Intro to Anemias (Exam 2) Flashcards
What is directly proportional to the amount of hemoglobin and size of RBC?
MCH
What are the 3 classes of anemias based on RBC indices?
test q
1) microcytic hypochromic (decreased MCV, MCH, and MCHC)
2) normocytic normochromic (normal MCV, MCH, and MCHC)
3) macrocytic normochromic (increased MCV and MCH, normal MCHC)
What are the general signs and symptoms of all anemias?
test q
-pallor
-heart palpitations
-muscular weakness
-fatigue
-rapid heart rate
-heart attack
-dizziness
-chest pain
-fainting
-SOB
What does a CBC show for someone to be diagnosed with anemia?
decreased RBC, Hb, Hct
A CBC shows decreased RBC, Hb, and Hct. What test is needed next for an official diagnosis?
RBC indices
What anemia category is thalassemia?
microcytic hypochromic (decreased MCV, MCH, and MCHC)
What anemia category is iron def anemia?
microcytic hypochromic (decreased MCV, MCH, and MCHC)
What anemia category is lead poisoning?
microcytic hypochromic (decreased MCV, MCH, and MCHC)
What are the 2 subcategories for normocytic normochronic anemias?
hemolytic and nonhemolytic
What anemia category is sickle cell disease?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is HgbSC and HgbC?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is G6PD?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is PNH?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is HDN?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is hereditary spherocytosis?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is microangiopathic anemia?
hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is aplastic anemia?
non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is myelophthisic anemia?
non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is hemorrhagic anemia?
non-hemolytic normocytic normochormic (normal MCV, MCH, and MCHC)
What anemia category is vit B12 and vit B9/folate def?
macrocytic normochromic (increased MCV and MCH, normal MCHC)
-blood disorder characterized by abnormal production of hemoglobin
-inherited in an autosomal recessive pattern
-not enough globin chains are made***
-chains are normal in structure but not enough of them
thalassemia
What are the 2 types of thalassemia?
alpha and beta (based on which globin chain is affected)
What is another name for beta thalassemia?
thalassemia major or hemoglobin F disease
Is thalassemia congenital or acquired?
congenital
-inherited blood disorder
-autosomal recessive
-reduced or absent production of beta globin chains**
-sometimes called hemoglobin F disease bc of increased amounts of HbF
beta thalassemia/thalassemia major
beta thalassemia/thalassemia major results in 2 things. What are they?
1) poor erythropoiesis
2) excessive destruction of RBCs= hemolysis
beta thalassemia/thalassemia major is common in who?
mediterraneans, middle eastern, asian descent
What anemia has these lab findings?
-severe anemia with extremely low RBC, Hgb, and Hct
-microcytic hypochromic
-polychromasia
-increased reticulocyte count
-anisocytosis
-poikilocytosis
-target cells
-decreased osmotic fragility
beta thalassemia/thalassemia major
What would hemoglobin electrophoresis show for beta thalassemia/thalassemia major?
test q
-increased HbF
-increased HbA2
-absent or severely reduced HgA
What anemia has these signs and symptoms?
-severe anemia
-distortion of skull, facial bones, and long bones
-slow growth
-cardiac dysfunction and failure due to iron deposits in cardiac muscle
-hepatomegaly
-splenomegaly
-prehepatic/ hemolytic jaundice (unconjugaed bilirubin)
beta thalassemia/thalassemia major
What are the most common imagining findings for beta thalassamia/thalassemia major?
compensatory bone marrow expansion and iron overload seen on Xray, MRI, or CT scan
What anemia has these xray findings?
-cortices of skull and long bones are thinned= osteoporosis= fractures
-skull has hair on end appearance
-spine has honeycomb pattern
-hemolytic facies: frontal bossing, maxillary hypertrophy, malar prominence
test q
beta thalassamia/thalassemia major
What are the 2 ways we get the iron we need?
diet and RBC breakdown
hemoglobin breaks down to
heme, AAs, and iron
T/F: heme is reused for heme synthesis
true
What form does iron have to be in to be absorbed in gut?
ferrous form
most iron in food is in what form?
ferric form
What enhances iron solubility?
stomach acidity
Once released in blood, ferrous iron is bound to and carried by?
test q
transferrin (iron biomarker!!)
Where does most iron go once its in the blood?
bone marrow for erythropoiesis (and what doesn’t, gets stored)
Transferrin is a protein that transports iron through the blood to tissues like….
liver, spleen, and bone marrow
Iron is converted to and stored as a protein iron complex called?
test q
ferritin
Most iron is stored where?
test q
liver
excess iron, not stored as ferritin, deposited most commonly in macrophages
hemosiderin
What are the 10 steps of iron metabolism?
1) RBC breakdown (heme->iron and bilirubin) and dietary iron
2) stomach acidity enhances absorption
3) iron absorbed into intestinal cells
4) ferric -> ferrous form in intestines
5) iron released from intestines in ferrous form
6) ferrous iron bound to transferrin
7) some carried to organs
8) some iron combines with apoferritin to form ferritin
9) ferritin stored in liver (some stored within cells as hemosiderin)
10) iron released as needed
What are the specific tests for iron deficiency?
test q
-serum iron
-serum ferritin (storage form)
-TIBC (total iron binding capacity)/transferrin
-transferrin saturation
Serum iron reflects only the…
iron bound to transferrin
decrease in serum iron indicates….
-iron def anemia***
-chronic blood loss
-malignancies
-active collagen diseases
-chronic infections preventing iron usage from storage areas
increase in serum iron indicates….
-hemosiderosis*
-hemochromatosis*
-intravascular hemolysis
What iron test reflects iron stores in the body?
serum ferritin (bc ferritin stores iron)
What is a reliable early indicator of iron deficiency anemia?
serum ferritin bc it reflects iron stores
decrease in ferritin=
iron def anemia (no iron= no stored iron)
increase in ferritin indicates…..
-iron overloading diseases like hemosiderosis and hemochromatosis
-megaloblastic anemias and hemolytic anemias
Which iron test measures the percentage of transferrin that is saturated with iron?
test q
transferrin saturation
increased levels of iron will saturate the transferrin
low iron= no iron to saturate transferrin***
we like to have about 45% saturation in normal cases
decreased transferrin saturation indicates….
iron def anemia or chronic illness bc theres no fe or low fe to saturate
increased transferrin saturation indicates….
-hemosiderosis
-hemochromatosis
-hemolytic anemias
-iron overdose
If iron levels are low, what does that mean for the binding sites?
test q
increased binding sites are available
Which iron test is this?
-measures the ability of transferrin to bind to iron
-measures the amount of iron that circulating transferrin could bind if fully saturated
total iron binding capacity (TIBC)/ transferrin
increased number of binding sites =
iron def anemia or blood loss
T/F: ferritin can be elevated in cases of inflammation, infection, or other chronic disease, even when iron stores are low
true
What is the most common anemia in the US?
iron def anemia
We need iron to make hemoglobin, iron deficiency impairs….
heme synthesis
What are the 3 broad causes of iron def?
1) inadequate iron supply (consumption of foods low in iron or impaired absorption of iron)
2) increased iron requirements due to physiologic stress (kids growing, pregnancy, lactation, menstruation)
3) increased iron requirements due to pathologic causes (chronic blood loss)
Iron def anemia in an adult is almost always due to….
chronic blood loss
What are the 3 most common causes of blood loss for adults?
test q
1) menstrual bleeding
2) chronic bleeding in males and post-menopausal females (cancers, ulcers)
3) test for occult blood in stool (fancy name for blood in stool= melena) , the test for diagnosis is called guaiac test
What are the 3 signs and symptoms of iron def anemia?
1) cheilitis
2) koilonychia
3) glossitis
What is cheilitis?
inflammation around mouth
What is koilonychia?
“spoon nails”
What is glossitis?
inflammation of tongue
What are the 3 weird cravings (pica) that people with iron def anemia have?
1) geophagia (dirt)
2) pagophagia (ice)
3) xylophagia (paper)
What anemia would have these lab results?
-decreased RBC, HGB, HCT
-decreased MCV, MCH, and MCHC
-decreased serum iron, ferritin, and transferrin saturation
-increased transferrin/TIBC
iron def anemia
What is a rare form of iron def anemia that mostly occurs in postmenopausal women and presents in a triad?
plummer-vinson syndrome
What is the triad of plummer-vinson syndrome?
1) esophageal webs (must perform barium swallow to see webs)
2) dysphagia (difficulty swallowing)
3) iron def anemia
Which anemia is this?
-microcytic hypochromic anemia
-iron is inadequately used to make hemoglobin, despite normal amounts of iron
-dysfunctional heme synthesis
sideroblastic anemia
What is another name for lead poisoning?
plumbism
What does lead do to the body?
-lead replaces calcium in bones
-interferes with heme synthesis= microcytic hypochormic anemia
-causes interstitial nephritis
-interferes with neurotransmitters
-high levels affects BBB and leads to encephalopathy, seizures, and coma
Lead replaces what in bones?
calcium
What are the 5 major effects of lead poisoning?
1) anemia
2) damage to the CNS
3) slowed growth and development
4) learning and behavioral problems
5) hearing and speech problems
What is lead poisoning caused by?
inhalation of lead dust or fumes, or ingestion of lead
Children are at an increased risk of lead poisoning because…..
test q
-incomplete development of BBB
-children frequently put their hands in mouth and eat items that are not food
What are some signs and symptoms of lead poisoning?
test q
-headaches*
-abdominal pain*
-irritability
-reduced sensations
-aggressive behavior
-difficulty sleeping
-poor appetite
-constipation
-anemia
Burton’s lines are thick black-blue lines visible along the margin of the gums and at the base of teeth. What patients have Burton’s lines?
chronic lead poisoning
What anemia would have these lab findings?
-blood serum lead levels
-basophilic stippling of RBCs seen on blood smear
lead poisoning
What is the definitive way to know if someone has lead poisoning?
blood serum lead levels
Is there any safe level of lead?
NO
