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Hematology > Other Microcytic Anemias > Flashcards

Other Microcytic Anemias Flashcards

1
Q

Most common anemia found in hospitalized patients

A

Anemia of Chronic Disease and Inflammation (ACD)

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2
Q

ACD causes

A

Unknown, but there are same theories

  • Impaired release of iron from macrophages -> less iron reaching erythroid precursors
  • impaired EPO production
  • Impaired EPO response in Pronormoblasts/Rubriblasts
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3
Q

Example conditions with ACD

A

Rheumatoid Arthritits

Chronic Kidney Disease

Thyroid Disorders

Malignancies

Inflammatory Bowel Disease

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4
Q

ACD Lab findings

A
  • Borderline low RBC, Hgb, Hct
  • Can range from: normocytic to microcytic. At most, slightly low MCV
  • normochromic to hypochromic - MCHC is usually normal
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5
Q
A

ACD Peripheral Smear

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6
Q

ACD Lab findings - Iron Studies

A

**N or high Serum Ferritin
**- Not a depletion of iron stores, just not being utilized

LOW TIBC

LOW Serum Iron

LOW % Transferrin saturation

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7
Q

ACD lab finding - Bone marrow

A

Adequate number of eythroid precursors

-N or HIGH M:E ratio –> due to decreased erythtropoiesis

Hemosiderin present - blue staining

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8
Q
A

ACD Bone Marrow

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9
Q

ACD Treatment

A
  • AVOID iron supplements
    Corection of the primary disease state
  • Erythropoietic Agents –> stimulate iron uptake and heme synthesis
  • Transfusion in severe cases - not used often
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10
Q

Sideroblastic Anemia (SA)

A
  • Non-heme iron accumulation in RBC precursors
  • Faulty Erythropoiesis
  • Dimorphism
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11
Q

Sideroblastic Anemia (SA) causes

A

Hereditary
- x linked (mutation in ALAS2 gene)
- Autosomal recessive

Acquired
- Alcoholism

  • Copper Deficiency
  • Drug indiced
    1. Isoniazid (TB treatment)
    2. Chloramphenicol (Antibiotic)
  • Lead poisoning
  • Myelodysplastic Syndrome
    1. Refractory Anemia with ringed sideroblasts (RARS)
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12
Q

SA Lab Findings

A

Dimorphic population
- microcytes and normocytes
- hypochrpmic and normochromic

Anisopoikilocytosis

Pappenheimer bodies

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13
Q
A

SA Peripheral smear

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14
Q

SA Lab Findings - Iron Studies

A
  • High Serum Feritin
  • Normal or LOW TIBC
  • HIGH serum iron
  • High % Transferrin sauration
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15
Q

SA lab findings - Bone marrow

A
  • Ringed sideroblasts
  • Erythroid hyperplasia
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16
Q
A

Sideroblastic anemia peripheral smear

17
Q

SA Treatment

A
  • Hereditary - medication to reduce iron in blood stream
    1. Autosomal recessive severe cases - allogenic stem cell transplant
  • Acquired - treat initial condition; dicontinue offending medication; chelation

Caution when considering transfusion
- Could develop iron overload

18
Q

Iron overload (NOT microcytic, hypochromic Anemia) Not an anemia

A

Accumulation of excess iron in reticuloendothelial cells in varying tissues

19
Q

Hemochromatosis

A

**Tissue damage resulting from excess iron
**
Excess iron stores in
- liver
- heart
- pancreas and other organs

Cause
- Hereditary - leads to inappropriate increase in intestinal iron absorption
- Acquired - increased iron without proper excretion mechanism (treatment for anemias)

20
Q
A

Excess iron stored in liver (Hemochromatosis)

21
Q

Hemochromatosis lab findings

A
  • High Hgb and Hct
  • High Serum Iron
  • High Serum Ferritin
  • High % Transferrin Saturation
  • High BM iron
  • Normal or LOW Serum TIBC
22
Q

Hemochromatosis Treatment

A

Goal is to remove excess iron

Therapeutoic phlebotomy
- initially approx. 2 weekly, then frequency decreases

Desferrioxamine
- Chelating agent that reduces iron stores
- Used to treat transfusion iron overload

23
Q

Iron Deficiency anemia

A

Iron: Decreased
Serum Ferritin: decreased
Serum TIBC: Increased
Transferrin Saturation: Decreased
Stainable bone marrow iron: absent

24
Q

Anemia of chronic disease

A

Iron: Decreased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrring Saturation: N/D
Stainable Bone marrow Iron: N/I

25
Q

Sideroblastic Anemia

A

Iron: Increased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrin Saturation: Increased
Staimanble Bone Marrow Iron: Ringed sideroblasts

26
Q

Hereditary Hemochromatosis (not an anemia)

A

Iron: Increased
Serum Ferritin: increased
Serum TIBC: N/D
Transferrin saturation: Increased
Stainable Bone marrow Iron: increased

27
Q

Porphyria

A

Disorders affecting one othe the enzymes of heme synthesis

Results in an increase of **Urinary excretion of the precursor molecules **

28
Q

P8 Deaminase issue

A

cannot continue the next ttep of the proporphyrin synthesis (heme synthesis)

Leads to accumulation of Porphobilinogen

29
Q

Porphyria symptoms

A

Symptoms
- photosensitivity
- motor dysfunction
- sensory loss
- mental disturbances

Treatments
- Hemin injections (artificial heme)
- Avoid sunlight exposure (vitamin D supplement)
- Medications to absorb excess precursors

Hematology (36 decks)

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