RBC Disorders Part #2

Question 1

Anemias due to impaired Hgb synthesis have what type of MCV?

Answer 1

It will a microcytic and/or hypo chromic RBCs (low MCV) <82.

Question 2

What is Iron deficiency anemia (IDA) caused by?

Answer 2

lack of iron. Some examples include:

1. chronic blood loss: GI or menstrual
2. decreased intake/not enough: pregnancy, kids, females, elderly
3. Progressive depletion of body iron stores: infants after 6 months.

Question 3

what will iron studies show for IDA?

Answer 3

decreased serum iron, decreased serum ferritin, increased TIBC

Question 4

How can you distinguish IDA from Anemia of Chronic Disease?

Answer 4

ACD will have decreased TIBC and increased ferritin

Question 5

What are the physical signs for someone with IDA?

Answer 5

iron lack causes brittle hair and nails, pica, glossitis.

you may see ovalocytes/pencils on microscopic exam.

Question 6

What is Anemia of Chronic Disease?

Answer 6

inability to use iron and decreased response to EPO. Usually due to persistent infection, chronic inflammation, collagen disorder (RA, SLE), malignant disease (carcinoma).

Question 7

T/F: ACD can be both microcytic or normocytic?

Answer 7

true. and theres no distinct morphology of the RBCs. the severity of the anemia parallels the severity of the disease.

Question 8

What will the iron studies show for ACD?

Answer 8

decreased serum iron, decreased TIBC, and normal or increased serum ferritin.

Question 9

what is Thalassemia?

Answer 9

inherited decreased in alpha or beta glob in chain production needed for Hgb A.

“Major” conditions are severe, Hgb A is absent
“Minor conditions are mild, common.

Question 10

What happens if someone has Thalassemia alpha major? thalassemia beta major?

Answer 10

alpha major = dies

beta major = lifelong transfusions

Question 11

What will thalassemia show on microscopy? electrophoresis?

Answer 11

Target cells on microscopy

increased Hgb A2 level (Beta)

Question 12

How can you differentiate thalassemia from iron deficiency?

Answer 12

you will have normal iron tests with thalassemia.

Question 13

What is sideroblastic anemia (SA)?

Answer 13

protoporphyrin block leads to iron overload. There are two types:
1. primary: cause unknown. Could be due to malignancy, requires bone marrow exam. you’ll see increased serum iron, decreased TIBC, and increased serum ferritin.

2. secondary is due to lead poisoning, alcohol, anti-TB drugs.
   you will see basophilic stippling of the red cells on morphology.

Question 14

What anemia is due to impaired DNA synthesis?

Answer 14

Megaloblastic or macrocytic anemia (MCV>98)

Question 15

What is Megaloblastic anemia due to?

Answer 15

due to deficiency of vitamin B12 or folate.

• DNA coenzymes necessary for nuclear maturation.
• both deficiencies cause enlarged fragile cells with reduced lifespan.

Question 16

How can you differentiate a megaloblastic anemia due to Vit b12 from folate defiency?

Answer 16

ONLY vit b12 deficiency causes neruological symptoms….b12 is required for myelin synthesis.

Question 17

What are the causes vitamin b12 deficiency

Answer 17

malabsorption is the most common cause due to a lack of intrinsic factor or antibodies to IF/parietal cells in pernicious anemia. Dietary defiency is UNCOMMON.

Question 18

What are the causes of folate deficiency?

Answer 18

dietary is leading cause, increased need (pregnancy), or drug induced (anti-folate chemo drugs)

Question 19

An MCV > 110 is most likely due to :

Answer 19

low b12 or folic acid

Question 20

what is aplastic anemia?

Answer 20

There will be normocytic RBCs, and normal MCV (82-98). It is due to decreased production of all cell lines by the bone marrow (hypo cellular). There will be a low absolute retic count. It is NOT due to red cell destruction, but rather decreased production.

Question 21

what other cellt ypes will you see a decrease in for aplastic anemia?

Answer 21

decreased WBC and decreased platelets

Question 22

What causes aplastic anemia?

Answer 22

it is due to an unknown agent (immune process), or damage by radiation, benzene, viruses, pesticides, etc.

Question 23

Describe usual blood findings for aplastic findings?

Answer 23

pancytopenia describes usual blood findings

• present with symptoms of bleeding and or infection
• low WBC with neutropenia, low RBC/HGB values, low PLT count.

Question 24

is a bone marrow exam required for aplastic anemia?

Answer 24

yes!!

Question 25

What is hemolytic anemia?

Answer 25

Normocytic RBCs, normal MCV.
severity depends on rate of hemolysis and the degree of bone marrow compensatory response.
- there is an increased absolute retic count but loss is greater than production.

Question 26

What are some hereditary hemolytic anemias?

Answer 26

Hemoglobin S disorders, Hbg SA trait, Hgb SS disease, Hereditary spherocytosis, G-6-PD deficeincy.

Question 27

What is the HGB S disorder?

Answer 27

amino acid substitution in beta glob in chain–> variant Hgb S.

Question 28

Hgb SA trait (heterozygous)?

Answer 28

asymptomatic, not anemic with target cells only, no sickle cells. patient may see potential problems if they are in hypoxic situations.

Question 29

Hgb SS disease (homozygous)?

Answer 29

RBCs contain Hgb S–> sick when oxygen is removed.
Hypoxic situations induce the changes of the cell.
There is NO Hgb A, > 90% is Hgb S.
Avoid infection, hypoxia, dehydration.

Question 30

Hereditary spherocytosis?

Answer 30

inherited RBC membrane defect–?> spherocytes. Treatment is a splenoctomy to increase RBC survival.

Question 31

G-6-PD deficiency?

Answer 31

inherited lack of G-6-PD enzyme needed to protect red cells from oxidative injury. Majority no problems unless exposed to oxidant which leads to RBC destruction–> schistocytes, spherocytes.