Krafts Anemia

Question 1

o Most important cause: GI bleeding (not the most common, just the most important)

o Microcytic (small), hypochromic (not enough Hb) anemia

o Increased anisocytosis (cells of varying sizes) and poikilocytosis (weird shape)

o Abnormal iron studies

Answer 1

Iron Deficiency Anemia

Question 2

o Defective DNA synthesis

o Nuclear/cytoplasmic asynchrony – cell’s nucleus does not mature at same rate as cytoplasm (nucleus lags behind)

o Cause: ¯ B12/folate

o Macrocytic anemia with oval macrocytes and hypersegmented neutrophils

Answer 2

Megaloblastic Anemia

Question 3

o Causes of B12 Deficiency

Answer 3

 Diet (rare), pancreatic damage, ileal damage

 Lack of IF – fairly common  pernicious anemia (autoimmune GI disorder)

 Tapeworm – not common but frequently on boards

Question 4

What do you ALWAYS check in a patient with macrocytosis?

Answer 4

B12!!!!

Question 5

o Causes of folate deficiency:

Answer 5

diet (small reserve)

EtOH abuse

jejunal damage

drugs (antineoplastic folate inhibitors)

Question 6

Signs of RBD destruction:

Answer 6

 ­ serum bilirubin – breakdown product of heme

 ­ lactate dehydrogenase (LDH) – found in RBC, released when destroyed

 ¯ free haptoglobin – binds free Hb, not measured when bound to free Hb

 Hemoglobinemia (Hb outside RBC in blood), hemoglobinuria (Hb in urine)

Question 7

Signs of RBC production:

Answer 7

 Reticulocytosis – see more early RBC in the blood (normally 1%)

 Nucleated red cells in blood – marrow is ramping up production, some nucleated cells slip out

Question 8

Morphology of Hemolytic anemia:

Answer 8

o Normochromic (Hb content appears normal), normocytic anemia (normal size range)

o Spherocytes; other poikilocytes: targets, sickles, fragmented red cells

Question 9

• TONS of spherocytes
• cytoskeleton defect (often spectrin)
• splenectomy is curative

Answer 9

Hereditary spherocytosis

Question 10

Common presentation triad for hereditary spherocytosis?

Answer 10

• anemia
• jaundice
• splenomegaly; crisis (often parvovirus)

Question 11

IgG (antibodies bound to RBC)

spleen

spherocytes

Answer 11

Warm autoimmune hemolytic anemia

Question 12

Hypersegmented neutrophils??????

Answer 12

Magaloblastic anemia

Question 13

• IgM + complement
• some intravascular hemolysis
• mostly spleen
• agglutination

Answer 13

Cold Autoimmune Hemolytic Anemia

-DAT does NOT pick up IgM but will be + for complement

Question 14

What’s the difference between warm and cold AHA?

Answer 14

Cold has RBCs covered with IgM (vs IgG of warm) which falls off in warm body parts so hemolysis gets aggravated by cold temps and…

Pallor and cyanosis in cold body parts

Question 15

General presenting sx of anemia:

Answer 15

• pale skin/mucous membranes
• jaundice (if hemolytic – due to bilirubin)
• tachycardia
• breathlessness
• dizziness
• fatigue

o Atrophic glossitis – papillae in tongue atrophy, tongue becomes smooth and shiny

o Angular cheilitis – cracks at the edge of the mouth

o Koilonychia in iron-deficiency anemia – finger nail abnormality

o You can be pretty anemic and not have any sx at all – sx more likely to occur if it happens suddenly