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PATH Heme-Onc > Hypoproliferative Anemias > Flashcards

Hypoproliferative Anemias Flashcards

1
Q

identify the causes

A
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2
Q

microcytic hypochromic anemias - pathogenesis

A
  • due to a cytoplasmic maturation effect - i.e., nuclear maturation / DNA synthesis normal
    • leads to decreased Hb maturation
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3
Q

iron deficiency

  • leads to what kind of anemia?
  • has what main causes?
A
  • microcytic hypochromic anemia
  • causes
    • dietary deficiency - infant (low Fe in breast milk), teenagers (poor diet), older adults (poverty)
    • impaired absorption
    • chronic blood loss: almost ALWAYS the cause of iron deficient anemia in: postmenopausal women, older men
    • increased requirement
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4
Q

briefly outline iron metabolism in the body

A
  • absorbed in gut
  • transported by transferrin to various tissues
    • bone (75%): for hematopoiesis
    • liver > heart (25%): for storage in the form of ferritin
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5
Q

discuss the clinical presentations of iron deficiency anemia

A
  • specific findings:
    • koilonychia - finger nail spooning
    • atrophic glossitis
    • alopecia
    • intestinal malabsorption
  • general findings
    • pale nail beds
    • palor
    • -/- thrombocytosis
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6
Q

discuss the RBC characteristics seen in iron deficiency anemia

A
  • microcytic hypochromic cells
    • anisocytosis - high RDW (difference in RBC size)
  • poikilocytosis: pencil cell elliptocytes
  • DECREASED RETICULOCYTE COUNT
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7
Q
A

glossitis

specific for either iron deficiency (microcytic hypochromic) or B12 / folate deficiency (macrocytic)

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8
Q
A

koilonychia (spooning fingernails) - specific for iron deficiency anemia

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9
Q
A

pale nail beds

see in any anemia

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10
Q
A

pale nail beds - seen in any anemia

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11
Q
A

iron deficiency anemia

  • microcytic hypochromic cells (with anisocytosis)
  • _presence of poikilocytosi_s “pencil cells”
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12
Q

contrast the images

A

left: normal bone marrow stain - blue stain (pearls stain) highlight normal iron stores in macrophages
right: absence of blue staining in iron deficiency anemia

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13
Q

what factors are used to help dx between the major causes of microcytic hypochromic anemia (iron deficient, chronic disease, sideroblastic) and what do they mean?

A
  • serum iron
  • total iron binding capacity (TIBC)- total transferrin concentration
  • serum soluble transferrin receptor (SSTR) - presence of serum transferrin, inversely proportional to iron stores
  • serum ferritin []: rough approximation of bone marrow iron stores
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14
Q

characterize iron deficiency anemia based on

  • serum Fe
  • TIBC
  • SSTR
  • % Sat
  • Marrow Fe
A
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15
Q

what are the m/c anemias?

A
  • iron deficiency
  • chronic disease

both microcytic, hypochromic

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16
Q

pathogenesis of anemia of chronic disease

A

microcytic, hypochromic anemia

  • driven by cytokine dysfunction:
    • impaired “hand off” of iron between macrophages and developing RBCs → iron trapped in macrophages → unavailable for heme synthesis
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17
Q

discuss the RBC characteristics of anemia of chronic disease

A
  • RBC morphology - typically microcytic hypochromic. however, no other morphological distinguishers.
  • reticulocyte count is low
18
Q

characterize anemia of chronic disease based on

  • serum Fe
  • TIBC
  • SSTR
  • % Sat
  • Marrow Fe
19
Q

sideroblastic anemia - pathogenesis/cause

A
  • abnormal iron metabolism within the RBC itself: iron is sequestered in the developing erythroblast mitochondria → unavailable for Heme synthesis. cause
    • hereditary
    • myelodysplastic syndromes
20
Q

sideroblastic anemia - RBC characteristics

A
  • microcytic hypochromic
    note: in bone marrow, siderblastic anemia can cause characteristic ringed sideroblasts: ring of dark blue-staining, iron containing mitochondria around nucleus
21
Q
A

sideroblastic anemia

increased iron stores (prussian blue stain) in the bone marrow

22
Q
A

sideroblastic anemia

“ringed sideroblasts” in the bone marrow: ring of iron around mitochondria

23
Q

characterize sideroblastic anemia based on

  • serum Fe
  • TIBC
  • SSTR
  • % Sat
  • Marrow Fe
24
Q

mego-blastic macrocytic anemia - pathogenesis / causes

A
  • nuclear defect (vs macrocytic - which is a cytoplasmic defect)
    • impaired DNA synthesis defective nuclear maturation → less divisions → ABNORMALLY LARGE RBCS
      • m/c cause: lack of VITAMINS necessary for DNA synthesis
        • VITAMIN-B12
        • FOLATE
      • copper deficiency
25
Q

what is nuclear:cytoplasmic asynchrony - definition, cause

A

imbalance of maration in cytoplasmic vs nucleus: nucleus morphology less mature

  • see in megoblastic microcytic anemia
26
Q

physical signs of megoblastic anemia

A
  • glossitis (also seen in iron deficiency microcytic anemia)
  • thrombocytosis - nonspecific
  • pallor / jaundice - nonspecific
27
Q
A

gastric atrophy

seen in pernicious anemia - megoblastic macrocytic anemia

28
Q
A

glossitis

seen in pernicious anemia - mego-blastic macrocytic anemia

29
Q

megoblastic anemia - RBC characteristics

A
  • macrocytic RBCs (oval, > 100ul), +
    • dacrocytes (tear drop cells)
    • presence of hypersegmented neutrophils

no abnormal pallor (no hb deficiency)

30
Q
A

megoblastic anemia

  • macrocytic, oval RBCs
  • hypersegmented neutrophils
  • dacrocytes (tear drop cells)
31
Q
A

severe megoblastic anemia → hypercellular bone marrow

32
Q

what are the levels of

  • serum B12
  • serum folate
  • RBC folate
  • methylamloic acid

in Vit B12 & folate deficiency anemia?

33
Q

aplastic anemia

  • definition
  • causes
  • presentation
A
  • definition: primary hepatopoietic failure
  • leads to
    • pancytopenia
      • anemia - weakness, pallor, dyspnea
      • thrombocytopenia - petechiae
      • neutropenia - many infections (esp fungal)
    • causes - fanconi anemia
34
Q

fanconi anemia - definition / presentation

A
  • an aplastic anemia - primary hematopoietic failure
  • presentation
    • pancytopenia
    • bone / skin abnormalities
35
Q

red cell aplasia

  • definition
  • causes
  • presentation
A
  • definition - primary bone marrow disorder in which only erythroid progenitors are suppressed
  • presentation
    • low erythryoid precursors
    • normal granulopoiesis & megakaryocytes
  • cause
    • neoplasms - thymoma & large granular lymphocytic leukemia
    • parvovirus B12
    • diamond-blackfan
36
Q

parvovirus B19 infection

  • causes what kind of anemia?
  • presentation / features?
A
  • pure red cell asplasia
  • presentation
    • transient arrest in erythropoiesis in healthy persons
      • granulopoiesis & megakaryopoiesis normal
      • +/- giant erythroblasts
37
Q

diamond blackfan anemia

  • what kind of anemia?
  • presentation?
A
  • pure red aplasia
  • presentation
    • markedly decreased reticulocyte count
    • short stature + thumb skeletal abnormalities
38
Q
A

fanconi anemia

aplastic anemia: skeletal abnormalities + pancytopenia

39
Q
A

fanconi anemia - markedly reduced hematopoiesis in bone marrow

aplastic anemia: skeletal abnormalities + pancytopenia

40
Q
A

black fan diamond anemia

red cell asplasia

41
Q
A

parvovirus

red cell aplasia

PATH Heme-Onc (3 decks)

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