Krafts- Anemia

Question 1

What are the most important causes of IDA?

Answer 1

GI Bleed

Menorrhagia in premenopausal women

Question 2

What are the signs of IDA?

Answer 2

Pale, spoon nails, smooth tongue, PICA

Question 3

What is the morphology of IDA?

Answer 3

Hypochromic and microcytic cells

Anisocytosis and Poikilocytosis

Decreased Reticulocytes

Question 4

What are the labs for IDA?

Answer 4

Decreased serum Fe

Increased TIBC

Decreased Ferritin

Question 5

What are the three types of anemia related to size and what happens in a nut shell?

Answer 5

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

Question 6

What is thalessemia?

Answer 6

When you have a defect in Hb and you can’t make enough alpha or beta chains

Question 7

What are the characteristics of Apha Thalassemia?

Answer 7

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

Question 8

What are the characteristics of beta thalassemia?

Answer 8

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

Question 9

What is the morphology of Thalessemia?

Answer 9

Target cells

Hypochromicc and microcytic

ansiocytosis and poikilocytosis depending on severity

Increased RBC count

Question 10

What are the characteristics of Megaloblastic Anemia?

Answer 10

Defective DNA synthesis

Nuclear/cytoplasmic asynchrony–> HUGE cytoplasms w/ immature nuclei

Deficiency in B12/Folate

Macrocytic anemia w/ oval macrocytes and hypersegmented neutrophils

Question 11

What are the anemias of abnormal shape?

Answer 11

1. Hereditary Spherocytosis
2. AIHA
3. Sickle Cell
4. G6PD Def
5. MAHA

Question 12

What are the characteristics of hereditary spherocytosis including the triad of clinical sxs?

Answer 12

Genetic defect in spectrin–> loss of SA–> Spherocyte

Normochromic, normocytic, w/ TONS OF SPHEROCYTES

Splenectomy

Triad: Jaundic, Anemia, Splenomegaly

Question 13

What is Warm Autoimmune Hemolytic Anemia (WAHA)?

Answer 13

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

Question 14

What is cold autoimmune hemolytic anemia?

Answer 14

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

Question 15

How do you diagnose both warm and Cold AHA?

Answer 15

DAT

Question 16

What is sicle cell anemia (hemoglobinopathy)?

Answer 16

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

Question 17

What is G6PD Deficiency?

Answer 17

*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

Question 18

What is microangiopathic hemolytic anemia (MAHA)?

Answer 18

Micro-angiopathic (Small blood vessels)

Increased coagulation factors in small blood vessels>

RBC getting cut by fribrin>

Physical trauma>

Sphistocytes/Traingulocytes>

Spleen destroys

ANEMIA

Question 19

What are the anemias of normal size and shape?

Answer 19

Anemia of blood loss

Anemia of chronic disease

Anemia of renal disease

Anemia of liver disease

Aplastic anemia

Question 20

How does anemia from normal blood loss appear?

Answer 20

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.

Question 21

What is anemia of chronic disease?

Answer 21

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.

Question 22

How can anemia occur with liver disease?

Answer 22

W/ end-stage kidney failure, there is a lack of EPO, leading to malformed RBCs call echinocytes–spiny RBCS.

Question 23

What percentage of pts w/ liver disease have anemia and what do cells look like?

Answer 23

3/4 of pts w/ liver disease are anemic

there are multiple causes

Cells are acanthocytes. Pointy spikes off a round cell.

Question 24

What is aplastic anemia?

Answer 24

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

Question 25

What are the clinical findings related to aplastic anemia?

Answer 25

Anemia- pallor dizziness, fatigue

Leukopenia- recurrent infection

Throbocytopenia- bleeding, bruising