Krafts- Anemia Flashcards
What are the most important causes of IDA?
GI Bleed
Menorrhagia in premenopausal women
What are the signs of IDA?
Pale, spoon nails, smooth tongue, PICA
What is the morphology of IDA?
Hypochromic and microcytic cells
Anisocytosis and Poikilocytosis
Decreased Reticulocytes
What are the labs for IDA?
Decreased serum Fe
Increased TIBC
Decreased Ferritin
What are the three types of anemia related to size and what happens in a nut shell?
IDA:
Decraesed iron–> decreased Hb–> Decrased RBC prod–> Anemia
Thalessemia:
Genetic defect in Hb–> make less Hb (protein that binds O2 in RBCs)–> fewer RBCS–> Anemia
Megaloblastic Anemia:
Inhibition of DNA–> decreased production of RBC–> Anemia
What is thalessemia?
When you have a defect in Hb and you can’t make enough alpha or beta chains
What are the characteristics of Apha Thalassemia?
Deletion of alpha genes–> not enough alpha chain and excess/unpaired beta
More common in asians and blacks
Carrier and thal trait: asymptomatic
HbH disease: mod to severe
Hydrops fetalis: fatal in utero
What are the characteristics of beta thalassemia?
Defective beta chains–> leads to a decrease in the amt of beta chains in Hb–> excess/unapired alpha chains
Mediterraneans, blacks, asians
Thal minor: asymptomatic
Thal major: variable severity, usually presents in infancy
What is the morphology of Thalessemia?
Target cells
Hypochromicc and microcytic
ansiocytosis and poikilocytosis depending on severity
Increased RBC count
What are the characteristics of Megaloblastic Anemia?
Defective DNA synthesis
Nuclear/cytoplasmic asynchrony–> HUGE cytoplasms w/ immature nuclei
Deficiency in B12/Folate
Macrocytic anemia w/ oval macrocytes and hypersegmented neutrophils
What are the anemias of abnormal shape?
- Hereditary Spherocytosis
- AIHA
- Sickle Cell
- G6PD Def
- MAHA
What are the characteristics of hereditary spherocytosis including the triad of clinical sxs?
Genetic defect in spectrin–> loss of SA–> Spherocyte
Normochromic, normocytic, w/ TONS OF SPHEROCYTES
Splenectomy
Triad: Jaundic, Anemia, Splenomegaly
What is Warm Autoimmune Hemolytic Anemia (WAHA)?
For unknown reasons/infection/autoimmune disorder >
Your IgG starts to coat RBCs when it’s WARM >
Macrophages DIGEST or BITE RBC >
Spherocytes or Bite cells (b/c the membrane is compromised) >
Spherocytes get stuck in spleen and are destroyed >
Warm Autoimmune Hemolytic Anemia
warm is GOOD–> IgG
What is cold autoimmune hemolytic anemia?
infection or lympoproliferative disease >
IgM and complement coating RBC >
IgM falls off in warm body parts, but in cold forms bridges across RBCs leading to clumbing
Complement- lyses RBCs
>
Hemolysis aggravated by the cold
How do you diagnose both warm and Cold AHA?
DAT
What is sicle cell anemia (hemoglobinopathy)?
Genetic Defect (more common in blacks)>
Pt mut in beta chain of Hb (V–> G)>
RBC assumes sickle shape>
vaso-occlusion and hemolysis>
Splenectomy>
Nucleated RBC, Target cells, Howell-Jolly Bodies, Pappenheimer bodies
What is G6PD Deficiency?
*You need G6PD to generate NADPH so that glutathione can remove ROS from cells.
Exposure to oxidants (fava beans, drugs) overwhelms your system>
Can’t reduce ROS >
ROS attacks Hb>
Hb breaks down, globin denatures and sticks to RBC membranes >
HEINZ body>
Spleen bites out Heinz body>
Bite cell
What is microangiopathic hemolytic anemia (MAHA)?
Micro-angiopathic (Small blood vessels)
Increased coagulation factors in small blood vessels>
RBC getting cut by fribrin>
Physical trauma>
Sphistocytes/Traingulocytes>
Spleen destroys
ANEMIA
What are the anemias of normal size and shape?
Anemia of blood loss
Anemia of chronic disease
Anemia of renal disease
Anemia of liver disease
Aplastic anemia
How does anemia from normal blood loss appear?
Trauma–> blood loss at first does not present as anemia because blood still looks normal. After 2-3 days reticulocytes appear indication that new blood is being made.
What is anemia of chronic disease?
Infection or inflammation (IL-7) causes the overproduction of hepcidin which leads to the increase in Fe storage. An increase in iron storage presents as anemia.
How can anemia occur with liver disease?
W/ end-stage kidney failure, there is a lack of EPO, leading to malformed RBCs call echinocytes–spiny RBCS.
What percentage of pts w/ liver disease have anemia and what do cells look like?
3/4 of pts w/ liver disease are anemic
there are multiple causes
Cells are acanthocytes. Pointy spikes off a round cell.
What is aplastic anemia?
Aplastic = empty
Bone marrow/cells are damaged>
Pancytopenia (reduced number of RBC/WBC produced)>
Blood smear/bone marrow look empty>
Anemia
*idiopathic, drugs, viruses, pregnancy
