Hematology Flashcards
Autoimmune hemolytic anemias, typically
Normocytic anemia
Acute blood loss anemia, typically
Normocytic anemia
G6PD anemia type
Hemolytic anemia, normocytic
Disseminated intravascular coagulopathy (DIC) anemia type
Hemolytic anemia, normocytic
Hemolytic-uremic syndrome anemia type
Hemolytic anemia, normocytic
Thrombotic thrombocytopenic purpura anemia type
Hemolytic anemia, normocytic
General (3) mechanisms of normocytic anemia
1) Increase destruction or loss
2) Decreased production
3) Overexpansion of plasma volume
Primary (4) causes of decreased RBC production
1) Marrow hypoplasia
2) Myelopathies
3) Myeloproliferative disease
4) Pure RBC aplasia
Secondary (5) causes of decreased RBC production
1) CKD
2) Liver disease
3) Endocrine deficiency
4) Anemia of chronic disease
5) Sideroblastic anemias
(2) Causes of overexpansion of plasma volume
1) Pregnancy
2) Hypervolemia
Initially nearly all anemias are of what type?
Normocytic normochromic
Most common cause of normocytic anemia?
Anemia of chronic disease/inflammation
Hallmark ferrokinetic profile of anemia of chronic disease?
Present but inaccessible iron: decreased serum Fe, decreased transferrin, normal or elevated ferritin
Endocrine (4) disorders resulting in normocytic anemia
1) Hypothyroidism
2) Adrenal or pituitary insufficiency
3) Hypogonadism
4) Hyperthyroidism
How might endocrine deficiency result in secondary bone marrow failure?
Reduced stimulation of EPO secretion
Anemia of chronic kidney disease is typically normocytic but may also be…?
Microcytic
How do AKI and CKD result in anemia?
Increased uremic metabolites decrease RBC lifespan and reduce erythropoiesis
EPO levels in anemia of CKD (2/2 uremia) vs. EPO levels in most other causes of anemia
Decreased vs. elevated
G6PD deficiency anemia type
Transitory hemolytic anemia, normocytic
Mechanism of G6PD hemolysis
Exposure to oxidative drug
Anemia in hypersplenism, conditions?
Seen after spleen reaches 3-4x normal size, as in liver cirrhosis, chronic infection, myeloproliferative diseases
Anemia in hypersplenism mechanism?
Primarily caused by removal of RBC from circulation (sequestering) but also increased RBC destruction
Most common causes of microcytic anemia
1) Iron deficiency anemia
2) Anemia of chronic inflammation/disease
3) Thalassemia trait
4) Pregnancy
5) Lead poisoning
Mechanisms of iron deficiency anemia
1) Occult blood loss
2) Decreased GI absorption as in Celiac disease and H. pylori infection
3) Menstrual blood loss
4) Malignancy
5) Poor intake/malnutrition
Why is ferritin elevated in anemia of chronic disease
Acute phase reactant
Acute phase reactants are either ____ or ____.
Positive or negative
Role of ferritin as acute phase reactant
Sequester circulating/free iron to make less available to tumor cells or reduce microbial iron scavenging.
Role of fibrinogen as acute phase reactant
Promote endothelial repair; correlates with ESR
Erythrocyte sedimentation rate is a proxy for…?
Fibrinogen levels (as an acute phase reactant)
What sort of acute phase reactant is albumin?
Negative
During acute phase albumin production is reduced to conserve____ for positive acute phase proteins
Amino acids
C-reactive protein’s function as an acute phase protein
Microbial opsonization, binding to degenerating cells, activate compliment pathways
Pathophysiology of alcohol-related macrocytosis/anemia
Believed to be 2/2 direct marrow toxicity to hematopoeitic cells; doesn’t result directly in folate deficiency though these often co-occur
DDx: high RBC, normal-low Hgb, low MCV, normal-high RDW
Thalassemia; polycythemia with iron deficiency anemia
DDx: normal-low RBC, low Hgb, normal-low MCV, normal-low MCH, normal-high RDW
Iron deficiency anemia (more normal in early disease); advancing anemia of chronic inflammation (resulting in iron deficiency anemia)
Mechanism: anemia of chronic kidney disease
Chronic inflammation; decreased EPO production
Mechanism: anemia of chronic disease/inflammation
Chronic release of cytokine interleukin-6 (IL-6) stimulates production of hepcidin leading to increased intracellular iron sequestration; also the chronic condition contributes to anemia, as in CKD
