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Hematology > Hypochromic Anemias > Flashcards

Hypochromic Anemias Flashcards

1
Q

Name 3 classifications of Anemia

A
  1. Disorders of Iron metabolism
  2. Disorders of Heme Synthesis (sideroblastic anemias)
  3. Disorders of Globin Synthesis
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2
Q

List 2 types of Disorders of iron Metabolism

A
  1. Iron deficiency anemia
  2. anemias of chronic disease
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3
Q

List 3 causes of iron deficiency anemia

A
  1. decreased dietary iron
  2. blood loss
  3. impaired iron transport
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4
Q

List 2 causes of anemia of chronic disease

A
  1. chronic inflammatory disease
  2. malignant disorders
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5
Q

List 3 types of disorders of Heme synthesis (Sideroblastic Disease)

A
  1. Heretitary sideroblastic anemias
  2. idiopathic sideroblastic anemias
  3. Secondary sideroblastic anemias
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6
Q

List three causes of secondary sideroblastic anemia

A
  1. drug induced
  2. alcohol induced
  3. lead poisoning
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7
Q

List 3 disorders of globin synthesis

A
  1. β thal
  2. α thal
  3. other thalessemias
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8
Q

List the functions of iron

A
  1. formation of heme in hgb and myoglobin
  2. components of cytochromes, catalses , myeloperoxidase
  3. enzyme activator in some reactions
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9
Q

State the total body iron in normal adults

A

total iron in adults 2-5 grams

males: 3.5g

females 2.3g

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10
Q

list 3 iron compartments and the distribution in each

A
  1. Heme {enymes, Hgb, myoglobin} 80%
  2. Transport: transferrin 0.1%
  3. Storage: spleen, liver etc 20%
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11
Q

List 3 factors which influence iron absorption

A
  1. serum iron concentration (inverse relationship)
  2. amount in diet (direct)
  3. pH in gut (acid pH enhances absorption)
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12
Q

Describe transferrin

A

transferrin is a β-globulin which carries two Fe3+ / molecule

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13
Q

Function of transferrin

A

transports iron in plasma from macrophages to developing normoblasts in bone marrow

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14
Q

Define transferrin saturation

A

the % of iron binding sites on transferrin which are occupied by iron

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15
Q

describe ferritin

A

main storage form of iron

is the water soluble and labile storage form found in nucleated rbcs, intestinal mucosal cells, blood plasma and in macrophages mostly in liver and spleen

this form is not visible under Perl’s Prussian blue stain

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16
Q

Describe hemosiderin

A

a type of storage iron

less labile than ferritin and is water insoluble

formed in macrophages by polymerization and processing of many ferritin molecules into large, dense aggregates

visible on Perl’s Prussian blue

17
Q

Describe the excretion of iron

A

there is NO normal physiologic mechanisms designed to excrete iron

18
Q

How is iron lost in a normal person

A

Fe is lost in small amounts each day

men and postmenopausal women: feces by desquamation, perspiration, and minute hemorrhages for a total loss of about 1mg/day

fertile but non pregnant females: due to menstrual loss 2mg/day

Pregnant women: diversion of iron to fetus loss = 3mg/day

19
Q

Dietary requirements of iron

A

men and post menopausal women: 10mg

infants and children: 5 mg

menstruating women: 20 mg

Pregnant women: 30 mg

20
Q

list the 5 main causes of Fe Deficiency

A
  1. Chronic bleeding (most frequent cause)
  2. decreased absorption of irom
  3. dietary deficiency
  4. increased requirements for iron
  5. decreased or abnormal transferrin (rare)
21
Q

Describe iron deficiency anemia

A

Fe deficiency results in decreased heme formation in nRBC and hypochromia and microcytosis of mature rbc

22
Q

Define hypochromia

A

rbcs with increases size of central pallor indicating they contain less Hgb than normal

23
Q

Define microcytosis

A

more cell divisions that occur while waiting for the cell to fill up with hgb which results in cells that are smaller than normal

24
Q

Three stages of the development of iron deficiency

A
  1. iron depletion: iron stores are reduced by not absent
  2. iron deficiency: iron stores are depleted to almost zero, the serum iron and transferring sat are decreased, and TIBC is increased
  3. Iron deficiency anemia: hgb decreased with hypo and micro
25
Q

List the lab findings in iron deficiency anemia

A

Peripheral blood:

  • hgb: ↓
  • hct: ↓
  • rbc count: normal
  • rbc indices: MCV, MCH, MCHC all ↓
  • RDW: ↑
  • RBC Morphology: micro hypo in mild cases plus in severe cases can get ovalocytes and target cells
  • Retic count: normal or sl ↑
  • WBC count/morph: normal or sl ↑ due to chronic bleeding
  • Plt count/morph normal or sli ↑ (chronic bleed)

Serum Chemistries:

  • Iron assay: ↓
  • TIBC: ↑
  • Transferrin Sat:↓
  • Ferritin: ↓
  • sTfR (soluble transferrin receptor): ↑
  • FEP (free erythrocyte protoporphyrin): ↑
26
Q

Define Thalassemia

A

group of disorders in which the rate of synthesis of a specific type of polypetide chain (α or β) used in globin production is decreased

seen as micro hypo anemia

27
Q

Define Sideroblastic anemia

A

anemia caused by a biochemical abnormalities in the sythesis of heme in developing red cells

Note: not due to a lack of Fe

Most cases involve abnormal enzyme functions in the synthesis of heme.

Iron accumulates in these because less than normal amts of protoporphyrin IX is formed.

28
Q

What are 2 major categories of Sideroblastic anemias:

A
  1. Refractory sideroblastic anemias

(poor response to therapy)

inherited and idiopathic

  1. Secondary sideroblastic anemia
  • due to vit B6 (pyridoxine) deficiency: required for coenzyme in first rx of heme synthesis
  • due to drugs toxins chemicals etc: inhibit heme synthesis eg: lead poisoning
29
Q

What are the lab findings in Sideroblastic anemia

A
  1. Ringed sideroblasts in bone marrow (nRBC containing prussian blue staining, iron loaded mitochondria and siderotic granules)
  2. Hypochromia and normocytic, macrocytic or morphology
  3. Basophilic stippling and possible pappenheimer bodies
  4. increased serum iron, transferrin sat and serum ferritin; TIBC is usually normal or decreased
  5. Monocytosis seen sometimes
30
Q

Define Anemia of Chronic Disease

A

sometimes anemia is seen in chronic inflammatory diseases eg:

  • chronic infection
  • autoimmune disorders,
  • renal failure
  • chronic leukemias
  • endocrine disorders

Morphology: normochromic and normocytic

31
Q

Causes of Anemia of Chronic Disease

A
  1. An inflammatory blockage of the release of iron stores from macrophages in the liver and spleen due tot he action of cytokines associated witht eh inflammatory response. the inability to release iron stores results in usually mild accumulation of iron in the storage areas and a deficiency of iron inside the developing red cells
  2. increased hemolysis of circulating red cells
  3. decreased erythropoietin production
32
Q

What are the lab findings in Anemia of Chronic Disorders?

A
  • hypochromia or normochromia
  • normocytic
  • decreased iron and transferrin saturation
  • Normal or increased storage iron
  • Serum ferritin is normal or increased
  • Serun sRfR is normal
  • Hgb rarely less than 90g/L
  • MCV is usually slightly low or low normal (75-80fL)

Hematology (3 decks)

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