Hypoproliferative Anemias

Question 1

Diagnosis for Low Reticulocyte Index (or Absolute Reticulocyte count <75000)

Answer 1

• Acute blood loss
• Nutritional anemia
• marrow depression
• Decreased RBC production
• Destruction of marrow erythroid precursors
• Replacement of normal bone marrow

Question 2

Megaloblastic Anemias

Answer 2

• Group of disorders characterized by DNA Synthesis Defect
• Nucleus immature
• Cytoplasm mature
• Increased MCV
• Increased RDW
• B12 and Folate deficiencies are most common etiologies
• looks like aplastic anemia or leukemia
• **Hypersegmented neutrophils **
• Beefy, red, smooth tonuge in both B12 and Folate deficiencies
• Neuro defects in ONLY B12 DEFICIENCY
  
  • bc B12 needed to make myelin

Question 3

Causes of B12 Deficiency

Answer 3

• Inadequate B12 intake
• Inadequate B12 absorption
  
  • Lack of gastric acid
  • Destruction of parietal cells –> Pernicious anemia
  • Gastric bypass
• Decreased ileal B12 absorption
  
  • Crohn’s disease
  • Metformin (medicine for Diabetics)
• Pancreatic insufficiency
• Competition for B12
  
  • Fish tapeworm
  • Bacterial overgrowth
• Nonfunctional TCII
• Cobalmine inactivation (NO)

Question 4

Ways to Diagnose B12 Deficiency

Answer 4

• Low B12 Levels
  
  • inaccurate
• Increased homocysteine - more accurate
• Increased methylmalonic acid - more accurate

Question 5

Treatment for B12 Deficiency

Answer 5

• Takes years to develop
• Lifelong IM B12 injections
• Treating with JUST FOLATE can percipitate Neurological symptoms

Question 6

What is crucial for Folate Absorption?

Answer 6

• Enterohepatic circulation
• so biliary drainage –> severe folate deficiency

Question 7

What protein does Iron bind to during travel in blood?

Answer 7

Transferrin

Question 8

Where is Hb synthesized?

Answer 8

Bone marrow

Question 9

What is Iron stored as?

Answer 9

Ferretin

Question 10

What happens as Iron deficiency increases?

Answer 10

• TIBC increases
• Transferrin Saturation decreases
• Ferritin levels decrease

Question 11

Transferrin saturation

Answer 11

• Fraction of free Fe-binding sites that have e bound to them

Question 12

How does Iron leave the body?

Answer 12

only when cells are lost

Question 13

Clinical Presentation of Iron Deficiency

Answer 13

• Glossitis (smooth, tender tongue)
• Angular chelitis (sores at mouth corners
• Koilonichia (nail spooning)
• Thrombocytosis
• Restless leg syndrome
• Hair Loss
• Increased RDW - 1st sign
• Decreased MCV - 1st sign
• Decreased Hb, Hct
• Decreased Serum Fe
• Increased TIBC
• Decreased transferrin saturation

Question 14

Anemia of Chronic Disease

Answer 14

• Anemia due to Chronic Inflammation
• Cytokines sequester Fe from blood by increasing hepcidin
  
  • decreased Fe absorption from gut
  • Decreased Fe export from liver
  • Decreased transferrin
  • Decreased TIBC
• Normal or elevated Ferritin