RBC and Bleeding Disorders V Flashcards
achlorhydria
no HCl in GI tract
no release of B12 from food
gastrectomy
IF not available for B12 uptake
ileal resection
no IF/B12 complex absorption
tapeworms
compete with host for B12 and can induce a deficiency state
pregnancy, hyperthyroid, cancer, chronic infection
increased demand for B12
-relative deficiency
neuro sx of B12 deficiency
not improved with folate administration
chronic gastritis
fundic gland atrophy - metaplasia to goblet cells - no IF produced - pernicious anemia
atophic glossitis
glazed beefy tongue
-with pernicious anemia
risks with B12 deficiency
gastric carcinoma
athersclerosis (with homocysteine)
chronic alcoholic
folate deficiency
methotrexate
folic acid agonist
-leads to deficiency
folate vs. B12 deficiency
folate - increased homocysteine
methylmalonate normal
no neuro symptoms
cause of megaloblastosis
suppressed synthesis of DNA
most common nutritional disorder in world
iron deficienct anemia
toddlers, menstruation, women of child bearing age
ferrous
Fe2+
ferric
Fe3+
absorption of Fe
proximal duodenum
ferroportin
basolateral for Fe transport
transferrin
Fe transport
ferritin
storage of Fe
also hemosiderin
hepcidin
released with increased serum iron
inhibits Fe transport
-downregulate ferroportin
most common cause of iron deficiency in western world
chronic blood loss
anemia of chronic disease
chronic inflammation results in increase hepcidin
-high hepcidin - leads to decreased Fe absorption
ferritin level in IDA
<12 ug/L
iron overload - 5000
low hepcidin
primary and secondary hemochromatosis
MDS
suppress hepcidin levels when iron stores are high
diagnosis of iron deficiency
lab studies
- decreased Hg and Hct
- poikilocytosis
- low ferritin
- increased TIBC
- decreased hepcidin
plummer vinson syndrome
triad in IDA
1 esophageal webs
2 micro-hypo anemia
3 atrophic glossitis
pica
eat things that arent food
-in IDA
severe long standing IDA
alopecia, atrophy tongue, intestine malabsorption, koilonychia
IL-6
stimulate hepcidin release in anemia of chronic disease
hepcidin - thought to suppress EPO release**
most common type of anemia in hospitalized patients
anemia of chronic disease
diagnosis of anemia of chronic disease
high ferritin
low TIBC
n/n anemia
normocytic normochromic anemia
anemia of chronic disease
aplastic anemia
pancytopenia
marrow suppressed and wiped clean of progenitors
pathology of aplastic anemia
extrinsic - immune mediated
intrinsic - abnormal stem cells
activated T cells inhibit HSCs
-involves TNF, IFN-gamma
leads to pancytopenia
fanconi syndrome
aplastic anemia
-rare, auto recessive
marrow dysfunction early in life
defect telomerase with short telomeres, or idiopathic
cancer chemo
can lead to aplastic anemia
diagnosis of aplastic anemia
bone marrow biopsy necessary
suppressed and wiped clean of progenitors
bone marrow bx of aplastic anemia
marked hypocellular with adipocytes
dry tap
in aplastic anemia
absent splenomegaly
aplastic anemia
prognosis of aplastic anemia
BM transplant
-5 year survival > 75%
pure red cell aplasia
only red cell precursors affected
causes of pure red cell aplasia
- thymoma
- large granular lymphocytic leukemia
- drugs
- autoimmune disorders
- parvovirus B19
pure red cell aplasia with thymoma
resection leads to improvement in 50% patients
myelophthisis anemia
space-occupying lesion in marrow replace harmful marrow elements
commonly metastatic cancer - breast, lung, prostate
chronic renal failure
anemia proportional to uremia
-decreased EPO synthesis
leukoerythroblastosis and teardrop-shaped RBCs
in myelophthisis anemia
teardrop-shaped RBCs
deformed escaping fibrotic marrow
relative polycythemia
hemoconcentration with decreased plasma volume
-dehydration, diarrhea
gaisback syndrome
stress polycythemia
HTN, obese, anxious
absolute polycythemia
increased total RBC mass
primary and secondary
primary absolute polycythemia
intrinsic abnormality of hematopoietic precursors
secondary absolute polycythemia
increased EPO
