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Heme > Microcytic anemia > Flashcards

Microcytic anemia Flashcards

1
Q

Anemia

A

Reduction of hgb and/or hct

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2
Q

Anemia is classified how?

A

Pathophysiologic mechanism

  1. Reduced production RBC
  2. Accelerated loss/destruction of RBCs
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3
Q

Low iron
Low TIBC
high ferritin
High cytokine levels

A

Anemia of chronic dz

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4
Q

Anemia of chronic dz expected lab values

A

Low iron
Low TIBC
high ferritin

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5
Q 
Low iron
High soluble transferrin recep
High TIBC
Low ferritin
Transferrin saturation low
Hypochromic RBCs
A

IDA

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6
Q

IDA expected lab values

A 
Low iron
High soluble transferrin recep
High TIBC
Low ferritin
Transferrin saturation low
Hypochromic RBCs
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7
Q

High iron
Low tibc
High ferritin

A

Suspect thalassemia

Must reflec w/ hgb electrophoresis

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8
Q

Thalassemia expected labs

A

High iron
Low tibc
High ferritin
—- must get hgb electrophoresis

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9
Q

High iron
NL TIBC
High ferritin

A

Sideroblastic anemia

As long as BM iron:
>10% Ringed sideroblast
Review RBC morphology

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10
Q

Sideroblastic anemis expected lab values

A

High iron
NL TIBC
High ferritin

BM - >10% ringed sideroblasts

RBC morphology

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11
Q

Anemia eval steps

A
  1. Determine MCV
  2. Hx/PE
  3. Determine MOA
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12
Q

MC cause of anemia (MC pop)

A

IDA - females (menses/preg)

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13
Q

Ferritin purpose

A

Amount of iron stored

Storage protein w/in cells

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14
Q

Transferrin purpose

A

Protein that transports iron

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15
Q

TIBC - total iron-binding capacity purpose

A

Measures bloods capability to bind iron w/ transferrin

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16
Q

Hepcidin is?

A

Hormone that assists regulation of iron storage

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17
Q

Where is Hepcidin produced?

A

Liver

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18
Q

Inflam/infection or increased iron levels changes iron metabolism how?

A

Hepcidin increases > decreases intestinal iron absorption

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19
Q

Insoluble form of iron is called?

A

Hemosidirin

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20
Q

When is hemosidirin formed?

A

Excess iron in the body/circulation

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21
Q

What intestinal cells absorb iron?

A

Duodenal enterocytes

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22
Q

Most iron is incorporated into? Where else

A 
RBC 1800mg
Liver parenchyma 1000mg
Spleen 600mg
BM 300mg
Muscle 300mg
Plasma transferrin 3mg
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23
Q

Iron content NL, in/out?

A

NL - 3-4mg

In/out - 1-2mg

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24
Q

IDA mechanisms of cause

A

Increased loss
Inadequate absorption
Inadequate intake

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25
Q

IDA development stages

A

1 - ferritin decreases
2 - RBCs hypochromic
3 - hgb drops
4 - MCV drops

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26
Q

Anema S/S

A

F- fatigue
L- light headed/dizzy
A- angina
P- palpitations

T- tachy-C/Poe
H- HOTN
P- pallor
S- syncope

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27
Q

Other unusual S/S of IDA

A

Glossitis - swollen, inflam, smooth tongue
Cheilosis - scaling, cracking, fissuring of lips (b12 issue usually)
Koilonychia - spoon nails
Nail dystrophy
Pica - craves non-nutritious substances >1mo

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28
Q

Plummer-vinson syndrome

A

Triad
1- Dysphagia
2- Esophageal webs (causes the dysphagia)
3- IDA

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29
Q

Plummer-vinson syndrome MC affects who

A

Post menopausal females

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30
Q

TIBC represents

A

Ability of transferrin to bind more iron

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31
Q

Transferrin saturation represents?

A

Ratio between serum iron:transferrin

32
Q

IDA due to decreased absorption suspect?

A

Celiac sprue
Bariatric procedures
PPI therapy
H. Pylori inf

33
Q

New onset IDA in a male >50 or postmenopausal female is what?

A

GI malig until R/O

34
Q

New onset IDA in a male >50 or postmenopausal female W/U

A

Eval GI blood loss w/

  • EGD
  • Colonscopy
35
Q

IDA 1st line TXT

A

(PO) replacement

-ferrous sulfate 325mg

36
Q

SE of iron replacement?

A

Constipation
ABD pain
Dark stools

37
Q

How long should iron replacement go for?

A

3-6mo to replenish stores
Until ferritin returns to NL
H/H return to NL 6-8wks

38
Q

IV iron therapy is reserved for? Req?

A

Cant tolerate or Refrac

Req internal med/hematology consukt

39
Q

Thalassemias are?

A

Hereditary dz w/ defects in the synth of globin chains in hgb.

40
Q

Alpha thalassemia is a genetic issue of

A

Deletion of the alpha chain allele

41
Q

Beta thalassemia is a genetic issue of

A

Mutation of beta chain allele

42
Q

MC genetic pop?

A

Mediterranean
Africa
Asian

43
Q

Hard sign of thalassemia

A

Microcytosis out of proportion to the degree of the anemia

44
Q

Alpha thalassemia mutation causes what to happen?

A

Unstable - Relative beta chain excess w/ no chance for alpha substitution

45
Q

Alpha thal minima

A

1 mutated chain - asymp

46
Q

Alpha thal Minor

A

2 mutations
Mild anemia
Clinically normal

47
Q

Hgb H disease (intermedia)

A

3 mutations

Severe chronic hemolytic anemia

48
Q

Hgb Barts-hydrops fetalis

A

4 mutations - no alpha chains

Death

49
Q

Beta thalassemia is

A

Impaired production of beta chains that leads to a relative excess alpha chains but can be substituted

50
Q

Beta chain reduction can be substituted w/

A

Delta chains - hgbA2

Gamma chains - hgbF

51
Q

Excess alpha globin chains are

A

Unstable, incapable of forming soluble tetramers leading RBC membrane damage

52
Q

What determines severity of beta thalassemia?

A

Degree of alpha globin chain excess

53
Q

Homozygous impaired beta globin synthesis results in?

A

Profound clinical manifestations

54
Q

Keys to thalassemia dx?

A

-Microcytosis out of proportion to anemia
-positive fam hx/lifelong microcytic anemia
-RBC morphology
—microcytes
—acanthocytes
—target cells

55
Q

Thalassemia trait is described as

A

Lab features w/out significant clinical impact

56
Q

Thalassemia intermedia is described as

A

Req RBC transfusions

Moderate clinical impact

57
Q

Thalassemia major is described as

A

Life threat

58
Q

Thalassemia Dx

A

R/o IDA
Iron shows overload
Elevated ferritin
Low TIBC

59
Q

Method of thalassemia detection

A

Hgb Electrophoresis

Or genetic testing

60
Q

Hgb electrophoresis resulta A/B thal

A

Alpha thal trait - NL
—-alpha still made
Beta thal - ABNL
—-gamma/delta high

61
Q

Mild Thalassemia txt

A

Avoid unnecessary iron
Avoid some Rx
-sulfa drugs (oxidative stress > hemolysis

62
Q

Severe thalassemia txt

A

Req freq transfusions
Folate supplement
Splenectomy
BM transplant

63
Q

Freq Transfusions can lead to?

A

Iatrogenic iron overload syndrome

64
Q

Anemia of chronic disease is

A

Ass/w chronic comorbidities like

  • chronic infectious processes
  • autoimmune d/o
  • malig
  • liver disease
  • chronic kidney disease
65
Q

Anemia of chronic disease labs

A

Normocytic or microcytic
Low serum, transferrin, TIBC
Nl - ^ ferritin

66
Q

Anemia of chronic disease txt

A

Txt underlying condition

67
Q

Siderobladtic anemia is

A

Mishandling of serum iron by mitochondria leading to ABNL RBC precursor processing of iron.

68
Q

W/ sideroblastic anemia bone marrow produces what?

A

Ringed sideroblast rather than NL RBCs

69
Q

Bone marrow composition w/ sideroblastic anemia?

A

> 10% bone marrow sideroblast in aspirate

70
Q

Sideroblast is?

A

RBCs >1 iron containing granule in Cytoplasm

-iron poorly incorporated into heme of RBC

71
Q

Sideroblastic anemia causes

A
  1. Inherited

2. Acquired (MC) (Rx/toxins)

72
Q

Rx causing sideroblastic anemia?

A 
Ethanol
Isoniazid INH
Cycloserine
Chloramphenicol
Busulfan
73
Q

Copper chelators causing sideroblastic anemia

A

Penicillsmine

Triethylene tetramine dihydrochloride

74
Q

Toxins causing sideroblastic anemia

A

Lead
Zinc
Auto-antibodies

75
Q

Sideroblastic anemia txt

A

D/C offending agent
Supportive
pRBC if hgb <7.0
(PO) pyridoxine B6

Heme (8 decks)

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