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Z - M2 Heme/Onc > Heme/Onc - Week 2 Review - Part 3 - Anemia > Flashcards

Heme/Onc - Week 2 Review - Part 3 - Anemia Flashcards

1
Q

Classifications of Mean Corpuscular Volume (MCV) - 3

A

Microcytic < 80
Normocytic - 80 to 100
Macrocytic > 100

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2
Q

Microcytic Anemia - 5 Types

A

1) Iron Deficiency Anemia
2) Anemia of Chronic Disease
3) Sideroblastic Anemia
4) Thalasemia
5) Lead Poisoning

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3
Q

Macrocytic Anemia - 2 Subdivisions - 5 Anemias

A

Megaloblastic Macrocytic - B12 and Folate

Non-Megaloblastic Macrocytic - Liver Disease + EtOH + Drugs (5-FU)

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4
Q

Normocytic Anemia with Extravascular Hemolysis (5)

A

1) Heriditary Spherocytosis
2) Sickle Cell
3) Hemoglobin C
4) Beta Thalessemia (Microcytic)
5) Immune Hemolytic Anemia - IgG Mediated

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5
Q

Normocytic Anemia with Intravascular Hemolysis (5)

A

1) Paroysmal Nocturnal Hemoglobinuria
2) G6PD Deficiency
3) Immune Hemolytic Anemia - IgM Mediated
4) Microangiopathic Anemia
5) Malaria

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6
Q

Normocytic Anemia with Underproduction (2)

A

1) Parvovirus B19

2) Aplastic Anemia

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7
Q

Classic S/Sx of Anemia (5)

A

1) Weakness
2) Fatigue
3) Pale Conjuntiva/Skin
4) Lightheaded/Headache (CNS Hypoxia)
5) Anigina (with preexisting CAD)

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8
Q

Microcytic Anemia - 4 Major Types to Review + Associated Defect

A

1) Iron Deficiency - Lack of Heme
2) Anemia of Chronic Disease - Lack of Heme
3) Sideroblastic Anemia - Lack of Protoprphorin
4) Thalesemia - Lack of Globulin Chain

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9
Q

Pathway of Iron Absorption

A

1) Absorbed in the duodenum via DMT1 transporters
2) Transported into the blood via ferroportin
3) Transferrin binds free Iron
4) Ferritin stores Iron

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10
Q

Major Laboratory Measures of Blood (4)

A

1) Serum Iron
2) Serum Ferratin (Stored Iron)
3) TIBC = Total Iron Binding Capacity - Amount of Transferritin
4) % Saturation = Amount of Transferrin bound by iron - normally 33%

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11
Q

Iron Lab Values in Iron Deficiency Anemia vs. Anemia of Chronic Disease

A

Iron Deficiency

1) Reduced Serum Iron + Saturation
2) Reduced Ferritin (Nothing to Store)
3) Elevated Transferritin (body looking or more iron

Chronic DIsease

1) Reduced Serum Iron
2) Increased Ferritin (all stored)
3) Decreased Transferritin (TIBC)

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12
Q

Major Causes of Iron Deficiency (7)

A

Absorption Issue

1) Breast Milk (infants)
2) Children (poor diet)
3) Malabsorption (Celiac)
4) Gastrectomy (Loss of stomach = less acid = less Fe2+ Iron = Less Absorbed)

Leech Issue

5) Peptic Ulcer
6) Hookworm
7) Colon Polyp/Carcinoma (Bleeds)

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13
Q

Change in Non-Iron Labs in Iron Deficiency Anemia (3)

A

1) Increased Free Erythrocyte Protoporphyrin (Still made but with not heme to bind)
2) Increased RDW (Cell Sizes Vary)
3) Low Hb/Hct

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14
Q

Additional Key Iron Deficiency S/Sx (2)

A

1) Pica - Eat dirt due to psychological drive to get iron

2) Koilonychias (Spoon Shaped Nails)

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15
Q

Plummer Vinson Syndrome - Triad

A

1) Iron Deficiency Anemia
2) Glossitis
3) Esophageal Webs

Typically presents as dysphagia with anemia

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16
Q

Anemia of Chronic Disease - Pathophisiology

A

Chronic inflammation activates immune system - Immune system responds by increasing hepcidin

Hepcidin hides Iron (with Ferritin) - Done to prevent bacteria from using the Iron

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17
Q

Sideroblastic Anemia - Mechanism of Anemia + Causes (4)

A

Mechanism - Decreased Protoporphyrin production - can’t make heme - Iron still goes into the mitochondria and gets trapped (Sideroblasts formed) - Free radial damage from the iron causes cell rupture

Causes

1) Congenital - ALAS Deficiency
2) Alcoholism (MItochondrial Poisoning)
3) Lead Poisoning (Inhibits ALAD + Ferrochetalase)
4) B6 Deficiency (ALAS Co-Factor - Common with Isoniazad Therapy for TB)

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18
Q

Protoporphyrin Synthesis - Key Steps (3)

A

1) Succinyl CoA - Converted to Aminoleuvinic Acid (ALA) via ALA Synthase (ALAS) + Vitamin B6 (Co-Factor)
2) ALA Converted to Porphobiligin via ALAD
3) Eventually transitioned to protophorin - made to heme via Iron addition (ferrochetalase) - Step Occurs in Mitochondria

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19
Q

Lab Findings in Sideroblastic Anemia (4)

A

Lab Findings - All Due to Iron Overloaded State (Ruptures Membrane)

1) Increased Serum Fe (Cell Lysis)
2) Increased % Saturation + Ferritin (Stored cause you can’t use)
3) Low TIBC (Low Transferritin) - Lots circulating, don’t want to promote more

Histology - SIderoblastic Microcytic RBCs (Ringing with Blue Iron)

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20
Q

Alpha Thalassemia - Mutation and Gene Location

A

Mutation of Chromosome 16 - 4 Possible Genes

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21
Q

Alpha Thalassemia - Results of # of Mutations

A

1 Deletion - Asymptomatic
2 Deletions - Mild Anemia - Cis (Asian) is worse - both on same chromosome
3 Deletions - Severe Anemia - Beta Chain Tetromeres (HbH) Damage RBCs
4 Deletions - Fetal Death (Hydrops Fetalisis) - Gamma Chain Tetromeres (HbBarts)

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22
Q

Beta Thalassemia - Mutation + Gene Location

A

Point Mutation - Can be Beta+ or Beta-Null

Chromosome 11

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23
Q

Beta Thalassemia Minor - Genetics + Presentation

A

Genetics - B/B+ - Most Mild Form
Asymptomatic with increased RBC Count - Microcytic Hypochromic Cells

Target Cells on Smear

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24
Q

Beta Thalassemia Major - Genetics + Sub-Populations + Labs (3)

A

Major = Beta-Null/Beta+

African Populations - Alpha and Beta Thalassemia
Mediterranean = Beta Thalassemia

Labs for Beta Major
Microcytic Hypochromic RBCs
Nucleated RBCs (Splenic Production)
Target Cells

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25
Q

Beta Thalassemia Major - Presentation + Findings (5)

A

Presentation - Presents after HbF Drops

Findings

1) Alpha Tetramers Aggregate - Extravascular Hemolysis
2) Massive Erythoid Hyperplasia - Skull hematopoeisis = Crew-Cut Skull
3) Facial Bone Hematopoeisis - Chipmunk Facies
4) Hepatosplenomegaly
5) High risk of Aplastic Crisis with Parvovirus B19 Infection

26
Q

Major Causes of Macrocytic Anemia (2)

A

Folate and B12 Deficiency (Megoblastic)

27
Q

Folate/B12 Pathway

A

Folate Absorbed as Tetra-Dihydrofolate - THF-Methylated for circulation - B12 removes the Methyl allowing for DNA Synthesis - B12 Produces Methionine from Homocystine in the Processs

28
Q

Impacts of Impaired DNA Synthesis (3)

A

1) Impaired RBC Synthesis - Macrocytic Anemia
2) Impaired Division of Granulycytic Precursors - Hyper-segmented Neutrophils (>5 Lobes)
3) Gut Enlargement of intestinal epithelium

29
Q

Folate Deficiency Causes (3)

A

1) Poor Diet - EtOH + Elderly
2) Increased Demand - Pregnancy - No Folate leads to congenital defects
3) Drugs (Methotrexate)

30
Q

Folate Deficiency Alternative Name

A

1) Giardiasis

31
Q

Folate Deficiency Findings (5)

A

1) Macrocytic RBCs
2) Hyper-Segmented Neutrophils
3) Low Serum Folate
4) Elevated Serum Homocystine (Not used by B12)
5) Glossitis

32
Q

Vitamin B12 Absorption Pathway - 5 Steps

A

1) Salivary Amylase Liberated B12
2) R-Binder holds B12 through the stomach
3) Pancreatic Proteases free B12
4) B12 Binds Gastric Parietal Cell Produced Intrinsic Factor
5) B12-IF Absorbed in the ileum

33
Q

Causes of B12 Deficiency (4)

A

1) Precocious Anemia = #1 Cause - Autoimmune Destruction of Parietal Cells (3 P’s - Proton Pump + Pink + Precocious Anemia
2) Pancreatic Insufficiency (No Removal of R-Binder Protein)
3) Diet (Vegan) - Rare
4) Damage to the Ileum (Crohn’s Disease)

34
Q

B12 Deficiency - Clinical Findings (3)

A

1) Macrocytic Anemia with Hyper-segmented Neutrophils
2) Glossitis
3) Sub-Acute Combined Degeneration of SC - Methylmalonic acid Build but destroys DCMLT + CST)

35
Q

B12 Deficiency - Keys Labs (4) + Key Test

A

1) Smear - Macrocytic Anemia with Hyper-segmented Neutrophils
2) Low Serum B12
3) High Homocystine (no Methionine ProductioN)
4) High Serum Methylmalonic Acid (No Succinyl CoA Production)

Schilling Test - Give Pt. Labeled B12 - Check if it makes it to the urine - If not give with IF and see if it makes it
Give IF - See B12 in Urine - Means Precocious Anemia (with lack of IF)

36
Q

Reticulocyte Count - Definition + Calculation + Impact of Corrected Count

A

Reticulocyte = Pre-mature RBC (24 hours) - Bluish cytoplasm from RNA - Normally 1-2% of RBCs

Calculation of Corrected Count =
(Reticulocyte Count * Hct) / 45
Normal Hct = 45

Corrected > 3% = Bone Marrow responding = Hemoylsis
Corrected < 3% = Bone Marrow not responding = Underproduction

37
Q

Extravascular Hemolysis - Location + Impacts + Major Findings (4) + Causes (4)

A

Macrophages destroy cells in Spleen/Liver/Lymph Nodes
Globin Broken down in AA and Heme in Iron (Recycled) And Protoporphoryin (bilirubin)

Findings

1) Anemia with splenomegaly
2) Jaundice (Elevated Bilirubin
3) Gallstones (Supersaturated with Bilirubin)
4) Marrow Hyperplasia

Causes

1) Hereditary Shpherocytosis
2) Sickle Cell
3) Hemoglobin C

38
Q

Intravascular Hemolysis - Location + Impacts + Major Findings (3) + Causes (5)

A

Occurs in the vessel - Initial change results in low haptaglobin (haptaglobin binds up all the free hemoglobin)

Findings

1) Hemoglobinemia (Lots of Hemoglobin in the blood
2) Hemoglobinuria (in the urine)
3) Hemosiderinuria (RT Cells pick up Hb and hold for a few days before they die

Causes

1) PNH
2) G6PD
3) Immune Mediated
4) Microangiopathic Anemia
5) Malaria

39
Q

Hereditary Spherocytosis - Type of Anemia + Pathophysiology

A

Normocytic Anemia with Extravascular Hemolysis

Defect in Ankyrin/Spectrin/ or Band 3:1 - Leads to issues with cytoskeletal teething of RBCs —- Creates membrane blebs which are removed by the spleen - Cells become round vs. dumbbell - Can’t pass splenic capillaries causing lysis

40
Q

Hereditary Spherocytosis - Clinical Findings (3) + Labs (3)

A

Clinical

1) Hepatosplenomegaly
2) Jaundice
3) Increased risk for aplastic crisis with Parvovirus B19

Labs

1) Spherocytes on smear
2) Increased RDW - Cell Sizes Vary
3) Increased Mean Corpuscular Hb Concentration (MCHC) = More Red

41
Q

Hereditary Spherocytosis - Diagnosis + Treatment (2)

A

Dx - Fragility Test - Hypotonic solution causes spherocyte rupture but not normal RBCs

Treatment - Spleenectomy - Howell-Jolly Bodies Reamin (RBCs DNA Left-Overs normally clearned by the spleen

42
Q

Sickle Cell Anemia - Type of Anemia + Genetics

A

Normocytic Anemia with Extravascular Hemolysis

Genetics - Autosomal Recessive
Single AA Substitutions in Hb on Chromosome 11 (Valine replaces a Glutamic Acid) - Beta Globin Gene

43
Q

Sickle Cell Anemia - Pathophysiology + Triggers (4)

A

HbS - Occurs with 2 Defective Genes –> Polymerizes under oxidative stress + Aggregates into needle stick struckes - continuously sickles + unsickles

Triggers

1) Cold
2) Hypoxemia
3) Acidosis
4) Dehydration

44
Q

Sickle Cell Anemia - Clinical Findings (5) + Causes

A

AREAS
A - Autosplenectomy (Increased Infections) + Target Cells + Howell Jowell Bodies
R - Renal Papillary Necrosis - From Howell Jowell Bodies
E - Encapsulated Organism Infection (Strep. Pneumoniae + Haemophilus Influenza)
A - Asplenic Anemia Risk (Parvovirus B19)
S - Salmonella Osteomyletis

45
Q

Sickle Cell Anemia - Lab Findings (4)

A

1) Target Cells - Asplenia + Blebs
2) Skull = Crew-Cut + Chipmunk Face
3) Metabisulfite Screen - Any amount of HbS will sick - Shows Triat and Disease
4) Hb Electrophoresis shows if it is trait of disease

46
Q

Hemoglobin C - Type of Anemia + Genetics

A

Normocytic Anemia with Extravascular Hemolysis

Genetics - Autosomal Recessive
Beta Globin (Chromosome 11) AA Mutation

Glutamic Acid - Lysine (vs. Valine in HbS)

47
Q

Hemoglobin C - Lab Findings (3)

A

1) Normocytic Anemia with Extravascular Hemolysis
2) Target Cells
3) HbC Crystals on Smear - Little Rectangles

48
Q

Paroxysmal Nocturnal Hemoglobuinuria (PNH) - Type of Anemia + Pathophysiology

A

Normocytic Anemia with Intravascular Hemoylysis

Acquired defect in the myeloid stem cell = loss of GPI (which holds DAF-CD55) on the RBC - No DAF means compliment can attack and lyse RBCs

49
Q

PNH Markers + Gene

A

Markers - Loss of CD55 and CD59

Genetics - PIG-A Gene (GPI Production

50
Q

PHN Clinical Features (4)

A

1) Night Time Hemolysis (Acidosis)
2) Morning Hemoglobinuria (Red Urine)
3) Sucruse Screening Test
4) Complications = Iron Deficiency Anemia + Risk of AML (Myeloid keeps mutating)

51
Q

Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD) - Type of Anemia + Pathophysiology

A

Normocytic Anemia with Intravascular Hemoylysis

Loss of GP6D = Loss of ability to produce NADPH
No NADPH = Can’t recycle glutathione
No Glutathione = High susceptibility to oxidative stress

52
Q

G6PD - Genetics + Variants (2) + Stress Triggers (4)

A

Genetics - X-Linked Recessive

Variants
African = Mild
Mediterranean - Severe

Triggers

1) Fava Beans
2) Acidosis (DKA)
3) Primaquin
4) Sulfonamides

53
Q

G6PD - Lab Findings (3)

A

1) Normocytic Anemia with Intravascular Hemoylysis
2) Heinz Bodies (Hb accumulations in the cells)
3) Bite Cells - Macrophages take bites out to try and remove Heinz Bodies

54
Q

Immune Hemolytic Anemia - Type of Anemia + Types (2)

A

Normocytic Anemia with Intravascular or Extravascular Hemoylysis

IgG - Macrophage Induced - Extravascular - Warm Agglutinate
IgM - Compliment Induced - Intravascular - Cold Agglutinate

55
Q

IgG Mediated Hemolytic Anemia - Type of Anemia + Key Points (2)

A

Warm Agglutinate + Extravascular Hemolysis

Consumption via splenic macrophages creates spherocytes

56
Q

IgG Mediated Hemolytic Anemia - Causes (4) + Treatment (3)

A

Causes
1) SLE
2) CLL
3-4) Drugs (Methyldopa + Cephalosporin)

Treatment

1) Cessation of Drug
2) IVIgG - Throw dog a bone and keep macrophages busy
3) Spleenectomy

57
Q

IgM Mediated Hemolytic Anemia - Type of Anemia + Key Point + Causes (2)

A

Cold Agglutinate - Intravascular Hemolysis
Fixes Compliment

Causes - Mycoplasma Pneumonia + EBV

58
Q

Microangiopathic Hemolytic Anemia - Type + Pathophysiology + Causes (4)

A

Normocytic Anemia with Intravascular Hemolysis

RBCs are sheered by the microthrombi as they pass in circulation - results in schistocyte (Helmet Cells)

Causes - Micro-Thormbi Disease

1) TTP
2) HUS
3) DIC
4) HELLP

59
Q

Normocytic Anemia Due to Underproduction - Key Finding + Causes (4)

A

Reticulocyte Count - Low - Not Corrected for Anemia

1) Parvovirus B19
2) Aplastic Anemia
3) Microcytic Anemia (falls in this category)
4) Macrocytic Anemia (falls in this category)

60
Q

Aplastic Anemia - Mechanism + Findings (4)

A

Damage to HSCs - Triggers Pancytopenia

Pancytopenia

1) Anemia
2) Thrombocytopenia (Bleeding)
3) Leukopenia (Infection)

4) Bone Biopsy - Empty Marrow + <10% Cellularity

61
Q

Aplastic Anemia - Causes (4) + Treatment (2)

A

Causes

1) Viral Infection (Parvovirus B19)
2) Drugs
3) Chemicals
4) Autoimmune - T-Cell Based

Treatment - Transfusion + Marrow Stimulation (GM-CSF)

Z - M2 Heme/Onc (10 decks)

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