Hem & Onc - Pathology (Anemias & Leukopenias)

Question 1

Define normocytic, microcytic, and macrocytic anemias according to MCV.

Answer 1

(1) Microcytic MCV < 80 fL (2) Normocytic MCV = 80-100 fL (3) Macrocytic MCV > 100 fL

Question 2

Again, what defines microcytic anemia? What are examples of microcytic anemia?

Answer 2

MCV < 80 fL; (1) Iron deficiency (2) Anemia of Chronic disease (3) Thalassemias (4) Lead poisoning (5) Sideroblastic anemia;

Question 3

What is unique about Anemia of Chronic Disease? How might ACD first present? What other cause of anemia presents the same way?

Answer 3

It can be either microcytic (and hypochromic) OR normocytic (and normochromic); ACD and iron deficiency may first present as a normocytic anemia & then progress to a microcytic anemia

Question 4

Again, what defines normocytic anemia? What are the major and minor divisions of normocytic anemia?

Answer 4

MCV 80-100 fL; Nonhemolytic versus Hemolytic; Within Hemolytic, Intrinsic versus Extrinsic

Question 5

What are examples of nonhemolytic, normocytic anemias?

Answer 5

(1) Anemia of Chronic Disease (2) Aplastic anemia (3) Chronic kidney disease

Question 6

What are categories/examples of intrinsic hemolytic, normocytic anemias?

Answer 6

(1) RBC membrane defect: hereditary spherocytosis (2) RBC enzyme deficiency: G6PD, PK (3) HbC (4) Sickle Cell Anemia (5) Paroxysmal noctural hemoglobinuria

Question 7

What are examples of extrinsic hemolytic, normocytic anemias?

Answer 7

(1) Autoimmune (2) Microangiopathic (3) Macroangiopathic (4) Infections

Question 8

Again, what defines macrocytic anemia? What are the divisions of macrocytic anemia?

Answer 8

MCV > 100 fL; Megaloblastic & Non-megaloblastic

Question 9

What are examples of megaloblastic macrocytic anemias?

Answer 9

(1) Folate deficiency (2) B12 deficiency (3) Orotic aciduria

Question 10

What are examples of non-megaloblastic macrocytic anemias?

Answer 10

(1) Liver disease (2) Alcoholism (3) Reticulocytosis

Question 11

What is ferritin?

Answer 11

Primary iron storage protein of body

Question 12

What is transferrin’s role? How does it relate to TIBC?

Answer 12

Transports iron in the blood; TIBC = indirectly measures transferrin

Question 13

What are the iron lab trends seen in iron deficiency? Which is the primary effect?

Answer 13

(1) Serum Fe - decreased (Primary) (2) Transferrin or TIBC - increased (3) Ferritin - decreased (4) % Transferrin saturation (serum iron/TIBC) - very decreased

Question 14

What are the iron lab trends seen in anemia of chronic disease? Which is the primary effect?

Answer 14

(1) Ferritin - increased (Primary) (2) Serum iron - decreased (3) Transferrin or TIBC - decreased (4) % Transferrin saturation - normal

Question 15

What are the iron lab trends seen in hemochromatosis? Which is the primary effect?

Answer 15

(1) Serum Fe - increased (Primary) (2) Transferrin or TIBC - decreased (3) Ferritin - increased (4) % Transferrin saturation - Very increased

Question 16

What are the iron lab trends seen in pregnancy/OCP use? Which is the primary effect?

Answer 16

(1) Transferrin or TIBC - Increased (Primary) (2) Serum Fe - normal (3) Ferritin - normal (4) % Transferrin saturation - decreased

Question 17

What is the evolutionary reasoning behind the decrease of transferrin or TIBC in chronic disease?

Answer 17

Pathogens use circulating iron to thrive, so body has adapted a system in which iron is stored within the cells of the body and prevents pathogens from acquiring circulating iron

Question 18

What factor impacting iron lab studies is increased in pregnancy and by oral contraceptives?

Answer 18

Transferrin production

Question 19

What kind of anemia can copper deficiency cause?

Answer 19

Copper deficiency can cause a microcytic sideroblastic anemia

Question 20

Define Neutropenia.

Answer 20

Absolute neutrophil count < 1500 cells/mm^3

Question 21

Name 5 causes of Neutropenia.

Answer 21

(1) Sepsis/postinfection (2) Drugs (including chemotherapy) (3) Aplastic anemia (4) SLE (5) radiation

Question 22

Define Lymphopenia in adults versus children.

Answer 22

Absolute lymphocyte count < 1500 cells/mm^3 (< 3000 cells/mm^3 in children)

Question 23

Name 8 causes of Lymphopenia.

Answer 23

(1) HIV (2) DiGeorge syndrome (3) SCID (4) SLE (5) corticosteroids (6) radiation (7) sepsis (8) postoperative

Question 24

Name 2 causes of Eosinopenia.

Answer 24

(1) Cushing syndrome (2) Corticosteroids

Question 25

What changes to immune/blood cells do corticosteroids cause, and why?

Answer 25

Corticosteroids cause neutrophilia, but eosinopenia and lymphopenia. Corticosteroids decrease activation of neutrophil adhesion molecules, impairing migration of the vasculature to sites of inflammation. In contrast, corticosteroids sequester eosinophils in lymph nodes and cause apoptosis of lymphocytes.