RBC Disorders (Part 2) Flashcards
This is a macrocytic anemia in which DNA synthesis is unimpaired.
Macrocytic nonmegaloblastic anemia
Macrocytosis tends to be mild; the MCV usually ranges from100 to 110 fL and rarely exceeds 120 fL
Macrocytic nonmegaloblastic anemia
This macrocytic anemia lacks hypersegmented neutrophils and oval macrocytes in the peripheral blood and megaloblasts in the bone marrow
Macrocytic nonmegaloblastic anemia
Pathologic result of nonmegaloblastic macocytic anemia
liver disease, chronic alcoholism, or bone marrow failure
What are the characteristics of a macrocytic anemia? Cite atleast three. (HIPA)
- Hypercellular Bone Marrow
- Presence of megaloblast
- Ineffective erythropoiesis
- Active intramedullary hemolysis
It is where there is an impaired DNA synthesis and many of the cells never undergo mitosis & rather they breakdown and
die in the bone marrow
Ineffective erythropoiesis
Cite at least three consequences of ineffective erythropoiesis.
- Bone marrow destructions of erythroid presursors
- Lack of regeneration of bone marrow elements during anemic stress
-Lack of nucleated red blood cells in peripheral smear
-Lack of polychromasia in peripheral smear - Reticulocytopenia
- Intramedullary hemolysis
- Increased bilirubin and LDH
- Decreased haptoglobin
What are the two major divisions of megaloblastic anemia?
Vitamin b12 (cobalamin, Cbl) deficiency
Folic acid deficiency
It manifests macro-ovalocytes and giant hypersegmented neutrophils
Megaloblastic anemia
What causes an impaired DNA synthesis?
Vitamin B12 or folate deficiency
If DNA synthesis is impaired what happens?
Nuclear replication slows down and each step of maturation will be delayed
If this is prolonged it would results in a large nucleus. Resulting to a megaloblast, large nucleus, increase cytoplasmic RNA, and early synthesis of hemoglobin
premitotic interval
Cite the megalocyte maturation sequence
Promegaloblast (Megaloblastic rubriblast) >
Basophilic megaloblast (Megaloblastic prorubricyte) >
Polychromatophilic megaloblast (Megaloblastic rubricyte) >
Orthochromic megaloblast (Megaloblastic metarubricyte) >
Polychromatophilic megalocyte (Megaloblastic reticulocyte) >
Megalocyte (Oval macrocyte)
A decrease amount of cells in all cell lines
(WBC, RBC, platelets)
Pancytopenia
Megaloblastic macrocytic anemia results to?
- Pancytopenia
- Increased MCV and MCHC
- Hypersegmented neutrophils (five lobes or
more in segmented neutrophils) - Increased bilirubin
- Increased LDH
- Hyperplasia in the bone marrow
- Decreased M:E ratio (usually 10:1)
- Reticulocytopenia
These are cells found in the bone marrow of a patient
with megaloblastic anemia
Megaloblasts
It is characterized by a more open chromatin
pattern, karyorrhexis, & multiple Howell Jolly
bodies
Megaloblasts
It is a product of maturation arrest or nuclear cytoplasmic asynchrony
Megaloblast
This causes the nucleus
and then cytoplasm to not mature together
nuclear-cytoplasmic asynchrony
Where does cobalamin absorption takes place?
Ileum of the small intestine
It is the only vitamin exclusively synthesized by microorganisms
Cobalamin
Form of stored cobalamin in the liver
adenosylcobalamin
In order to absorb cobalamin, it requires?
Castle’s factor or Intrinsic factor
Cobalamin is transported in the plasma in the form of?
methylcobalamin
Transporter of methylcobalamin
transcobalamin
Vitamin B12 is otherwise known as?
cyanocobalamin
What are the causes of Vitamin B12 deficiency?
- Fish tapeworm Diphyllobothrium latum infection
- Pernicious anemia
- Malabsorption syndrome caused by gastric resection, gastric carcinoma, and some forms of celiac disease or screw
- Nutritional deficiency
- Hypochlorhydria
It refers to the decrease production of hydrochloric acid in the stomach
hypochlorhydria
Hypochlorhydria is associated with?
pernicious anemia
It is caused by failure of the gastric mucosa to secrete intrinsic factor
Pernicious Anemia
Other term for Pernicious Anemia
Addison’s anemia or Atrophy gastritis
Pernicious anemia is an autoimmune disease caused by two antibodies called?
Anti-parietal cell antibodies and Anti-intrinsic factor antibodies.
It produces a yellow lemon color of the skin
Pernicious anemia
Because pernicious anemia has neurologic symptoms, it has been called as?
Megaloblastic madness
It is an autosomally recessive inherited defect in the
intestinal absorption of cobalamin
Imerslund-Grasbeck Syndrome
There is a problem in the absorption of cobalamin but the intrinsic factor is normal
Imerslund-Grasbeck Syndrome
What are the diagnosis used for cobalamin deficiency?
Schilling test
Serum Cobalamin Assay
Methylmalonic Acid and Homocysteine
Assays
Deoxyuridine Suppression Test
It tests the ability of the patient to absorb an oral dose of
radioactive cobalamin
Schilling test
It is a microbiological assay which utilizes the organism
called Euglena gracilis
Serum Cobalamin Assay
It measures the ability of the marrow cells in vitro
Deoxyuridine Suppression Test
These both increase in megaloblastic anemia
Methylmalonic Acid and Homocysteine
Assays
It is considered as the reference procedure for
the determination of pernicious anemia
Schilling test
In Schilling test, If the abnormal result of stage 1 improves with administration of intrinsic factor, it means that a patient has?
Intrinsic factor
deficiency
Folate is absorbed where?
Jejunum
It cannot be
corrected by having vitamin b12 supplementation
folate deficiency
This can be partially corrected by folate even in the absence
of cobalamin supplementation
Anemia of cobalamin
deficiency
What are the causes of folate/folate acid deficiency? (CPPS)
- Chronic alcoholics
- Poor dietary habits
- Pregnancy
- Steatorrhea - tropical sprue, nontropical sprue, celiac disease
Diagnosis of folate deficiency
- Microbiological assay (definitive)
- Serum folate (<3 ug/L)
- Red cell folate
This test for folate deficiency utilizes the organism Lactobacillus casei
Microbiological assay
If the patients has low Vit. B12, normal or high serum folate and low red cell folate the patient has?
Vitamin B12 deficiency
If the patient has normal Vit. B12, but low serum folate and red cell folate, the patient has?
Folic Acid deficiency
If the patient has low Vit. B12, low serum folate, and low red cell folate, the patient has?
Both Vitamin B12 and Folate acid deficiency
How can you spot a megaloblastic anemia?
By looking at the MCV. One of the signs of a megaloblastic anemia is the presence of a high MCV .
Aside from a high MCV result what are the other indicators that would confirm that a patient has megaloblastic anemia?
hypersegmented neutrophil plus the presence of macroovalocytes in the peripheral blood smear
Termed as “shift reticulocytes”, especially in response to acute blood loss, hemolysis, and bone marrow infiltration
Non-megaloblastic anemia
Results in high levels of EPO
Non-megaloblastic anemia
Seen in a plastic anemia, refractory anemia, and Diamond-Blackfan anemia
High levels of EPO
This macrocyte is seen in folic acid deficiency, vitamin b12 deficiency, and pernicious anemia
Oval macrocyte
This macrocyte is seen in alcoholism, hypothyroidism, and liver disease
Round hypochromic macrocyte
This macrocyte is seen in neonate response to anemic stress and response to anemic stress
Blue- tinged macrocyte
This macrocyte is seen in non-megaloblastic anemia
Round hypochromic
macrocyte
Reticulocyte stain with
supravital stain
Blue-tinged macrocyte
This macrocyte is seen in megaloblastic anemia
Oval macrocyte
Characterized by
Normochromic and normocytic
Myelophthisic anemia
Associated with marrow replacement by involvement with abnormal cells or tissue
Myelophthisic anemia
Characterized by increased NRBC
Myelophthisic anemia
A condition in which bone marrow is replaced by abnormal cells but still the peripheral smear would present a normochromic and normocytic RBCs but there is an increase in the presence of
your nucleated RBC
Myelophthisic anemia
A condition in which bone marrow does not produce any blood
cells
Aplastic anemia
Seen in pancytopenia, macrocytosis, increase RDW, and chloramphenicol
Aplastic anemia
It is a medication that can commonly cause aplastic anemia
Chloramphenicol
An inherited Aplastic Anemia
Fanconi’s Anemia
Presence of scattered giant pronormoblasts in the bone marrow
Transient Aplastic Crises
Caused by increased levels of Hb F and i antigen
Fanconi’s Anemia
Caused by parvovirus B19 infection
Transient Aplastic Crises
It is often preceeded by an infection.
Transient Aplastic Crises
Not an aplastic anemia but just pure red cell aplasia
Transient Aplastic Crises
A condition where there is pancytopenia. Wherein all of the cell lines are affected.
Fanconi anemia
An anemia wherein only the red cells are affected
Diamond Blackfan anemia