Normocytic Anemias w/ CRC >3% Flashcards

1
Q

There are 2 locations that you can kill a RBC, what are these?

A

Intravascularly

Extravascularly- spleenic macrophage

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2
Q

What clinical finding do you see in patients with extravascular hemolytic anemia?

A

Jaundice- increased unconjugated bilirubin

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3
Q

What clinical findings do you see in patients with intravascular hemolytic anemia?

A

Hemoglobinuria

Low haptoglobin levels

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4
Q

Hemolytic anemias can be caused by intrinsic or extrinsic factors. Detail the intrinsic causes of hemolytic anemia.

A

M- membrane defects
A- abnormal Hb
D- deficiency of enzymes

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5
Q

List hereditary causes of RBC membrane defects.

A

Hereditary spherocytosis

Paroxysmal nocturnal hemoglobinuria

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6
Q

What is the inheritance pattern of Sickle cell disease?

A

Autosomal recessive disorder

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7
Q

What are the 2 pathologic processes in sickle cell disease?

A

Hemolytic anemia

Painful vasoocclusive crises

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8
Q

What is the most common cause of death in children with sickle cell disease?

A

Strep. pneumoniae sepsis- increased susceptibility to infections due to autosplenectomy

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9
Q

Contrast Heinz bodies and Howell-Jolly bodies.

A

Heinz bodies: aggregates of denatured hemoglobin, removal by splenic macrophages produces bite cells
Howell-Jolly bodies: nuclear remnants within RBCs, indicate absence/hypofunction of spleen

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10
Q

Detail the inheritance of G6PD deficiency.

A

XR

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11
Q

What is the role of glutathione?

A

Neutralizes hydrogen peroxide to water

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12
Q

What effect does hydrogen peroxide have on Hb?

A

Damages Hb causing it to precipitate

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13
Q

Is G6PD deficiency primarily an intravascular or extravascular hemolytic anemia?

A

Intravascular- Heinz bodies damage RBC membranes

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14
Q

What precipitates hemolysis in a patient with G6PD deficiency?

A

Infection

Drugs

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15
Q

Regarding autoimmune hemolytic anemia, what type of antibody is associated with the “warm” and “cold” types?

A

Warm- IgG

Cold- IgM

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16
Q

What is the most common autoimmune hemolytic anemia, and what most commonly causes this condition?

A

Warm, due to lupus

17
Q

Define immune hemolytic anemia.

A

Group of extrinsic hemolytic anemias with intravascular or extravascular hemolysis

18
Q

What are the categories of immune hemolytic anemias?

A

Autoimmune
Drug induced
Alloimmune

19
Q

What is the most common cause of immune hemolytic anemia?

A

Autoimmune

20
Q

Detail the hemolysis that occurs in patients with IgG mediated hemolysis.

A

Extravascular- removed by splenic macrophages

21
Q

Detail the hemolysis that occurs in patients with IgM mediated hemolysis.

A

Intravascular- activation of complement

22
Q

If you suspect an autoimmune hemolytic anemia, what test must you order?

A

Coombs test

23
Q

What does a direct/indirect Coombs test look for?

A

Direct- RBCs sensitized with IgG

Indirect- detects antibodies in the serum

24
Q

The second most common cause of immune hemolytic anemia is drugs. There are 3 types of drug induced hemolytic anemia, what are these?

A

Type 2 hypersensitivity- IgG against drug, drug attached to RBC membrane (penicillin)
Type 2 hypersensitivity- (methyldopa( alters Rh antigens, then autoantibodies form against
Innocent bystander- IgM attaches to drug and forms immune complex, complex attaches to RBC (quinidine)

25
Q

Define a schistocyte. What conditions are these commonly seen in?

A

Fragmented RBC

Commonly seen in micro/macro-angiopathic hemolytic anemias

26
Q

A patient comes in complaining of red urine. On physical exam there is a systolic ejection murmur at the 2nd intercostal space of the right sternal border. They have a low MCV. What do you expect to see on the peripheral blood smear, why?

A

Schistocytes- likely due to aortic stenosis