icr: ANEMIA

Question 1

pancytopenia

Answer 1

decrease in RBC, WBC, and platelets

Question 2

normal HB

Answer 2

12-16 for female; 14-18 for males

Question 3

normal HCT

Answer 3

37-47 female; 40-54 male

Question 4

African American hb and hct is…

Answer 4

lower than caucasians

Question 5

leukopenia

Answer 5

decreased WBC

Question 6

thrombocytopenia

Answer 6

decreased platelets

Question 7

aerobic exercise tends to _____ hb and hct

Answer 7

lower

by increasing plasma volume and increasing erythrocyte 2,3DPG synthesis

Question 8

in pregnancy, what increases? what falls?

Answer 8

plasma volume, RBC mass increase

MCV and Hb fall

Question 9

O2 delivery =

Answer 9

cardiac output x O2 carrying capacity

Question 10

symptoms of insufficient oxygen delivery

Answer 10

fatigue, irritability, confusion, poor focus, dyspnea on exertion, angina, mental status changes, pallor,(all indicate anemia)

Question 11

if MCV is increased…

Answer 11

large RBC = nuclear problems

megaloblastic anemia, myelodysplastic anemia, chemo induced

Question 12

if MCV is low ..

Answer 12

small RBCs = cytoplasmic problem

iron deficiency anemia, abnormal Hb

Question 13

HCT

Answer 13

the percentage of blood occupied by RBC

CALCULATED, NOT measured

Question 14

what is the best measure of oxygen carrying capacity?

Answer 14

Hemoglobin

Question 15

MCV

Answer 15

size of individual RBC; allows categorization of macrocytic, normocytic, or microcytic

Question 16

high RDW means…

Answer 16

there is more than one population of RBCs

Question 17

saturation %

Answer 17

iron/transferrin ratio

Question 18

iron deficiency vs chronic disease vs pregnancy

Answer 18

distinguished by transferrin

increases in iron deficiency, decreases in anemia of chronic disease, and slightly increased in pregnancy

Question 19

iron is increased

Answer 19

in hemolytic anemia; when serum iron turnover is fast

Question 20

reticulocytes (ARC)

Answer 20

slightly blue due to residual RNA;

hypo 100,000

Question 21

HIGH reticulocytes means

Answer 21

acute blood loss or RBC destruction

Question 22

causes of iron deficiency anemia

Answer 22

iron malabsorption
transferrin deficiency
loss of iron

Question 23

ferritin vs transferrin

Answer 23

f stores iron; t transports it

Question 24

symptoms of iron deficiency

Answer 24

headache
glossitis
pica
leg cramping
somatitis

Question 25

B12 deficiency

Answer 25

via lack of intake(meat/dairy) or impaired absorption (r binder, intrinsic factor from parietal cells) marrow arrested in S phase --> increased RBC size ***inverse relationship of severity of anemia and neurologic disease SYmptoms: anemic signs, glossitis, dementia, ipersonality change, loss of vibratory and position sense larger MCV, oval, hypersegmented neutrophils

Question 26

B12 is necessary for

Answer 26

DNA synthesis

Question 27

normal B12 absoprtion

Answer 27

b12 binds to gastric r binder parietal cells release intrinsic factor b12-r binder dissociate in duodenum due to pancreatic proteases B12 and IF bind --> absorbed in distal ileum

Question 28

sickle cell anemia

Answer 28

``` abnormal Hb (glutamate instead of valine at 6th position of beta chain) HbS becomes polymerized in times of low Oxygen--> sickling--> microvascular infarcts and severe anemia ``` sickle cells and target cells

Question 29

``` 1- acanthocyte 2- echinocyte 3 - elliptocyte 4 - schistocyte 5 - sickle cells 6 - spherocyte 7 - stomatocyte 8 - codocyte/target cell 9 - dacrocyte ```

Answer 29

``` 1 spines w irregular lengths and spacing 2 short rounded even spaced spines 3 oval and elongated 4 fragmented, crescent with a few spines 5 crescent, pointy ends 6 small spheres with no central pallor 7 slit like center 8 thin cell, increased diameter Hb 9 tear drop ```

Question 30

what disease has a majority of TARGET cells

Answer 30

thalassemia

Question 31

bite cells -->

Answer 31

G6PD deficiency

Question 32

Hgb is measured

Answer 32

directly

Question 33

microcytic anemias

Answer 33

``` CELTICS chronic disease eHgb lead poisoning thalassemis iron deficiency cancer sideroblastic ```

Question 34

normocytic anemias

Answer 34

early renal or early chronic disease sickle cell hemolytic hemorrhage

Question 35

macrocytic anemias

Answer 35

b12/folate, alcohol, meds, thyroid, reticulocytosis, aplastic anemia,

Question 36

hepcidin

Answer 36

iron absorption regulator

Question 37

iron deficient anemia synptoms

Answer 37

pica pallor glossitis koilonychias of nails

Question 38

in IDA, TIBC is? ferritin is?

Answer 38

``` tibc high ferritin low ( ```

Question 39

when is ferritin high?

Answer 39

not IDA | it is in inflammatory states

Question 40

in anemia of chronic disease, MCV is

Answer 40

initially normocytic, but become microcytic

Question 41

labs of anemia of chronic disease

Answer 41

``` high esr or crp normal or high ferritin normal or low tibc normal or low iron increased IL6 increased hepcidin ```

Question 42

in anemia due to chronic kidney disease...

Answer 42

underproduction of EPO (produced in the kidneys in adults) | low reticulocyte count and increased inflammation

Question 43

pernicious anemia

Answer 43

destruction of parietal cells -> b12 cant be absorbed (no intrinsic factor)

Question 44

B12 is a cofactor for two rxns

Answer 44

1) methylation of homocyteine to methionine by homocsteine methyltransferase 2) methylmalonyl coa --> succinyl coa by methylmalonyl coa mutase

Question 45

b12 molecules has

Answer 45

cobalt (cobalamin) - picks up the methyl from FH4

Question 46

folate vs b12 def

Answer 46

``` foalte = low folate, high homocysteine (NO NEURO symptoms) b12 = normal folate, low b12, high homocycteina and methylmalonic acid ```