Microcytic hypochromatic anemia

Question 1

MC Microcytic anemia?

Answer 1

Iron Def. Anemia

Question 2

Very Early in Iron Def. Anemia, what kind of an anemia is it?

Answer 2

Normocytic

Question 3

Pathogenesis of Iron Def. Anemia?

Answer 3

Increased demand or loss of iron=> decreased final step in heme synthesis

Question 4

Where is iron absorbed in the gut?

Answer 4

Duodenum

Question 5

Lab findings in Iron Def. Anemia?

Answer 5

Decreased Ferritin Iron=> Increased TIBC
Decreased Serum Iron
Decreased Iron Saturation
Increased RDW
Increased FEP (Free Protoporphyrin)

Question 6

MCC of Iron Def. Anemia in Infants? Child? Adult Males? Adult Females? Elderly? Developing world?

Answer 6

Infant=>Breast Feeding
Child=>Poor Diet
Male=>Peptic Ulcer Disease
Female=>Menses
Elderly=>Colon Polyp
Developing=>Hookworm

Question 7

Classic Symptoms of Iron Def. Anemia?

Answer 7

Conjunctival pallor, Spoon nails (kolionychia) and PICA

Question 8

What syndrome has iron def. Anemia, Esophageal webs and atrophic glossitis?

Answer 8

Plummer-Vinson Syndrome

Question 9

How does Gastrectomy cause Iron Def. Anemia?

Answer 9

Gastrectomy=>decreases acidic environment=>decreased Iron absorption

Question 10

α-thalassemia MOA?

Answer 10

α-globin gene deletions=>decreased 􏰀􏰄α-globin synthesis

Question 11

Trans African Train?

Answer 11

Trans more common in Africans

Question 12

4 allele deletion? What does it lead to? Compatible with life?

Answer 12

Excess γ-globin forms γ4 (Hb Barts). Incompatible with life (causes hydrops fetalis).

Question 13

β-thalassemia MOA?

Answer 13

Point mutations in splice sites and promoter sequences=> decreased 􏰀􏰄β-globin synthesis.

Question 14

β-thalassemia most commonly occurs in?

Answer 14

Mediterranean populations.

Question 15

β-thalassemia minor (heterozygote) underproduced or absent?

Answer 15

underproduced

Question 16

β-thalassemia minor (heterozygote) Dx?

Answer 16

Increased HbA2 (> 3.5%) on
electrophoresis.

Question 17

β-thalassemia major (homozygote) MOA?

Answer 17

β chain is absent=> 􏰀severe anemia

Question 18

Blood Transfusions can lead to?

Answer 18

2o Hematchromatosis

Question 19

β-thalassemia major patients have increased?

Answer 19

Marrow expansion (“crew cut” on skull x-ray)

Extramedullary hematopoiesis (leads to hepatosplenomegaly)

Question 20

Extramedullary hematopoiesis can lead to?

Answer 20

Increased risk of parvovirus B19–induced aplastic crisis

Question 21

Lead Poisioning MOA?

Answer 21

Lead inhibits ferrochelatase and ALA dehydratase=>decreased heme synthesis and increased RBC protophyrin

Question 22

Lead Poisoning leads to?

Answer 22

Basophilic Stippling

Question 23

Lead Poisoning’s LEAD?

Answer 23

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.

Question 24

Lead Poisoning Tx?

Answer 24

Dimercaprol and
EDTA are 1st line of treatment.

Succimer for kids

Question 25

Sideroblastic anemia MOA?

Answer 25

X-linked defect in δ-ALA synthase

gene.

Question 26

Aside from genetics, what other cause can cause sideroblastic anemia?

Answer 26

alcohol is most common

Question 27

What cells do you see?

Answer 27

Ringed sideroblasts

Question 28

Sideroblastic anemia Labs?

Answer 28

Increased 􏰃iron, normal/􏰄TIBC,􏰃 Increased ferritin.

Question 29

Tx for Sideroblastic Anemia?

Answer 29

B6 (B6->remember is cofactor! for ALA synthase)