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Lecture 2 Flashcards

1
Q

ANEMIA OF CHRONIC DISEASE

A

Normocytic normochromic

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2
Q

Anemia of chronic disease is seen

A

Collagen disease
Chronic kidney disease
Chronic liver disease
Chron’s
Ulcerative colitis
Systemic lupus
Malignancy(leukemia and lymphoma) by infiltration of bone marrow

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3
Q

Pathophysiology of anemia of Chronic inflammation

A

Inflammation>cytokinesrelease>hepcidin increase>decrease erythropoeitin>decreases usage of iron>decrease life span of RbCs

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4
Q

HEMOLYTIC ANEMIA

A

RBCS get broken down before 120 days
It could be due to acquired or congenital disease
It could be extravascular or intravascular

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5
Q

SEVERE HEMOLYTIC ANEMIA

A

Rbcs live for 20 days

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6
Q

Mild hemolytic anemia

A

40 days

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7
Q

HEMOLYTIC ANEMIA gets classified according to

A

LIFE SPAN (MILD,MODERATE,SEVERE)

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8
Q

RBCs when broken down intravascularly release

A

Hemoglobin that either binds to haptoglobin then release haemoglobinemia
Or binds to hempoxin in kidney and gets filterated there to give hemoglobinemia

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9
Q

Output in hemolysis

A

Hemoglobin ±uria
+ emia
+haptoglobin decreases
+ hemosideuria (when hemoglobin goes to cell it gives hemosiderin deposit)

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10
Q

HOW TO know HEMOLYTIC ANEMIA ?

A

Reticulocytosis are high (more than 2%)
INDIRECT/UNCONJUGATED BILIRUBIN IS HIGH
HEMOGLOBINEMIA
HEMOGLOBINURIA
HEMOSIDEROSIS
HDH increases
NORMOCHROMIC NORMOCYTIC (except thalassemia)
HAPTOGLOBIN OR HEMOPEXIN IS LOW

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11
Q

2 types of hemolysis

A

Intravascular
Or extravascular
(Macrophage takes Rbcs out and accumulates it in liver,spleen, and gall stones so they become enlarged and there will be repeated gall stone)

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12
Q

HEMOLYTIC crisis

A

Patient with sickle cell anemia travelled and got exposed to hypoxia (abdominal pain,nausea,Vomiting,haematuria,bone pain)

Or patient with favism G6PD deficiency who took drug that got him to crisis

Patient with folic acid and b12 deficiency got into megaloblastic crisis

Or immunocompromised so gets viral infection=APLASTIC crisis

Sickle anemia causes obstruction

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13
Q

To diagnose hemolytic anemia

A

1) Normochromic normocytic(Except thalasemia)
2) Reticulocytosis more than 2%
3)white blood cells/platelets may increase
4)BONE marrow erythrocyte is high (normoblastic except incase of vitb12 deficiency or megaloblastic anemia)
5)Bilirubin is indirect
6)Haptoglobin decreases and hemopexin decreases
7)LDH increases
8)Blood film(Spherocytosis or thalassemia or sicklecellanemia or unspecific paroxysmal nocturnal hemoglobinuria or autoimmune hemolytic anemia)

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14
Q

Intracorpscular causes of hemolytic anemia

A

1) inherited (Paroxysmal nocturnal hemoglobinuria)
2)Defect in membrane (spherocytosis/nocturnal hemoglobinuria)
3)defect in globin(thalassemia or sickle cell anemia)
4)defect in enzymes G6PD

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15
Q

Extrinsic

A

Acquired or
autoimmune or
mechanical :(soilder who stands for 12 hours)
:people who have artifical valves
Or infections like malaria
Or chemicals (organophosphorus/snake or Scorpio bite)

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16
Q

HEREDITARY SPHEROCYTOSIS

A

*due to loss of spectrin no na/k Atp pump so salt water get retained in rbc so it doesn’t live

*it is familial
*anemia symptoms
*Repeated gallstones
*test osmotic fragility test
*early hemolysis
*treated by splenectomy

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17
Q

Major thalassemia

A

Severe anemia
Hemoglobin F or A2 (delta)
Depends on blood transfusion for survival

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18
Q

Minor thalasemia

A

Mild anemia
Hemoglobin 7 or 8 or 9
Spleenomegaly
Hemoglobin F or A2
Doesn’t always need blood transfusion

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19
Q

Intermediate thalassemia

A

Moderate anemia
Needs blood transfusion in certain situations such as surgery or stress or pregnancy

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20
Q

2 sheets of alpha affected

A

Hyochromic anemia

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21
Q

3 sheets affected

A

HEMOGLOBIN H
Spleenomegaly and blood transfusion in stressful situations

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22
Q

4 sheets affected

A

Parrot hemoglobin=death

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23
Q

Thalassemia complain

A

Jaundice even after 6 months from birth

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24
Q

THALASSEMIA hemoglobin

A

F

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25
Q

Blood group of thalassemia

A

Unknown forever

26
Q

Bonemarrow of thalassemia

A

Hyperactive leading to Mongolia features (prominent zygomatic or maxilla)

27
Q

Organs of thalassemia

A

Hepatospleenomegaly

28
Q

Kind of anemia of thalassemia

A

Microcytic

29
Q

Thalassemia diagnosis

A

Hemoglobin electrophoresis hemoglobin F and A2
Or DNA analysis if 1 or 2 sheets only are affected

30
Q

Differentiation between iron deficiency anemia and thalassemia

A

In thalassemia mean corpscular volume and iron binding capacity are low

31
Q

Thalassemia contraindication

32
Q

Thalassemia management

A

Estral+
folic acid+
bone marrow transplantation+
gene therapy+
splenectomy (last resort or if there is huge spleen)

33
Q

Sickle cell anemia types

A

SS (most dangerous)
SA

34
Q

Sickle cell problem

A

Is a globin problem where one aminoacid gets replaced by another

35
Q

Patient is normal except in the following cases

A

Hypoxia
Infection
ACIDOSIS

36
Q

What happens in sickle cell anemia

A

Change in shape of Rbc leads to rbcs sticking to each other this blocks veins or leads to venocclosive disease such as abdominal or brain infarction

37
Q

Spleen of sickle cell anemia

38
Q

Symptoms of sickle cell anemia

A

Severe pain at limbs
Osteomyelitis
Repeated infarctions(stroke or myocardial)
Retina may lead to blindness
Immunocompromised
Ulcer
Repeated gall stones
Avascular necrosis

39
Q

Since sickle cell patients are immunocompromised

A

They have to take vaccines such as
Pneumoconiosis influenza virus and meningococci

40
Q

DIAGNOSIS OF SICKLE CELL PATIENT

A

Normocytic normochromic anemia
Reticulocytosis
LDH increases
Hemoglobin electrophoresis

41
Q

Hemoglobin electrophoresis variants

A

Hemoglobin S (sickle )
Hemoglobin SS (most dangerous)
Hemoglobin SA (least dangerous)
Hemoglobin Sand F (sickelcell anemia and thalassemia)

42
Q

Treatment of sickle cell anemia

A

Vaccine
Bone marrow transplantation (when needed)
Gene therapy
Folic acid
Blood transfusion
During crisis give oxygen in case of hypoxia and pain killer and hydroxurea drug (chemotherapy)

43
Q

Acute chest syndrome

A

1)Occurs in patients with sickle cell anemia due to venoocclosive diseases

2)They will be in a hypoxic situation,will have fever and leukocytosis

3)infiltration will be seen in X ray

4)poor prognosis

5)symptoms are like respiratory chest syndrome/COVID

44
Q

GLUCOSE 6 PHOSPHATE DEFICIENCY

A

The enzyme that produces glutathione to prevent Rbcs from oxidation is deficient

45
Q

GLUCSE 6 PD is also called

46
Q

GLUCOSE 6 PD is

A

Hereditary and found in Africa

47
Q

Contraindications for g6pd patients

A

Legumes
Sulfur containing drugs
Antimalarial drugs(quinolones)
Aspirin
Phenytoin

48
Q

Lab findings

A

LDH high
Reticulocytosis high
But everything else is low

49
Q

Autoimmune hemolytic anemia

A

A person of 45 years of age
A male or a female with jaundice
Pallor
Patient will have rheumatoid arthritis/Systemic lupus or lymphoma

50
Q

Key of autoimmune hemolytic anemia

A

Coombs test IgM IgG

51
Q

Investigations of autoimmune hemolytic anemia

A

Reticulocytosis
Combs test
Blood film

52
Q

Causes of autoimmune hemolytic anemia

A

Worm time IgG (37)
Idiopathic (lymphoma,lupus,leukemia)
Alpha methyl dopa

53
Q

Symptoms of hemolytic anemia

A

Hemolytic anemia and huge spleen

54
Q

Evan syndrome

A

Hemolytic anemia+pregnant+thrombocytopenia

55
Q

Autoimmune disease treatment

A

Prednisone
Azathioprine
Cyclosporin
Immunosuppressant
Monoclonal antibodies
If all of them fail=splenectomy

56
Q

Combs test false positive

A

37degree and above may be due to infectious mononucleosis

57
Q

Drugs that may cause autoimmune hemolytic anemia

A

Alpha methyl dopa
Cephalosporin
Penicillin
Antimalarial drugs
Or drugs contraindicated in G6pd

58
Q

Paroxysmal Nocturnal hemoglobinuria

A

It’s a stem cell disease
One protein in cell membrane is affected

59
Q

Paroxysmal nocturnal hemoglobinepuria complain

A

Wake up with blood in urine

60
Q

Associated diseases of paroxysmal nocturnal hemoglobinuria

A

Venocclusive diseases (abdominal pain and Mesenteric infarction and recurrent infection)

61
Q

Investigation of paroxysmal nocturnal hemoglobinuria

A

HANS
FLOW CYTOMETRY CD55

62
Q

Treatment of paroxysmal nocturnal hemoglobinuria

A

Anticoagulant and blood transfusion

ANEMIA (2 decks)

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