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SBM hematology > microcytic anemia > Flashcards

microcytic anemia Flashcards

1
Q

main criteria for microcytic anemia

A

MCV < 80fL

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2
Q

types of microcytic anemia

A
  • iron deficiency
  • thalassemia
  • chronic inflammation
  • sideroblastic
  • lead poisoning
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3
Q

what is sideroblastic anemia?

A

inability to synthesize heme

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4
Q

what is thalassemia?

A

inability to synthesize globin

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5
Q

in terms of iron, what is the difference between iron deficiency and chronic inflammation?

A
  • iron deficiency is the lack of iron in the body which in chronic inflammation, iron is sequestered in macrophages after they consume RBCs.
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6
Q

diagnostic criteria for iron deficiency

A
  • MCV<80fL
  • hypochromic smear (pale RBCs, low MCH)
  • anisocytosis (increased RDW)
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7
Q

where is iron absorption regulated?

A

duodenum by hepcidin

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8
Q

how do we lose iron?

A

urine, skin, feces

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9
Q

causes of iron deficiency

A
  • chronic blood loss, usually intestinal
  • decreased intestinal absorption
  • decreased oral intake
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10
Q

what can cause decreased intestinal absorption in iron deficiency?

A
  • gastritis
  • H. pylori
  • bypass surgery
  • celiac disease
  • use of antacids
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11
Q

when is checking of gastrointestinal bleeding in iron deficiency patient absolutely necessary?

A

over age 50

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12
Q

signs and symptoms of iron deficiency

A
  • S and S of anemia
  • pica
  • restless leg?
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13
Q

what is the most accurate way to assess body iron stores?

A

ferritin, but it can be elevated by inflammation

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14
Q

what happens to transferrin levels in iron deficiency?

A
  • high, looking to bind any available iron
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15
Q

transferrin saturation test

A
  • iron/transferring
  • high saturation in elevated iron levels
  • low saturation in low iron levels
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16
Q

treatment for iron deficiency

A
  • ferrous sulfate
  • sometimes iron given IV
  • check underlying cause of any blood loss
17
Q

what type of genetic defect is thalassemia?

A

autosomal recessive

18
Q

what type of defect pathophysiologically is thalassemia?

A
  • quantitative defect (not enough globin)

- defect in production of either a or b chain

19
Q

a and b chain genes for globin

A
  • beta chains are one gene on each chromosome 11 (2 loci)

- alpha chains are two genes on each chromosome 16 (4 loci)

20
Q

what is pathological in alpha thalassemia?

A
  • not enough alpha chains so there is an excess of free beta chains. the beta chains are toxic to RBC membranes
21
Q

what is alpha trait?

A

when only 1 or 2 of the 4 loci are affected, tends to be little or no anemia but decreased MCV. don’t usually need treatment

22
Q

what is hemoglobin H?

A
  • stands for “heavy”
  • when three loci are affected, beta chains form unstable tetramers
  • RBCs with hemoglobin H globules hemolyse
  • hepato and splenomegaly
  • normal lifespan usually
  • sometimes need splenectomy
23
Q

what is hydrops fetalis?

A
  • all four loci affected
  • hemoglobin Bart’s (gamma aggregates)
  • incompatible with life
  • DNA analysis required for diagnosis, electrophoresis insufficient
24
Q

what is beta-thalassemia trait?

A
  • only one of two loci affected, one compensating for the other
  • no or very mild anemia
  • low MCV and RDW
25
Q

what is beta-thalassemia major?

A
  • both loci affected
  • body produces fetal hemoglobin
  • severe anemia
  • developing red cells containing alpha chain globules lyse in the marrow
  • marrow, and thus bones, expand
  • ## hepato and splenomegaly
26
Q

how do we diagnose beta-thalassemia major?

A
  • electrophoresis, shows decreased hemoglobin A1 and increased fetal hemoglobin
27
Q

what do you see on a thalassemia smear?

A
  • target cells (bullseye)

- microcytic, hypochromic anemia

28
Q

treatment for thalassemia?

A
  • traits generally don’t need treatment
  • symptomatic thalassemia often requires frequent blood transfusions so iron levels need to be monitored
  • iron over 1000 ng/mL may require iron chelation therapy
29
Q

what do all sideroblastic anemias have in common?

A
  • ringed sideroblasts in bone marrow

- defect in heme synthesis

30
Q

contrast sideroblastic anemia with porphyria

A

defects of heme biosynthesis in the mitochondria cause anemias while defects in the cytoplasm cause porphyries

31
Q

acquired clonal/neoplastic forms of sideroblastic anemias are called….

A

myelodysplastic syndromes

32
Q

examples of acquired metabolic sideroblastic anemias

A
  • alcoholism
  • medications
  • copper deficiency
33
Q

what does lead to do blood?

A

inhibits enzymes in heme synthesis

34
Q

what do you see on a blood smear for lead poisoning?

A

basophilic stippling

SBM hematology (14 decks)

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