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heme/onc > hypoproliferative > Flashcards

hypoproliferative Flashcards

1
Q

erythropoiesis in bone marrow does not match the demand for oxygen-carrying capacity (red cells) in the peripheral blood circulation

A

anemia

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2
Q

in the most simplest term anemia is when there is

A

inadequate delivery of O2 to tissues

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3
Q

of red cells in a ul of blood

A

RBC count

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4
Q

measures the size of the red cell

Hct/RBC

A

MCV

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5
Q

measures hemoglobin concentration within a single red cell

Hb/RBC

A

MCH

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6
Q

hemoglobin concentration in a given volume of red cells

Hb/Hct

A

MCHC

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7
Q

measures red cell size distribution

A

RDW

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8
Q

orthostatic hypotension

A

decreased blood pressure upon standing

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9
Q

youngest normal RBC entering circulation from the bone marrow

A

reticulocyte

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10
Q

how does a reticulocyte looks like

A

large purplish cell in standard peripheral blood smear

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11
Q

reticulocytes contains ____ remnants and ____ machinery precipitated and visualized with supravital stains

A

contains RNA remnants and ribosomal machinery

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12
Q

wright stain

A

large purplish cells with no central pallor- reticulocytes

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13
Q

normal reticulocyte count

A

1%

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14
Q

absolute reticulocyte count

A

absolute number of red cells that are reticulocytes

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15
Q

reticulocyte index

A

correct the measured retic count for the degree of anemia

retic. count (%) x patient’s Hct/ 40

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16
Q

if the retic. index is <2 and/or if the absolute retic. count is less than normal

A

hypoproliferative anemia

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17
Q

if the retic. index is elevated and/or is the absolute reticulocyte is increased in a patient with anemia

A

hyper-proliferative anemia

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18
Q

microcytic

A

red cell size is smaller

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19
Q

normocytic

A

red cell size is within normal

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20
Q

macrocytic

A

red cell size is larger

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21
Q

Fatigue, pallor, dyspnea (common to all anemias)

Hair loss

Pica

Restless legs

Spoon shaped nails (koilonychia)

Angular cheilitis

Swollen and sore tongue

A

symptoms for iron deficiency

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22
Q

iron homeostasis is highly regulated

A

yep

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23
Q

total body iron

A

4 grams

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24
Q

iron is reduced to ferrous state by

A

duodenal cytochromeb – DCYtb

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25
Q

how is iron tranported into the cell

A

divalent metal transporter 1 (DMT1)

26
Q

a ferrioxidase that re-oxidazes iron for release from enterocyte to plasma transferrin

A

hephaestin

27
Q

key transport protein in the exchange of FE from enterocyte ti transferrin

A

ferroportin

28
Q

iron transport protein in plasma circulation

A

transferrin

29
Q

key iron regulator and blocks iron transport at multiple sites, including intestinal epithelium and macrophages.

A

hepcidin

30
Q

Hepcidin is a protein synthesized in the _____ and forms a high affinity bond with TfR; which is capable of sensing the level of _______saturation.

A

Hepcidin is a protein synthesized in the liver and forms a high affinity bond with TfR; which is capable of sensing the level of transferrin saturation.

31
Q

Hepcidin synthesis is ________ in inflammation and secondary iron overload, and _________ in iron deficiency and hypoxia.

A

Hepcidin synthesis is increased in inflammation and secondary iron overload, and decreased in iron deficiency and hypoxia.

32
Q

as we know hepcidin is a central regulator of iron metabolism it binds to

A

ferroportin and down-regulates efflux of iron

33
Q

how does hepcidin regulates efflux of iron? (3)

A
  1. decrease of iron absorption by enterocyte
  2. decrease of ferroportin-mediated export from enterocyte into blood
  3. decrease of iron from macrophages of RES
34
Q

iron storage forms (2)

which is the main one?

A
  1. ferritin– main storage of iron in cells

2. hemosiderin- insoluble form of iron that is no longer available for chemical rxn

35
Q

CBC in iron deficiency:

  1. MCV
  2. MCH
  3. red blood count
  4. retic. count
A
  1. low MCV- microcytosis
  2. low MCH- hypochromia
  3. decreased red blood count
  4. low retic. count
36
Q

diagnosis of Fe deficiency studies :

  1. serum Fe
  2. TIBC
  3. Ferritin
  4. Transferrin Sat
A
  1. serum Fe is low
  2. TIBC is high
  3. ferritin is low
  4. transferrin Sat is low
37
Q

treatment of Fe deficiency

A
  1. oral
  2. IV
  3. transfusion
38
Q

Pb inhibits the _____ and also inhibits the breakdown of ____. this causes____

A

final steps in heme synthesis and also inhibits the breakdown of RNA. this causes RNA aggregates in RBC- basophilic stippling

39
Q

lead toxicity is what type of anemia?

A

microcytic hypoproliferative anemia

  • low MCV
40
Q

Symptoms: abdominal pain, anemia,
neurological symptoms, fatigue, malaise,
irritability

what type of diagnostic test should we do?

A

Serum Pb level to check for Pb toxicity

41
Q

This form of anemia develops because there is functional rather than absolute iron deficiency. That is, the lack of iron in the circulation is not due to deficient dietary intake, but instead dysregulation of iron transport.

A

anemia of chronic disease

42
Q

anemia of chronic disease

  1. associated with
  2. ______ induces hepcidin expression leading to dysregulation of iron transport, utilization and storage
  3. Fe release from enterocytes and macrophages is
  4. decrease plasma Fe but normal
A
  1. associated with inflammatory disorders
  2. inflammatory cytokines induce hepcidin expression leading to dysregulation of iron transport, utilization and storage
  3. Fe release from enterocytes and macrophages is inhibited
  4. decreased plasma Fe but normal bone marrow iron stores
43
Q

anemia of chronic disease lab results:

  1. Serum iron
  2. TIBC
  3. transferrin saturation
  4. ferritin
  5. MCV
A
  1. low serum iron
  2. decreased TIBC
  3. normal transferrin saturation
  4. increased or normal ferritin
  5. normal or low MCV
44
Q

treatment of chronic disease of anemia

A

treat he underlying disorder

45
Q

megaloblastic anemia (2)

A
  1. folate deficiency

2. B12 deficiency

46
Q

megaloblastic anemia is what type of anemia

A

hypoproliferative macrocytic anemia

47
Q

___ is a water-soluble vitamin. Under normal conditions _____is absorbed throughout the proximal half of the small intestine, like most vitamins and minerals (with the notable exception of vitamin B12). _____ is a carrier of 1-carbon fragments (methyl groups) and is required for synthesis of purines, pyrimidines, and methionine. ____exists in various methylated forms, of which tetrahydrofolate (THF) is the biologically active form. ______ is conjugated with a series of glutamic acid residues, which controls its ability to be retained within cells.

A

Folate

48
Q

causes of folate deficiency (5)

A
  1. dietary
  2. malabsorption
  3. increased demands such as pregnancy
  4. drugs such as methotrexate
  5. liver disease
49
Q

______absorption is more complex than folate absorption. Cobalamin ________ is bound by a series of transport (R-binder) proteins until it reaches the duodenum. After digestion of the B12-R binder complex by pancreatic enzymes in the duodenum (alkaline pH), free cobalamin is bound to Intrinsic Factor (IF), which is secreted by parietal cells of the stomach (acid pH). _____-IF complexes traverse the small intestine and are internalized at the terminal ileum through a specialized receptor.

Cobalamin is a coenzyme for 2 enzymatic pathways: one is involved in amino acid metabolism and the other in the formation of methionine and the conversion of methyltetrahydrofolate to tetrahydrofolate. Thus adequate ____stores are required for adequate synthesis of biologically active folate.

A

vitamin B-12

50
Q

causes of vit. B-12 deficiency (5)

A
  1. malabsorption- lack of intrinsic factor
  2. gastrointestinal- ileal resection
  3. transcobalamin II deficiency
  4. NO toxicity
  5. meds- metformin, proton pump inhibitors
51
Q

giant hypersegmented neutrophils

A

seen in folate and B-12 deficiency

52
Q

feared complication of B-12 deficiency

A

neuropathy and neural column degeneration

53
Q

Folate and Vit B12 deficiencies predispose to ________ defects in the fetus

A

neural tube

54
Q

labs in B-12 deficiency

  1. Serum B-12
  2. RBC folate
  3. serum folate
A
  1. serum B12 low
  2. RBC folate normal/low
  3. serum folate normal/high
55
Q

labs in folate deficiencies

  1. Serum B-12
  2. RBC folate
  3. serum folate
A
  1. Serum B-12 normal
  2. RBC folate low
  3. serum folate low
56
Q

evaluation of B12 deficiency (3)

A
  1. increased homocysteine and methylmalonic acid levels in blood
  2. endoscopy to evaluate for atropic gastritis
  3. blood for parietal cell antibodies
57
Q

treatment for B-12 deficiency

A

administer both B12 and folate (large doses of folate will correct the hematologic picture bit not neuropathy)

58
Q

spinal cord damage is irreversible in B-12 deficient pt.

A

yep

59
Q

When the fine balance of iron uptake and iron loss is disturbed iron overload can occur, leading to disease. Transfusion is a common cause of iron overload.

A

yep

60
Q

hereditary hemochromatosis

  1. mutation in
  2. inheritance
  3. allele prevalence
  4. what happens
  5. increased levels of
  6. iron deposition
  7. presentation
A
  1. mutation in HFE gene chromosome 6
  2. autosomal recessive
  3. 1:300
  4. excessive absorption of FE from GI tract- iron overload
  5. increased transferrin saturation and ferritin
  6. iron deposition in liver, heart and endocrine organs
  7. presentation usually in adults

heme/onc (30 decks)

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