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ClinMed_I > Lecture 1b > Flashcards

Lecture 1b Flashcards

1
Q

What are some causes of erythropoiesis?

A

Low O2 delivery
EPO(Erythropoietin) stimulation
RBC proliferation and maturation
Reticulocyte release

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2
Q

How does EPO increase RBC production?

A

Binds to marrow erythroid precursors(pro erythroblasts) inducing cell maturation

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3
Q

What vitamins assist in proliferation of erythroblasts?

A

Folate and Vitamin B12

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4
Q

How does iron assist in RBC production?

A

Accumulation of hemoglobin

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5
Q

What are the characteristics of reticulocyte?

A

Immature RBC (non concave, slightly bluer)
Contains RNA (absorbed before maturing to a RBC)
4-5day lifespan (3 days in bone marrow 1-2days in blood)

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6
Q

What are the optimal conditions for erythropoiesis?

A

Normal EPO production
Normal erythroid marrow function
Adequate Hgb accumulation

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7
Q

What are the two approaches to anemia?

A

Kinetic approach and morphologic approach

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8
Q

Define kinetic approach.

A

Addresses the mechanism responsible for the fall in Hgb concentration

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9
Q

Define morphologic approach.

A

Categorizes anemias based on alterations in RBC characteristics and reticulocyte response

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10
Q

What mechanisms can cause anemia?

A

Decreased RBC production
Increased RBC destruction(hemolysis)
Blood loss

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11
Q

What is RBC production directly related to?

A

RBC destruction

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12
Q

What is the average daily RBC production amount?

A

1% of Red cell mass

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13
Q

What are common causes of decreased RBC production?

A

Lack of nutrients(iron, B12, folate)
Bone marrow disorders
Bone marrow suppression
Low levels of trophic hormones
Acute/chronic inflammation

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14
Q

What are some examples of bone marrow disorders?

A

Aplastic anemia
Pure RBC aplasia
Myelodysplastic syndromes
Tumor infiltration

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15
Q

What are some examples of bone marrow suppression?

A

Drugs
Chemotherapy
Irradiation

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16
Q

What are some causes of low levels of trophic hormones?

A

Chronic renal failure
Hypothyroidism
Hypogonadism

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17
Q

How does inflammation affect RBC production?

A

Decreases RBC production by affecting iron concentration, reduces EPO and decreases RBC lifespan

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18
Q

What are some causes of increased RBC destruction?

A

Inherited hemolytic anemias
Acquired hemolytic anemia
Hypersplenism(enlarged spleen)

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19
Q

What are some examples of inherited hemolytic anemias?

A

Hereditary spherocytosis
Sickle cell disease
Thalassemia major

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20
Q

What are some examples of acquired hemolytic anemias?

A

Coomb’-positive autoimmune hemolytic anemia
Thrombotic thrombocytopenia purpura(TTP)
Malaria
Paroxysmal nocturnal hemoglobinuria

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21
Q

What are some causes of blood loss(main cause of anemia)?

A

Gross blood loss
Occult blood loss
Iatrogenic blood loss
Under appreciated menstrual blood loss

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22
Q

What are some examples of gross blood loss?

A

Trauma
Surgery
Melena
Hematemesis
Severe menomotro

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23
Q

What are some examples of occult blood loss?

A

Slowly bleeding ulcer or carcinoma

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24
Q

What are some examples of iatrogenic blood loss?

A

Repeated diagnostic testing
Hemodialysis losses
Excessive blood donation

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25
Q

What tests do we use to classify anemia?

A

MCV, MCH, MCHC

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26
Q

What is the normal range for MCV?

A

80-100 fL

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27
Q

What can cause macrocytic anemia?

A

Folate and B12 Deficiency
Drugs interfering with nucleic acid synthesis(zidovudine and hydroxyurea)
Abnormal RBC maturation (myelodysplastic syndrome, acute leukemia)
Alcohol abuse(folate deficiency)
Liver Disease

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28
Q

What can cause microcytic anemia?

A

Iron deficiency
Alpha and beta thalassemia minor

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29
Q

Microcytic anemia is associated with what levels of MCHC?

A

low MCHC due to decreased HgB content in small RBC

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30
Q

What are the causes of normocytic anemia?

A

Chronic kidney diseases
Anemia of chronic disease/inflammation
Mild iatrogenic “hospital” anemia

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31
Q

What type of anemia is often required an evaluation by a peripheral smear?

A

Normocytic anemia

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32
Q

What are anemic symptoms related to?

A

Decreased O2 delivery to tissues

33
Q

How does the body compensate when in an anemic state?

A

Increased in O2 extraction
Increase in SV and HR (maintains O2 delivery util HgB falls below 5g/dL)

34
Q

How much more O2 can the body extract from HgB?

A

25% to 60%
25% is normal extracting
60% usually in anemia/hypoperfusion

35
Q

What are the common S/S of anemia?

A

Fatigue
Tachycardia/dyspnea
Palpitations
Pulsations
Bounding pulses
Pallor

36
Q

What are the S/S of anemia by volume depletion?

A

Fatigue
Muscle cramps
Dizziness/syncope
Lethargy
Hypotension/shock/death

37
Q

What 4 questions do you ask when you suspect anemia?

A
  1. Is patient bleeding? Where?
  2. Evidence of increased RBC destruction?
  3. Is there bone marrow suppression? Why?
  4. Is Patient nutrient deficient in iron, folate, B12? Why?
38
Q

What do you need to look at when a patient has an onset of symptoms?

A

New onset most often related to acquired d/o?
Lifelong anemia likely inherited
Compare recent to remote HgB&hematocrit/RBC indices

39
Q

What recent symptoms can be a sign of anemia?

A

Unintentional weight loss
Loss of appetite
Fever
Night Sweats

40
Q

What medical conditions are associated with anemia?

A

Melena (upper GI bleed, bleeding ulcer)
Large hematochezia (Lower acute GI bleed)
Menorrhagia (Dysfunctional uterine bleeding)
Renal failure
RA
CHF

41
Q

What do you look for on the skin for signs of anemia?

A

Pallor, jaundice
Petechiae, bruising

42
Q

What do you look on the eyes for signs of anemia?

A

Pale conjuctiva, scleral icterus

43
Q

What other physical signs do you look for in anemia?

A

Lymph nodes
Abdomen (hepatosplenomegaly)
Bony tenderness (sternum/anterior tibia)
Stool for occult blood

44
Q

How does volume affect the interpretation of a CBC?

A

HgB,Hct, RBC are all concentration and dependent on red cell mass(RCM)

So if RCM is decreased and/or plasma vol is increased then RBC and H&H will be low (and vice versa)

45
Q

What is hemoconcentration?

A

Decreased plasma vol, RBC and H&H elevated
Example: Dehydration

46
Q

What would an automatic reticulocyte count be preferred over manual?

A

More blood can be assessed

However manual used if there are errors such as blood clots

47
Q

What are reticulocyte count reported as?

A

Percentage of RBC

48
Q

What is a reticulocyte index(RI) calculation? Whats the equation?

A

More accurate reflection of relic count in anemia patients
RI = reticulocyte percentage × (patient’s HCT/normal HCT)

Normal RI <3%

49
Q

Increased retic count is indicative of hemolysis, what other labs do we order to determine more?

A

Serum lactate dehydrogenase(LDH)
Indirect bilirubin(unconjucated)
Serum haptoglobin

50
Q

What does an increase of LDH mean?

A

LDH is concentrated in RBCs so destruction of RBC will have increased LDH

51
Q

What does an increase of indirect bilirubin mean? How do we calculate it?

A

Total bilirubin - direct bilirubin(conjugated)
From the breakdown of HgB so signs of hemolysis

52
Q

What does a decrease of serum haptoglobin mean?

A

Binds free HgB that is released from hemolyzed RBC
So in increased hemolysis it binds to more HgB therefore low haptoglobin levels

53
Q

What is the Coombs Test, Direct(Direct anti globulin test)? What is used to screen for?

A

Screened for autoimmune hemolytic anemia
Assess presence of antibodies on the surface of RBC’s, which ultimately causes RBC destruction

54
Q

What can indicate a positive Coombs Test?

A

Autoimmune hemolytic anemia
Hemolytic transfusion reaction
Drug sensitizations
Hemolytic disease of newborns (erythroblastosis fetalis)

55
Q

What are some drug sensitizations for a positive Coombs test?

A

Methyldopa
Levodopa
Cephalosporins
Penicillin
Quinidine

56
Q

What do we use to test for microcytic anemia?

A

Retic count
Serum Iron
Transferrin
Total Iron binding capacity
Transferrin Saturation
Ferritin
Peripheral Blood smear
Coombs test

57
Q

Where is iron found in the body?

A

65% bound to HgB
30% stored as ferritin or hemosiderin in spleen, bone marrow, and liver
4% bound up in myoglobin molecules
<1% remains in cells throughout the body
<0.1% bound to transferrin

58
Q

What are ways humans lose iron?

A

Perspiration
Epithelial cell desquamation
Menstruation

59
Q

What is serum iron a measure of?

A

Circulating iron bound to transferrin

60
Q

What could cause decreased iron levels?

A

Iron-deficiency anemia
Nephrosis
Anemia of chronic disease and infection
Chronic blood loss
Malabsorption disorders

61
Q

What can cause increased iron levels?

A

Hemochromatosis
Excessive iron intake
Hemolysis of erythrocytes
Liver necrosis

62
Q

What is the function of transferrin?

A

Major plasma transport protein for iron
Carries iron from duodenum to marrow

63
Q

Where is transferrin produced in?

A

Liver

64
Q

What can cause decreased transferrin saturation?

A

Iron-deficiency anemia

65
Q

What can cause increased transferrin saturation?

A

Hemochromatosis
Iron overload
Thalassemia
RBC transfusions

66
Q

What does the total iron binding capacity(TIBC) measure?

A

Blood’s capacity to bind iron with transferrin
Indirectly measures transferrin

67
Q

What is function of Ferritin?

A

Body’s major iron storage protein
Iron molecules not used in marrow bind to ferritin

68
Q

What can cause in increase of ferritin?

A

Iron overload
Inflammation
Liver disease

69
Q

What measurement is the most reliable indictor of total-body iron status? Which test is even more accurate?

A

Ferritin
Bone marrow is more accurate

70
Q

Why is measuring ferritin better for diagnosing iron-deficiency anemia?

A

Its more specific and sensitive than iron concentration or TIBC

71
Q

What labs to we measure for microcytic anemia?

A

Reticulocyte count
Vitamin B12
Folate

72
Q

Where is vitamin B12 found in?

A

Animal proteins

73
Q

Where is vitamin B12 stored?

A

In the liver

74
Q

What else is needed for vitamin B12 to be absorbed and where is it absorbed?

A

Needs intrinsic factor and absorbed in ileum

75
Q

Where is folic acid found in?

A

Eggs
Milk
Leafy vegetabels
Yeast
Liver
Fruits

76
Q

Where is folate absorbed and stored?

A

Absorbed in upper 1/3 of intestine and stored in the liver

77
Q

How does B12 affect folate?

A

B12 is needed to move folate into tissue cells

78
Q

What is the difference between folate and folic acid?

A

Folate is naturally made
Folic acid is synthetic

79
Q

What labs do we need to evaluate normocytic anemia?

A

Reticulocyte count
Workup based upon differential

ClinMed_I (15 decks)

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