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Pathology - Hematology > RBC Decreased Synthesis > Flashcards

RBC Decreased Synthesis Flashcards

1
Q

Important blood findings in Vit B12, Folate deficiency

A

Macrocytosis, Normochronic, anisocytosis
Low Retic Count
Large, hypersegmented PMNs
Large megakaryocytes

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2
Q

Erythroid:Myeloid ratio in Vit B12, Folate deficiency

A

1:1

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3
Q

Probably cause of Vit B12, Folate deficiency

A

Folic – Dietary insufficiency

B12 - malabsorption (pernicious anemia)

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4
Q

Vit B12, Folate deficiency – which one has neuro probs

A

B12

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5
Q

What might cause an increased B12 requirement?

A

Pregnancy, Hyperthyroid, Ca

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6
Q

Where does B12 come from

A

animal products

get ya 2-3 gm/day

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7
Q

Describe B12 handling

A

IF secreted in fundus parietal cells
Peptic digestion + rapid binders (cobalophilins)
IF+B12 in duodenum
Absorbed in ileum

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8
Q

B12 is required for…

A
  1. Homocysteins –> Methionine

2. Methylmalonyl coenzyme A –> Succinyl coenzyme A

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9
Q

Problem with elevated methylmalonyl coenzyme A

A

Forms abnormal fatty acids that incorporate into lipids

Neurological complications

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10
Q

How does pernicious anemia happen

A

Autoimmune destruction –> Chronic atrophic gastritis

Loss of Parietal cells

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11
Q

Clinical findings of pernicious anemia?

A
  • Atrophic glossitis (Glazed, beefy tongue)
  • Chronic gastritis w/ fundic atrophy –> Intestinalization + Gastric Cancer
  • CNS lesions (Subacute combined degeneration)
  • Hemosiderosis of liver, spleen, BM
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12
Q

What is a schilling test?

A

a test of ability to absorb radioactive cobalamin

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13
Q

Causes of diminished folate

A

Diet, Diffuse interstitial disease/resection, anticonvulsant therapy, oral contraceptives

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14
Q

Name three folate antagonists

A

Methotrexate
6-mercaptopurines
Cyclophosphamide

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15
Q

Folate deficiency is most commonly seen in what populations?

A

alcoholics, indigent, elderly

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16
Q

Metabolic processes that use folate

A
  1. Purine synth
  2. Methionine –> homocysteine
  3. Synth of dTMP
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17
Q

Unique test for folate deficiency

A

FIGlu in urine after histidine admin

18
Q

Most common nutritional disorder in the world

A

Iron deficiency anemia

19
Q

Most common causes of iron deficiency

A

In US – chronic blood loss (Colon Cancer)

In world – nutritional deficiency

20
Q

Why do infants get iron deficiency?

A

Low iron in breast milk

Cows milk has poor iron bioavailability

21
Q

Pathogenesis of iron deficiency

A
  1. Iron reserves (ferritin and hemosiderin) are consumed to maintain hematopoesis
  2. Eventually, serum iron, plasma ferritin, and transferrin sat drop. TIBC rises
22
Q

On peripheral smear, iron deficiency anemia shows

A

Microcytic, hypochromic

23
Q

Three clinical associations of anemia of chronic disease

A

Chronic microbial infections (osteomye., endocardi.)
Chronic Immune disorders (RA, regional enteritis)
Neoplasms (Hodgkin’s disease, carcinoma of lung/breast)

24
Q

Clinical features of anemia of chronic disease

A

Low iron, reduced TIBC, high ferritin

25
Q

____ may cause decreased utilization of iron by erythroid precursors in anemia of chronic disease

A

IL-1

26
Q

Describe hematocrit changes surrounding blood loss

A

Immediately after normal (equal loss of cells+Fluid)
Then, fluid retention to compensate drops Hct
Low Hct will trigger erythropoesis to return to normal

27
Q

Important physiological difference in external and internal hemorrhage

A

Internal hemorrhage will not cause loss of iron stores

28
Q

DJ and I. What is absorbed where?

A

D - Iron
J - Folate
I - B12

29
Q

anemia of chronic disease. maco, normo, or microcytic?

A

Micro or Normo

30
Q

Other work from chromatin clumping

A

Pkynosis

31
Q

What is achlorhydria (like in B12)

A

Lack of hydrochloric acid in gastric secretions

32
Q

How does she explain ferritin and hemosiderin

A

Ferritin – Storage form of iron

Hemosiderin – Garbage dump of iron (not really coming back)

33
Q

Predictable dose dependent causes of Aplastic Anemia

A

Benzene, Chloramphenicol, Alkylating Agents, Antimetabolites

34
Q

Idiosyncratic reactions that trigger Aplastic Anemia

A

Phenylbutazone, Chlorpromazine

Streptomycin, Carbamazepine (TEGRETOL)

35
Q

Non-drug related causes of Aplastic Anemia

A

Whole Body Radiation
HIV, Hep C
Inherited (Fanconi)

36
Q

Aplastic Anemia can transform into

A

Acute leukemia

37
Q

Pathology associated with Aplastic Anemia

A

Hypocellular marrow with increased fat cells, fibrous stroma

If multiple transfusions, can cause iron overload and hemosiderosis

38
Q

Other than Aplastic Anemia, what are the four important forms of marrow failure

A
  1. Pure Red Cell Aplasia
  2. Diffuse Liver Disease
  3. Chronic Renal Failure – EPO loss + uremic suppression
  4. Chronic Infections (via IL-1)
39
Q

Difference btw primary and secondary polycythemia

A

1 – Intrinsic stem cell abnormality

2 – RBC progenitors normal, but high EPO pushes production

40
Q

What is a polycythemia

A

RBC overproduction

Pathology - Hematology (9 decks)

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