Microcytic hypochromatic anemia Flashcards
MC Microcytic anemia?
Iron Def. Anemia
Very Early in Iron Def. Anemia, what kind of an anemia is it?
Normocytic
Pathogenesis of Iron Def. Anemia?
Increased demand or loss of iron=> decreased final step in heme synthesis
Where is iron absorbed in the gut?
Duodenum
Lab findings in Iron Def. Anemia?
Decreased Ferritin Iron=> Increased TIBC Decreased Serum Iron Decreased Iron Saturation Increased RDW Increased FEP (Free Protoporphyrin)
MCC of Iron Def. Anemia in Infants? Child? Adult Males? Adult Females? Elderly? Developing world?
Infant=>Breast Feeding Child=>Poor Diet Male=>Peptic Ulcer Disease Female=>Menses Elderly=>Colon Polyp Developing=>Hookworm
Classic Symptoms of Iron Def. Anemia?
Conjunctival pallor, Spoon nails (kolionychia) and PICA
What syndrome has iron def. Anemia, Esophageal webs and atrophic glossitis?
Plummer-Vinson Syndrome
How does Gastrectomy cause Iron Def. Anemia?
Gastrectomy=>decreases acidic environment=>decreased Iron absorption
α-thalassemia MOA?
α-globin gene deletions=>decreased α-globin synthesis
Trans African Train?
Trans more common in Africans
4 allele deletion? What does it lead to? Compatible with life?
Excess γ-globin forms γ4 (Hb Barts). Incompatible with life (causes hydrops fetalis).
β-thalassemia MOA?
Point mutations in splice sites and promoter sequences=> decreased β-globin synthesis.
β-thalassemia most commonly occurs in?
Mediterranean populations.
β-thalassemia minor (heterozygote) underproduced or absent?
underproduced
β-thalassemia minor (heterozygote) Dx?
Increased HbA2 (> 3.5%) on electrophoresis.
β-thalassemia major (homozygote) MOA?
β chain is absent=> severe anemia
Blood Transfusions can lead to?
2o Hematchromatosis
β-thalassemia major patients have increased?
Marrow expansion (“crew cut” on skull x-ray)
Extramedullary hematopoiesis (leads to hepatosplenomegaly)
Extramedullary hematopoiesis can lead to?
Increased risk of parvovirus B19–induced aplastic crisis
Lead Poisioning MOA?
Lead inhibits ferrochelatase and ALA dehydratase=>decreased heme synthesis and increased RBC protophyrin
Lead Poisoning leads to?
Basophilic Stippling
Lead Poisoning’s LEAD?
Lead Lines on gingivae (Burton lines) and on
metaphyses of long bones D on x-ray. Encephalopathy and Erythrocyte basophilic
stippling.
Abdominal colic and sideroblastic Anemia. Drops—wrist and foot drop.
Lead Poisoning Tx?
Dimercaprol and
EDTA are 1st line of treatment.
Succimer for kids
Sideroblastic anemia MOA?
X-linked defect in δ-ALA synthase
gene.
Aside from genetics, what other cause can cause sideroblastic anemia?
alcohol is most common
What cells do you see?
Ringed sideroblasts
Sideroblastic anemia Labs?
Increased iron, normal/TIBC, Increased ferritin.
Tx for Sideroblastic Anemia?
B6 (B6->remember is cofactor! for ALA synthase)
