Intro to Anemia Flashcards
Define anemia
decreased O2 carrying capacity of the blood
symptom of other diseases, not a disease itself
How to we measure/test for anemia?
decreased Hb concentration of blood
Main Functional consequences of anemia?
decreased oxygen delivery to tissue
tissue hypoxia in severe cases
6 compensatory mechanisms in anemia
increased 2,3 DPG shunting of blood from non-vital to vital areas increased CO increased RR increased red cell production increased plasma volume
Main Symptoms
weakness, fatigue, marrow expansion/bony abnormalities, pallor, tachycardia, DOE
*symptoms more severe with rapid onset
Functional Classification of Anemias
blood loss
decreased production
accelerated destruction
Morphologic Classification of Anemias
microcytic (normo or hypochromic)
Normochromic/normocytic
macrocytic
Measurements related to red cell mass (3)
Hb, Hematocrit, RBC count
Measurements related to characteristics of the red cells (RBC “indices”)
MCV, MCH, MCHC, RDW
Microcytic anemia DD (3)
iron deficiency, thalassemia, ACD
Macrocytic anemia DD (2)
megaloblastic (impaired DNA synthesis)
-B12/folate defic, drugs, MDS
non-megaloblastic
-reticulocytosis, liver disease, hypothyroidism, drugs
Causes of spherocytes
hereditary spherocytosis, autoimmune hemolytic anemia
causes of target cells
liver disease, splenectomy, hemoglobinopathies
causes of elliptocytes (ovalocytes)
hereditary elliptocytosis, megaloblastic anemia, iron deficiency, myelofibrosis
causes of teardrop cells
megaloblastic anemia, myelofibrosis, extramedullary hematopoiesis
causes of sicked cells
sickle cell disease
causes of fragments/schistocytes
TTP, DIC, malignant HTN
causes of bite cells
oxidant hemolysis (ie/G6PD deficiency)
term for red cell size variablility
anisocytosis
anisocytosis, microcytosis, hypochromia
iron deficiency anemia
causes of howell-jolly bodies (nuclear fragments)
splenectomy, megaloblastic anemia
causes of pappenheimer bodies (iron granules)
splenectomy, iron overload
causes of basophilic stippling (coarse)
talassemias, MDS, lead poisoning
causes of Hb C crystals
HbCC disease, HbSC disease
Cause of rouleaux
decreased repulsive forces between RBCs
occurs w/increased serum proteins
Causes of aggluination
IgM RBC antibodies (cold agglutinins)
Causes of hypersegmented neutrophil
megaloblastic anemia
After blood loss when does reticulocyte count increase and peak?
increases after 2-3 days
peaks after 7-10 days
RBC production sites throughout developments
embryo:yolk sac
fetus: liver
shortly after birth-rest of life: bone marrow
Where do normoblasts obtain iron from?
plasma transferrin for Hb synthesis
What gives reticulocytes their blueish tinge?
residual RNA
What are causes of decreased RBC production?
ineffective erythropoeisis
decreased RBC precursors
anemia of chronic disease
Ineffective erythropoiesis examples
iron deficiency
megaloblastic
MDS
Ineffective erythropoiesis features
increased RDW
dysmaturation of precursors in marrow
decreased RC
inappropriately increased iron absorption from gut
Decreased RBC precursors features
defects in proliferation, stem cell defects with adequate erythropoietin
Decreased RBC precursors causes
congenital or acquired
red cell aplasia or pan aplasia
amrrow replacement, decreased EPO
Normal RBC destruction
after ~120 days
intravascular: breach of membrane in circulation, low freq under normal conditions
extravascular: clearance in reticuloendothelial system as a result of RBC senescence
Does hemolysis always cause anemia?
No, can have hemolysis wihout anemia if bone marrow is able to compensate
Why does extravascular hemolysis occur?
due to decreased RBC deformability, can’t traverse slits in splenic cords and sinusoids, damaged by splenic cordal env, phogcytized by cordal macrophages
