L3 Cytopenia and approach to anemia

Question 1

List 6 possible symptoms for anemia.

Answer 1

1. SOB (pallor)
2. Palpitations, angina
3. ET reduced (cardiomegaly, CHF)
4. Fatigue, weakness (bounding pulse, tachycardia)
5. Headache
6. Visual disturbance (retinal hemorrhage)

Question 2

Specific signs (2) for Iron deficiency anemia?

Answer 2

1. Koilonychia (spoon nails)

2. angular stomatitis

Question 3

Jaundice = possible types of anemia?

Answer 3

1. Megaloblastic anemia/

2. Hemolytic anemia

Question 4

Leg ulcers = possible type of anemia?

Answer 4

Sickle cell anemia

Question 5

Bone deformities = possible type of anemia?

Answer 5

Thalassaemia major

Question 6

Reticulocyte count increases when anemia is due to?

Answer 6

Peripheral destrucion causes:

• hemolytic (autoimmune, metabolic/membrane defect, hemablobinopathy)
• Blood loss

Question 7

In hypoproliferative causes of anemia (e.g. Marrow damage, IDA, CKD), reticulocyte count ____________

Answer 7

decreases/ remains normal

Question 8

In ineffective production causes of anemia (e.g. thalassaemia, IDA, sideroblastic anemia… ), reticulocyte count __________—-/

Answer 8

decreases/ remains normal

Question 9

4 Causes for microcytic hypochromic anemia?

Answer 9

1. IDA
2. Thalassemia
3. Anemia of chronic disease (ACD)
4. Sideroblastic anemia (iron containing erythroblasts)

Question 10

3 causes for normocytic normochromc anemia?

Answer 10

• decreased production (reduced reticulocyte):
  1. Anemia of chronic disease
  2. renal failure
  3. Aplastic anemia
• increased destruction (increase reticulocyte)
  1. Acute blood loss
  2. Hemolytic anemia
• mixed macrocytic and microcytic deficiencies

Question 11

Different causes for macrocytic normochromic anemia?

Answer 11

• Megaloblastic
  1. Vit B12 deficiency
  2. Folate deficiency
• Non-megaloblastic
  1. Alcohol
  2. Liver disease
  3. Hypothyroidism
  4. Myelodysplasia
  5. Aplastic anemia (fail to produce sufficient cells)
  6. Cold agglutinin disease

Question 12

_____________ results from aplasia of BM and thus causes anemia, leukopenia and thrombocytopenia.

Answer 12

Pancytopenia

Question 13

Decreased production is the main cause for pancytopenia. State examples and their change in BM.

Answer 13

Primary

1. Aplastic anemia (congenital: Fanconi; acquired, BM with fat)
2. Acute leukemia (BM with leukemic blasts)
3. Myelofibrosis (BM with fibroblasts)
4. Myelodysplastic syndromes (ineffective marrow)

Question 14

Fanconi anemia (a type of aplastic anemia) causes pancytopenia. It has ________ pattern of inheritance, and is diagnosed by increased _______________. It can be treated by androgens and HSCT.

Answer 14

recessive;
random chromosomal breaks

• Growth retardation and congential defects of the skeleton (microcephaly), of renal tract (pelvic/horeshoe kidneys) or skin (hypo/hyperpigmentation) and mental retardation

Question 15

Myelofibrosis is when bone marrow is filled with fibroblasts. In cytological pictures, ________ cells are characteristic.
Primary cause can be a hematological malignancy, secondary cause can be in response to _____________________.
___________picture can also be seen, in which blasts, nucleated RBCs and myelocytes are present in PB.

Answer 15

tear drop;
marrow infilatration and irritation (carcinomatous infiltration);
Leucoerythroblastic

Question 16

Peripheral destruction is also a cause for pancytopenia. State 3 examples.

Answer 16

1. Hypersplenism
2. Paroxysmal nocturnal hemoglobinuria (PNH)
3. Autoimmune disorders like SLE

Question 17

Large spleen with pancytopenia =?

Describe the mechanism.

Answer 17

Hypersplenism

• destroy both normal and worn out blood cells
• spurious cytopenia because quality check of immature blood at spleen takes a longer time

Question 18

Isolated cytopenia can be due to increased destruction/ decreased production. It is relatively rare.
State the 4 types of isolated cytopenia caused by deceased production.

Answer 18

1. Congenital Pure red cell aplasia (PRCA)
   - Diamond- Blackfan syndrome (DBS) - macrocytic anemia with recitulocytopenia
2. Acquired PRCA
   - Chronic: idiopathic
   - Acute: parvovirus B19 infection/ drugs/ Riboflavin deficiency (VitB2)
3. Pure amegakaryocytic thrombocytopenia
   - rare congeintal
   - acquired
4. Leukopenia

Question 19

DBS (diamond black-fan syndrome) has a ________ pattern of inheritance.

Answer 19

autosomal dominant

Question 20

Cause for agranulocytosis in leukopenia?

Answer 20

Hypersensitivity reaction (HSR) against selective ganulocyte precursors by drugs (anti-convulsants, anti-thyroid) 
(so need to check WBC levels after giving anti-thyroid drugs!)

Question 21

Causes for lymphopenia?

Answer 21

1. AIDS
2. SARS
3. COVID-19

Question 22

Cause for monocytopenia?

Answer 22

Hairy cell leukemia

Question 23

Give examples of increased destruction that causes isolated cytopenia.

Answer 23

1. Immune destruction
   - RBC and Plt (ITP)
   - alloimmune (Ab vs self Ag) or autoimmune (Ab vs foreign Ag)
2. Mechanical destruction: heart valves
3. Infection: malaria, typhoid fever
4. Drug-induced