b.
Hemolytic anemia

c.
Lead poisoning

CSMLS (46 decks)

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