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AS - N935 Advanced Patho II > Hematologic Pathophysiology Anemias > Flashcards

Hematologic Pathophysiology Anemias Flashcards

1
Q

Erythrocyte

A

Red blood cell (RBC)
1° function to transport hemoglobin
Transport oxygen to tissues
Contains carbonic anhydrase - enzyme that catalyzes reaction b/w CO2 & H2O to form carbonic acid H2CO3
Produced in the bone marrow
Lifespan 120 days
Individual erythrocyte contains ≈ 300 million Hgb molecules

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2
Q

Reticulocyte

A

Immature erythrocyte

Day 1 or 2 in the bloodstream

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3
Q

Anemia

A 
↓RBCs 
Reduced number circulating RBCs
Adverse effect ↓oxygen-carrying capacity
Hgb <12g/dL 
Pregnancy - physiologic anemia d/t ↑plasma volume
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4
Q

Mean Corpuscle Volume

A

Size

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5
Q

Normocytic

A

Normal sized cells

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6
Q

Microcytic

A

Smaller than normal size cells

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7
Q

Macrocytic

A

Larger than normal size cells

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8
Q

Hemoglobin

A

Four folded globin chains
2 alpha α
2 beta β

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9
Q

Hemolytic anemia

A

Abnormal hemolysis (RBC breakdown)

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10
Q

Erythropoetin

A

Glycoprotein
Formed in the kidneys
Epo stimulated when any condition ↓oxygen transport to tissues

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11
Q

Erythropoesis

A

Red blood cell production
Pluripotent hematopoietic stem cell → proerythroblast → erythroblast (Hgb synthesis begins) → reticulocyte → erythrocyte
Erythroblast loses nucleus
Reticulocyte loses remaining organelles

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12
Q

Polycythemia

A 
↑circulating RBCs
Adverse effect ↑blood viscosity
Slows blood flow ↓oxygen delivery
Significant when Hct >55-60%
- Threatens organ perfusion
- Risk venous/arterial thromboses
Relative polycythemia - dehydration, diuretics, vomiting
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13
Q

Anemia Causes

A

Blood loss - acute or chronic
↑destruction (thalassemia, hemolytic anemia, sickle cell)
↓production (iron deficiency or autoimmune)
Infectious (malaria, babesia, parvovirus)

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14
Q

Polycythemia Causes

A

Sustained hypoxia results in compensation
↑RBC mass ↑Hct

Cancer
COPD (not enough O2)
High altitude adaption

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15
Q

Acute Blood Loss

A

Body replaces plasma fluid portion in 1-3 days leaving low RBC concentration
RBC concentration usually returns to normal w/in 3-6wks

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16
Q

Chronic Blood Loss

A

Unable to absorb enough Fe (via GI) to make Hgb as rapidly as lost
RBCs produced smaller & have little Hgb inside - microcytic hypochromic anemia

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17
Q

Blood Transfusion Thresholds

A

10/30 rule
Hgb <10g/dL
Hct <30%

*Hgb <6g/dL clear benefit from transfusion

EBL <15% no intervention
30% replace w/ crystalloids/albumin
30-40% RBC transfusion
>50% massive transfusion 1:1:1 RBC / FFP / Plt

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18
Q

Transfusion Risks

A

Viral illness transmission (Hep B/C or HIV)
Bacterial infections
TRALI or TACO
Hemolytic transfusion reactions

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19
Q

Iron Deficiency Anemia

Causes

A 
Nutritional Fe deficit 
- Lower income 
- Pica
Fe stores depletion
- Chronic GI bleeds of menstruation
Pregnancy ↑RBC mass required during gestation
20
Q

Iron

A

Iron required for hemoglobin synthesis
Fe deficiency impairs RBC maturation & diminishes RBC production
Produces microcytic hypochromic anemia
Small & pale RBCs ↓O2 delivery

21
Q

Iron Deficiency Anemia

Treatment

A 
Fe supplements
Elective surgery postpone 2-4mos PO supplements to correct deficiency
Continue at least 1yr after corrected
Urgent surgery IV w/in few weeks
RBC transfusion
22
Q

Hemolytic Anemia

A 
Accelerated RBC destruction/hemolysis
Immune disorders
Lifespan <120 days
↑immature erythrocytes (reticulocytes)
Unconjugated hyperbilirubinemia
↑lactate hydrogenase
↓haptoglobin
23
Q

Sickle Cell Anemia

A

Autosomal recessive disorder caused by single amino acid substitution in β globin that creates sickle hemoglobin (HbS)
β globin mutation leads to HbS polymerization into long stiff chains when deoxygenated → elongated sickle shape
Returns to normal shape when oxygenated
Most common familial hemolytic anemia
Protective against malaria in heterozygotes

24
Q

HbA

A

Normal hemoglobin

25
Q

HbF

A

Fetal hemoglobin

Newborns w/ sickle cell anemia are asymptomatic until ↓HbF at 5-6mos

26
Q

Sickle Cell Crisis →

A

Chronic hemolytic anemia
Ischemic tissue damage
Spleen auto infarction

27
Q

Chronic Hemolytic Anemia

A

Repeat sickling damages the RBC membrane

Eventually producing irreversible sickled cells that are removed from circulation

28
Q

Ischemic Tissue Damage

A

Localized microvasculature obstruction → acute chest syndrome, joints, stroke(s), retinal damage

29
Q

Spleen Auto Infarction

A

↑sepsis risk w/ encapsulated bacteria

30
Q

Sickle Cell Treatment

A

Hydroxyurea ↑HbF levels
Anti-inflammatory
↓rate acute chest syndrome & blood transfusions 50%

Stem cell transplants

31
Q

Autoimmune Anemia

A

Autoimmune hemolytic anemia (AIHA)
IgG & IgM antibodies directed against RBCs
RBC lifespan severely decreased

32
Q

Autoimmune Anemia

Causes

A

Idiopathic
Leukemia
Infectious (mononucleosis)
Drug-induced (PCN or Quinidine)

33
Q

Autoimmune Anemia

Treatment

A

Immunosuppression & steroids

34
Q

Newborn Hemolytic Disease

A

Incompatibility b/w mother & fetus
- Erythroblastosis fetalis
Fetus inherits RBC antigenic determinants from father that are foreign to the mother

Mother Rh¯
Father Rh+
Baby Rh+

Fetal RBC enter maternal circulation during 3rd trimester & childbirth (fetomaternal bleed)
- Sensitizes mother to paternal RBC antigens leading to IgG anti-D antibodies that cross the placenta & cause fetal RBC hemolysis
2nd pregnancy Rh antibodies attack Rh+ fetus RBCs causing Rh disease (RBC lysis)

35
Q

Rh

A

Rhesus factor
Protein found on RBC surface
Genetically inherited
Factor refers to Rh (D) antigen only - most immunogenic all non-ABO antigens

36
Q

Rho(D) Immune Globin

A

Rh disease preventable w/ modern antenatal care
RhoGAM IgG anti-D antibody injections
1st antigen-incompatible pregnancy does not produce disease bc mother does not produce anti RBC IgG antibodies (cross the placenta) before delivery
When any incompatibility detected mother often receives an injections at 23wks gestation & birth to prevent antibody development towards the fetus

37
Q

G6PD Deficiency

A

Glucose-6-Phosphate Dehydrogenase
X-linked genetic disease
G6PD metabolic enzyme involved in the pentose phosphate pathway (important to RBC metabolism)
Erythrocyte half-life ≈ 60 days
Hemolysis occurs d/t inability G6PD deficient RBCs to protect self from oxidative damage

38
Q

What precipitates G6PD deficiency?

A

Infection
DKA
Medications
Fava beans

39
Q

G6PD Deficiency Peripheral Smears

A

Bite cells - RBCs w/ severely damaged membranes that have portions bitten off by macrophages to remove patches associated w/ Hgb precipitates known as Heinz bodies leading to intravascular hemolysis

40
Q

Oxidative Stress

A

Hemolysis often transient even w/ persistent infection or drug exposure
Older cells lysis leaves younger cells w/ ↑G6PD levels that are resistant to oxidant stress

41
Q

G6PD Deficiency Treatment

A 
No cure
Avoid triggers
Treat hemolytic episodes
- Hydration
- Blood transfusions
42
Q

Physiologic Polycythemia

A

Natives who live at altitude 14,000-17,000 feet
Low atmospheric oxygen
↑RBC 30%
Heritable genetic adaption

43
Q

Polycythemia Vera

A

PCV
Stem cell or myeloproliferative disorder Hct 60-70%
JAK2 gene mutation - does not stop RBC production when too many present
Excess erythrocytes
Platelets & leukocytes potentially also increase
S/S appear 60-70s

44
Q

PCV S/S

A

Cyanosis, headache, dizziness, GI symptoms, hematemesis, & melena
↑total blood volume
Common presenting sign hepatic, coronary, & cerebral thrombosis
30% patients fatal thrombolytic complications
30% mortality r/t leukemia
Viscous & engorged vessels
Blood passes sluggishly through capillaries
↑amount deoxygenated resulting in bluish/ruddy skin appearance
Marrow fibrosis in 10% patients (marrow replaced by fibroblasts & collagen)

45
Q

PCV Treatment

A

W/o treatment death d/t vascular complications w/in mos
Minimize thrombosis risk
Phlebotomy helps extend survival 10yrs
Myelosuppressive drugs (Hydroxyurea)

46
Q

Polycythemia

Anesthesia Management

A

Thrombosis risk
Reduce Hct prior to surgery - phlebotomy & hydration
Hydration NPO status vs. IV fluids
Continue hydroxyurea (cytoreductive agent)

AS - N935 Advanced Patho II (20 decks)

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