Hypoproliferative Anemia Study guide

Question 1

How are anemias categorized morphologically?

Answer 1

Classification: Morphology

1. Microcytic
2. Normocytic
3. Macrocytic

Question 2

How are anemias categorized functionall?

Answer 2

1. Anemia of blood loss (acute or chronic)
2. Hemolytic anemias
3. Hypoproliferative anemias

Question 3

characterized by ineffective erythropoiesis +/- hematopoiesis.

Answer 3

Hypoproliferative anemias

Question 4

General categories within this group
of anemias includes: nutritional deficiency-related anemias, marrow failure syndromes, and anemias of chronic disease and renal failure.

Answer 4

Hypoproliferative anemias

Question 5

is considered to be the most frequent cause of anemia overall in hospitalized patients.

Answer 5

ACD

Question 6

The severity of ACD is related to the ______ of the chronic inflammatory disorder or the
______ in malignancy.

Answer 6

level of disease activity

Question 7

In ACD, the anemia is generally _____ with

hemoglobin levels usually not lower than __ g/dL in uncomplicated cases.

Answer 7

mild or moderate,

9

Question 8

What do we see on PBsmear in ACD?

Answer 8

mild to moderate anemia without noticeable polychromasia or anisocytosis (understimulation of erythropoiesis ) IG normochromic, normocytic

Question 9

iron transport to the erythroid precursors is characteristically diminished in ACD, resulting in functionally iron-deficient conditions even in light of the already reduced stimulation of erythropoiesis associated with ACD. As a result, anemia becomes

Answer 9

hypochromic and microcytic in approximately 10-20% of cases.

Question 10

Why would a prussion blue stain help Dx ACD?

Answer 10

Iron stored as hemosiderin within macrophages will be normal or, more commonly increased, whereas nucleated red cells with iron-containing granules (i.e.
sideroblasts) will be absent…The lack of sideroblasts indirectly reflects diminished delivery of iron to
erythroid precursors, which is typical of ACD

Question 11

Labs in ACD;
Bone marrow iron stores
serum ferritin
serum Fe
TIBC
Transferin saturation

Answer 11

BM stores have increased stored iron and decreased sideroblastic iron
Increased serum ferritin
Decreased serum Fe
TIBC is decreased or normal
Transferin sat: decreased or normal

Question 12

due to decreased erythropoietin production by the damaged kidneys.

Answer 12

Anemia of renal failure

Question 13

It is a normocytic, normochromic anemia and is usually

responsive to recombinant erythropoietin therapy.

Answer 13

anemia of renal failure

Question 14

i. Marrow infiltration by carcinoma

ii. Tear drop cells and leukoerythroblastic reaction

Answer 14

Myelophthisic Anemia

Question 15

multifactorial and mechanisms are not
entirely clear. It is seen in chronic conditions, including chronic hepatitis or cirrhosis. Pancytopenia may be observed.

Answer 15

Anemia of liver disease

Question 16

The RBCs tend to be_____ due to abnormal lipid processing in liver disease and the incorporation of lipids within the RBC membrane

Answer 16

macrocytic

Question 17

rare condition in which there is selective inhibition of

erythropoiesis. Other lineages are not affected.

Answer 17

Pure red cell aplasia (PRCA)

Question 18

Pure red cell aplasia (PRCA) produces ____, _____anemia due to no erythroid precursors in the marrow.

Answer 18

normocytic, normochromic

Question 19

What is PRCA associated with?

Answer 19

It may be associated with thymic hyperplasia/thymomas, large granular lymphocytic leukemia, drugs, or autoimmune diseases.

Question 20

What is the pathophysiology of PRCA?

Answer 20

autoimmune destruction of erythroid

precursors.

Question 21

Pathophysiology of IDA

Answer 21

Iron is depleted in the diet,lost in chronic blood loss or by
malabsorption leading todecreased iron stores and
incorporation into hemoglobin

Question 22

 Microcytic, hypochromic anemia with pronounced anisopoikilocytosis
 ↓ serum ferritin, marrow iron stores, % saturation
 ↑TIBC

Answer 22

IDA

Question 23

Most common nutritional disorder worldwide

Answer 23

IDA

Question 24

IDA see in >50 yo is ______

Answer 24

gastrointestinal carcinoma until proven otherwise

Question 25

Anemia of chronic disease: Increased_____ levels, caused by inflammatory mediators: blocks the transfer of iron from _______ to sideroblasts (red cell precursors)

Answer 25

hepcidin | marrow macrophages

Question 26

``` ACD: serum ferritin TIBC Marrow in iron stores Sideroblastic iron ```

Answer 26

Increased serum ferritin decreased TIBC Increased marrow iron stores decreased sideroblastic iron

Question 27

Most common anemia of hospitalized patients | Seen in inflammatory,infectious, and neoplastic conditions

Answer 27

Anemia of chronic disease

Question 28

 Normocytic, normochromic |  Echinocytes

Answer 28

Anemia or renal fail

Question 29

Decreased erythropoietin production secondary to | kidney disease leads to decreased erythropoiesis

Answer 29

Anemia of renal fail

Question 30

Folate or vitamin B12 deficiency leading to impaired | DNA synthesis see in what type of anemia

Answer 30

Megaloblastic anemia

Question 31

What is the result of Folate or Vit B 12 deficiency that causes impaired DNA synthesis

Answer 31

produces nuclear to cytoplasmic asynchrony in erythroid and granulocytic maturation

Question 32

Macrocytic anemia  Macroovalocytes  Hypersegmented neutrophils  Nuclear to cytoplasmic asynchrony in marrow

Answer 32

Megaloblastic anemia

Question 33

Unique cause of Vit B12 deficiency seen in Megaloblastic anemia

Answer 33

``` Pernicious anemia (atrophicvgastritis leading to vitamin B12 deficiency due to intrinsic factor deficiency) ```

Question 34

In Megaloblastic anemia, what deficiet is associated with neurologic deficiets?

Answer 34

Neurologic deficits in vitamin B12 deficiency

Question 35

Suppression of bone marrow pluripotent stem cells likely by autoreactive T cells

Answer 35

Aplastic Anemia

Question 36

Cytopenias related to marrow infiltration by a carcinoma or | storage disorder

Answer 36

Myelophthisic anemia

Question 37

 Tear drop cells  Leukoerythroblastic reaction seen in what type of hypoproliferative anemia?

Answer 37

Myelophthisic anemia

Question 38

Anemia of the liver is macro or mircocytic

Answer 38

macrocytic

Question 39

Unknown but hypothesized to be autoimmune destruction of erythroid precursors in the marrow

Answer 39

Pure red cell aplasia

Question 40

PRCA is  Normocytic, microcytic, macrocytic Hypochromic or normochromic

Answer 40

Normocytic | normochromic

Question 41

``` May be associated with thymic hyperplasia or thymoma, large granular lymphocytic leukemia, or autoimmune diseases ```

Answer 41

PRCA

Question 42

Why is serum Fe low in IDA and TIBC high?

Answer 42

serum Fe is low for obvious reasons, Fe is low | TIBC will increase (totol iron binding capacity) because teh body is TRYING to extract more iron

Question 43

Why is Fe low in ACD?

Answer 43

Because ACD is an inflammation situation. You make hepcidin which encourages Fe to stay stored in Bone marrow instead of being released (thus the lack of sideroblats)

Question 44

If Fe is low in ACD, why doesn't TIBC increase?

Answer 44

TIBC won't increase because the body doesn't want to increase serum iron, it assumes that because there is inflammation it will make more FE available for bugs!

Question 45

Why is ferritin increased in ACD?

Answer 45

because ferittin is an acute phase reactant and ACD is inflammatatory process