Intro To Anaemia Flashcards
Anaemia can be described as a
1)decrease in ____________
2) decrease in ___________
3)decrease in ____________
4)decrease in ____________
5)decrease in ____________
Red cell mass
Oxygen carrying capacity of the blood
Hb conc of the blood
Pcv of the blood
Red cell count of that blood
In adult male, oxygen delivery is impaired when Hb conc is less than _________
In adult female , oxygen delivery is impaired when Hb conc is less than _________
13g/dl
12g/dl
In children between 6-14 of both sexes, oxygen delivery is impaired when Hb conc is less than _________
12g/dl
In children between 30days- 6yrs of both sexes, oxygen delivery is impaired when Hb conc is less than _________
11g/dl
In children between 0-30days of both sexes, oxygen delivery is impaired when Hb conc is less than _________
13.5g/dl
1g of Hb would bind to ____ml of oxygen
1.34
Hb conc of 15g/dl would contain ____ml of oxygen
Meaning that,
For every ____ml of blood, there is __g of Hb
Which means that for every ____ of blood, ___ml of oxygen
20-1
100;15
100;20.1
___ml = 1dl
100
Hb conc of 10g/dl would contain ____ml of oxygen
13.4
Oxygen tension of blood is the __________
Amount of oxygen present in 100ml of blood
Normal oxygen tension of blood is _______
20 volume %
With decrease in Hb conc of blood, oxygen tension of blood __________
reduces
When oxygen tension of blood is 20volume% , the partial pressure of oxygen in the blood is ____mmHg
100
When the oxygen tension of blood is 15volume%, the partial pressure of the blood is only ____mmHg
40
Arterial blood has oxygen tension of _____ and partially pressure of ——-
Venous blood has oxygen tension of _____ and partially pressure of ——-
20; 100
15; 40
In terms of oxygen tension, the arteriovenous difference sub??
5volume%
4 Physiological adaptations of Anaemia
1)modulation of ______
2)_______ mechanism/______ mechanism
3)________ of blood flow from___ to ____
4)Mechanism to widen the narrowed ________ by bringing down the ____
Hb’s Oxygen affinity
Cardiovascular adaptive/compensatory
Redistribution;less o2 sensitive organs to more o2 sensitive organs
Arteriovenous oxygen difference ; venous oxygen blood tension
Modulation of Hb’s oxygen binding affinity
By oxygen affinity Hb, we mean the ____/_____ with which Hb binds/complexes with oxygen
Avidity
Tenacity
The normal haemoglobin is created in such a way that under ___ partial pressure of oxygen , it avidly combines with oxygen and under ____ partial pressure of oxygen, it readily parts with oxygen
high
low
High oxygen affinity haemoglobin
They bind with oxygen at _________ partial pressure and ____________
High and low
Do not part with oxygen
Low oxygen affinity haemoglobin bind with oxygen at _________ partial pressure of oxygen
Only very high
Low oxygen affinity haemoglobin readily picks up oxygen from the lungs
T/F
F
In anaemic conditions , the love of oxygen by normal haemoglobin is (increased or decreased?)
Decreased
Reduction of oxygen’s affinity by normal Hb is pathological
T/F
F
Physiological
In glycolytic/ _________ pathway, G3P is broken down to _____ which is broken down to _____ so as to generate ____ but ____ is not interested in doing that
Embden-Meyerhoff
1,3PG
3PG
Anaemic Rbc
Anemic rbc converts 1,3 DPG to ______ using _____ enzyme
2,3 DPG
1,3 DPG mutase
A proton is usually emitted when _____________ happens
Hb complexes with oxygen
HHb + o2 ——> ______ + ____
Hbo2-
H
Hbo2- is known as _______
Oxyhemoglobin
Oxyhemoglobin is found in the acidic or alkaline milleiu?
Acidic
The mechanism by which 1,3 DPG is converted to 2,3 DPG is called ____________ pathway or _________ shunt
Energy clutch
Rapoport lubering
Rapoport lubering shunt generates ATP
T/F
F
In Anaemic rbcs, Hb exists as ???
HHb or Hbo2-
HHb
________ stimulates 1,3 DPG mutase
Alkalinity of the cytoplasm of the anaemic rbc
2,3 DPG is that molecule that is capable of complexing with ____ and allow ____ to be ________at ______ partial pressure of oxygen and permits oxygen to be ____
Hb
O2
Detached from Hb
Low
Moved into the tissue
We say that ______________ is the most important adaptive mechanism to anemia
Generation of 2,3 DPG
The hypoxia of blood vessels results in ___________
Vascular dilatation
Hypoxia of blood vessels leads to ____eased peripheral resistance
Decr
The HR changes in anemia to as high as ___ or ____ bpm or more
90
100
In Anaemia, CO is affected
T/F
T
Cardiac output = ___ x ___
SV
HR
Normal
CO?
SV?
HR?
5L
70ml
72bpm
What is the oxygen carrying capacity of the normal CO of the body?
1000ml
Out of the 1000ml of oxygen that reaches the body at each pump,the body only requires about ____ml of oxygen per minute
250
Out of the essential 250ml of oxygen that the body needs per minute, the brain alone consumes about __ml of it, the heart consumes about __ml of it, while the muscle mass consumes about __ml of it
60
50
60
The oxygen sensitive tissues of the body includes the ____,_____, and ____
Heart
Brain
Skeletal muscle
Cardiovascular adaptive mechanism is equally vital as a survival mechanism as much as the modulation of Hb’s oxygen affinity
T/F
T
The cardiovascular adaptive mechanism has no energy implications
T/F
F
It does
The cardiovascular adaptive mechanism will easily fail if the Hb conc falls to the extreme
T/F
T
The failure of ______ is usually the cause of death in severe anaemic conditions
The cardiovascular adaptive mechanism
The cardiovascular adaptive mechanism is effective when the Hb conc is between ______ g/dl
7 and 8
With the Hb conc of ______ , the cardiovascular adaptive mechanism will fail
Less than 7g/dl
We define severe Anaemia in adults as Hb conc being ______because at this level , _________ would appear and at __________ the whole thing would fail
Less than 8g/dl
Features of failure of cardiovascular adaptive mechanism
7g/dl
In children less than ____ years, The cardiovascular adaptive mechanism may not fail until the Hb conc level is ____ or below
5
5g/dl
The feature of The cardiovascular adaptive mechanism is :
- Very high ________
- ______ failure
- _______ failure
Heart rate
Right ventricular heart
Left ventricular heart
Right ventricular heart failure usually manifests as:
- Raised ———-
2.________/________
3._______ - _____ dependent ______
Jugular venous pressure
Hepatomegaly/hepatoplenomegaly
Ascites
Gravity; leg edema
Ascites = excess ________
Abdominal fluid
Left ventricular heart failure results in _____ edema which basically ______ the anemic patient to death
Pulmonary
Chokes
_____ murmurs in the lungs occurs as a result of Anaemia
Haemic
The kidney requires ___ml of oxygen per minute to stay alive even though the blood delivered to it per minute is as much as ____ml but this su for the purpose of _____
4
100
Filtration
In Anaemia, which is more,
Plasma or red cell mass?
Plasma
If the cause of the anemia is not due to bone marrow failure , another adaptive mechanism is _________
Increase in erythropoiesis
Anaemia is classified broadly into 2
1) ________ classification
2)___________ classification
Morphological
Etiological
MORPHOLOGICAL CLASSIFICATION
3 types
1)________________
2)__________________
3)_______________
Macrocyctic normochromic
Microcytic hypochromic
Normocytic normochromic
Macrocyctic normochromic
-Cell size is ________
-cell Hb content is ______
-impairment in ________ and not ________
-aka_________
Large
Normal
DNA synthesis; rna transcription
Megaloblastic Anaemia
Microcytic hypochromic
-Cell size is ________
-cell Hb content is ______
-impairment in ________ and not ________
Small
Small
Heme synthesis; dna synthesis
Normocytic normochromic
-Cell size is ________
-cell Hb content is ______
-usually associated with ______ disorders
-AKA __________
Normal
Normal
Chronic
Anaemia of chronic disorders
ACD
_________
Anaemia of chronic disorders
Etiological classification
1) Anaemia of _______ / _____ Anaemia
2) Anaemia of decreased _______/ ____ Anaemia
3)Anaemia of __________ failure
Blood loss; hemorrhagic
Cell survival; hemolytic
Bone marrow
Hemorrhagic Anaemia can be either _____ or ______
Acute or chronic
Commonest cause of acute hemorrhagic Anaemia is ____________
Ghastly road traffic accident
Acute obstetric Hemorrhage : include obstetric conditions such as
1)______
2)______
3)_____
4)_________
Placenta previa
Abruptio placenta
Ectopic gestation
Uterine rupture
Placental retention can lead to bleeding which is an example of ___________ hemorrhage
Post partum
In Post partum hemorrhage due to placenta retention, the woman has given birth , but ___________ due to ————
The placenta doesn’t come out
It’s adherence
Bleeding as a result of snake poison or another poisonous animal
Acute or chronic hemorrhagic Anaemia?
Acute
Vomiting of blood is ______
Coughing out blood is ______
Sneezing out blood is ______
Hematemesis
Hemoptysis
Epistaxis
DIC = ___________
Disseminated intravascular coagulopathy
DIC
Acute or chronic haemorragic anemia?
Acute
Causes of hematemesis
Mention 4
Gastric ulcerations
Gastric carcinoma
Duodenal ulcers
Esophageal varices
Epistaxis is usually a phenomenon associated with ______/_____
Weakened blood vessels
Loss of integrity of blood vessels
Causes of hemoptysis includes:
1) chronic chest infections such as _____
2)____ disorders such as _______
3)____/_____ cancer
4)______ failure
5)pulmonary _______
TB
Collagen;wegners granulomatosis
Lung; bronchial
Heart
Infarctions
Epistaxis may be a feature of
________________
Systemic diseases such as _________
Impairment of ___________
Severe hypertension
Thrombocytopenia
Platelet functions
Bleeding into the stool
Aka
————
Haematochezia
Haematochezia may be as a result of _________ or ________
Upper GIT bleeding
Lower GIT bleeding
Haematochezia of upper GIT bleeding usually presents with ______ stooling
Malena
Malena stooling is the passage of ___ colored, _____ smelling faeces
Dark
Foul
The causes of upper GIT Haematochezia is the same as the causes of hematemesis
T/F
T
Haematochezia of lower GIT bleeding may be as a result of:
1) _______
2)colonic ______
3) colonic _______
4)colonic ______
5)_______
Bleeding hemorrhoids
Polyposis
Diverticulosis
Carcinoma
Anal tear
Haematochezia
Inapparent GIT blood loss can also be caused by ________ eg ______
Intestinal parasite
Hookworm
Bleeding from/into the urethra is called _______
Hematuria
Hematuria may be as a result of a pathology in ____,_____,_____ or _____
Kidney
Ureter
Urethra
Bladder
Hematuria as a result of pathology in kidney could be caused by :
___________
Renal ________
Kidney ______
Pyelonephritis
Papillary necrosis
Cancer
Renal Papillary necrosis occurs in patients with ______ disease
Sickle cell
Example of a kidney Cancer
Wilm’s tumor
Hematuria as a result of pathology in ureter could be caused by :
________ resulting in ______
Ureteric stones
Ureteric surface erosions
Hematuria as a result of pathology in bladder could be caused by :
1)infestations such as _________
2)bladder _____
3)___________
Schistosoma hematobium
Cancer
Erosion due to stones
Hematuria as a result of pathology in urethra could be caused by :
Urethral ________/______ as a result of ____________
Destruction
Fibrosis
Post gonococcal infections
In urethral fibrosis, a ______________ is inserted to dislodge and open the fibrosis. This is done using (short or long?) acting but deep anaesthesia such as _______
Bougienage
Short
Epontol
Menorrhagia is as a result of
____itis / ____itis
_____ /_______ cancer
Bleeding __________
Dysfunctional _________
Cervicitis; vaginitis
Cervical; endometrial
Endometrial fibroid
Uterine bleeding
Haemathrosis is _______
Hematoma is _______
Bleeding into joints
Bleeding into soft tissues
Haemathrosis and Hematoma are seen in patients with ______ disorders or ________ deficiencies
Eg, a patient with ______
Coagulation
Coagulant protein
Hemophilia
Bleeding into the skin is referred to as ______
Purpura
Purpura could be as a result of :
1)_______ disorders (both ____ and ___)
2)________ disease
3)vascular collagen disorder like _____
Platelets; qualitative and quantitative
Von willebrand
Ehler danlos syndrome
2 causes of hemolytic Anaemia?
Intra corpuscular pathology
Extra corpuscular pathology
Intra corpuscular pathology( as a result of ______)
Extra corpuscular pathology(as a result of ________)
The red cell itself
The red cell environment
Intra corpuscular pathology is of 2 types
List them
Red cell membrane pathology
Cytoplasmic pathology
Red cell membrane pathology is of 2 types
List them
Acquired membrane pathology
Inherited membrane pathology
Acquired membrane pathology usually leads to ________________, as a result of deficiency of _______
Parapxysmal nocturnal hemoglobinuria
Decay attack mechanisms
In Acquired membrane pathology , __________ proteins which are capable of ________ the ____ that make up the rbc membrane
Perforator
Lysin/dissolving
Lipids
Perforator proteins are usually a product of _________
Complement protein activation
There are some mechanisms on the rbcs membrane that is able to to see and neutralize the activated complement proteins and causing them to decay
T/F
T
Acquired membrane pathology is as a result of _________
Zeid’s triad
Zeid’s triad consists of ???
Alcoholic liver disease
Hyperlipidemia
Hemolytic Anaemia
Severe alcoholics are those who take atleast ___g of alcohol everyday for atleast _____ years
80
10
Zeid’s triad
In severe alcoholics , the liver is unable to properly _________ hence they _______ , causing __________ which then migrated to the ________, which leads to that cell to be _________ leading to ____
Biodegrade lipids
move back into the plasma
Hyperlipidemia
Membrane of rbcs
Permanently removed from the circulation
Anaemia
5% of alcohol = ____
5g of alcohol in 100ml
Inherited membrane pathologies
List 6
Inherited membrane pyropoikilocytosis
Inherited membrane acanthocytosis
Inherited membrane spherocytosis
Inherited membrane stomatocytosis
Inherited membrane ovalocytosis
Inherited membrane elliptocytosis
There are 2 types of cytoplasmic pathologies
List them
Enzymopathies
Hemoglobinopathies
Enzymopathies and Hemoglobinopathies would result in _______ Anaemia
Hemolytic
Enzymopathies are of 2 types
1)deficiency of enzyme in the ______ pathway
2) deficiency of enzyme in the _______ pathway
Glycolytic
HMP
Glycolytic pathway enzyme deficiency only includes some of the enzymes in the pathway
T/F
F
Involves all
The commonest enzymes deficient in the Glycolytic pathway enzyme deficiency group is ????
Hexokinase
Putivate kinase
Glycolytic pathway enzyme deficiency eventually leads to ________ of the red cell
Osmotic lysis
The reducing power of the red cell is ____?
NADPH2
Deficiency of enzyme reducing power:
NADPH2 is required by the red cell to ___________ macromolecules , including membrane ________ and _____
Reduce oxidized membrane
Proteins and Lipids
When the valency points of carbon atom is fully occupied by ___ atoms, they can get detached if you bring _____ like _____ near it, leading to the formation of _______ which allows for way breakage between the carbon atoms
Hence , with each oxidation of the carbon skeleton of membrane protein or lipids, it’s gets closer to its destruction point
Oxidant; H2o2
Double of triple bonds
What the rbc uses to reduce oxidized macromolecules is ??
Glutathione (GSH)
Glutathione is a ___peptide consisting of ??
Tri
Glutamine
Cysteine
Methionine
The 2 enzymes involved in Glutathione formation are
1) _____________ in the rbc which helps to link ________
2)________ in the rbc which links _____ to form _____
Gamma-glutamyl-cysteinyl transferase
Glutamic acid to cystein
Glutathione synthase
Methionine; Glutathione
Glutathione is written as ____ to show that there’s a presence of a ____ containing amino acid which has a _______ attached to it and can be used to _______________________ from membrane macromolecules
GSH; sulfur
hydrogen atom
replace any H atom that has been detached
Reduced state of carbon means when carbon is ______
Fully hydrogenated
GSH, when used to replenish H atoms becomes ___ which is _____. Therefore 2 glutathione link together to become a stable compound ‘ _____ ’ with the help of __________ enyme.
GS; unstable
GSSG
glutathione peroxidase
_____ is oxidized glutathione
GSSG
GSSG must be reduced to ____ because __________________. This is where we need the red cell ______ which is _____
GSH
the red cell doesn’t have unlimited capacity to keep synthesizing GSH
reducing power
NADPH
One GSSG is reduced to _________ by ____ enzyme with the help of NADPH2
2 GSH
Glutathione reductase
Nadp has to be recycled to NADPH2
T/F
T
Nadp has to be recycled to NADPH2. For this to happen, we need a molecule of ______ to be converted to ______ (instead of ________) using ________ enzyme .
This is done using ________ pathway
glucose 6 phosphate
6phosphogluconate
fructose 6 phosphate
glucose 6 phosphate dehydrogenase
Hexosmonophosphate shunt pathway
Bone marrow fat (BMF) is located in the bone marrow cavity and accounts for ___% of adult bone marrow volume.
70
O2 tension 15% ; partial pressure =____mmHg
40
1g of Hb= ____ml of oxygen
10g/dl pf Hb =____ ml of oxygen
15g/dl pf Hb =_____ ml of oxygen
100 ml of blood= ___g of Hb
1.34
13.4
20.1
15
Anaemia occurs if Hb levels drop below these
5yr old- ___g/dl
0-30 days- ____g/dl
30days-6yrs- ___g/dl
6-14 yrs old- ____g/dl
Adult male- _____g/dl
Adult female-____ g/dl
5; 13.5
11; 12
13;12
Normal Hb levels
For adult males: _____ to ____ grams per deciliter (g/dL) of blood
For adult females:____ to ____ g/dL of blood
13.5 to 17.5
12.0 to 15.5
Burr cell - occurs due to _____ defecienccy
Schistocytes- occurs in ___,_____,____
Macro-ovalocytes- occurs in ______
Target cells occurs in ????
Pyruvate kinase
HUS, TTP, DIC
Megaloblastic anaemia
HALT( HbC Asplenia, liver disease , thalassemia)
Burr cell - AKA _______
Schistocytes- AKA _______
Spur cells AKA _______
Target cells AKA _______
Echinocyte
Helmet cells
Acanthocyte
Codocyts
