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SBL Test 1 > Robbins 14: Anemia Review > Flashcards

Robbins 14: Anemia Review Flashcards

1
Q

Anemias are characterized by

A
  1. ↓ RBC
  2. ↓ Hct
  3. ↓ Hb
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2
Q

What is RDW and what does it tell us?

A
  • Red cell distribution width = Measure of variability of RBC size
  • Wide (↑) RDW = Reactive phenomenon seen in anemia when our BM is functioning properly: marrow is pumping out reticulocytes (larger cells)
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3
Q

What is MCHC?

A
  1. Average concentration of Hgb in RBC
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4
Q

What is MCH?

A

Mean cell hemoglobin = average mass of Hgb/RBC

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5
Q

What qualifies as Anemia in M and W?

A

Men: Hb < 13

Women: Hb <12

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6
Q

Microcytic anemias are due to…

A

↓ hemoglobin in the RBC due to:

  1. Loss of globins
  2. Loss of iron
  3. Loss of heme
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7
Q

Normocytic anemias are due to…

A

↑ destruction (hemolysis)/blood loss or ↓ production of RBC by BM.

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8
Q

Patient presents with normocytic anemia.

How do differentiate the cause?

A

Reticulocyte count

  • ↑ reticulocyte count ➔ ↑ destruction (hemolytic anemia)
    • BM has NL response to anemia
  • ↓ reticulocyte count ➔ underproduction
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9
Q

Macrocytic anemias are due to…

A

Abnormalities that impair maturation of erythroid precursors in BM

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10
Q

Types of Microcytic Anemia

A

Iron LAST

  1. Iron-deficiency
  2. Lead poisoning
  3. Anemia of chronic disease (mostly, normocytic)
  4. Sideroblastic Anemia
  5. Thalassemias
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11
Q

What are Microcytic Anemias that occur due to ↓ iron?

A
  1. Iron-deficiency anemia
  2. Anemia of Chronic Disease (iron is trapped as ferritan)
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12
Q

What are Microcytic Anemias that occur due to ↓ globins?

A

Thalassemias

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13
Q

What are Microcytic Anemias that occur due to ↓ heme?

A
  1. Lead poisoning
  2. Sideroblastic anemia
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14
Q

Types of Macrocytic Anemias

A
  1. Megaloblastic Anemias (B12/folate deficiency/ pernicious anemia): ABNL DNA synthesis
  2. Other: Alcoholism and liver failure
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15
Q

Morphology of Megaloblastic Anemias

A
  1. Macro-ovalocytes
  2. Hypersegmented neutrophils (>5 lobes)
  3. Anisocytosis (variation in size)
  4. Poikilocytosis (variation in shape)
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16
Q

What are the Hct and MCV in Megaloblastic anemia?

A
  • INC MCV
  • DEC Hct
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17
Q

Normocytic anemias can be hemolytic or NON-hemolytic

Types of normocytic, hemolytic anemias due to intrinsic causes

What is the reticulocyte count?

A

↑ Reticulocytes (>2%)

  1. Hereditary Spherocytosis
  2. Paraoxysmal Nocturnal Hemoglobinuria
  3. G6PD Deficiency
  4. Sickle Cell Anemia
  5. HbC Disease
18
Q

Normocytic anemias can be hemolytic or NON-hemolytic

Types of normocytic, hemolytic anemias due to extrinsic causes

What is the reticulocyte count?

A

↑ Reticulocytes (>2%)

  1. AI Hemolytic Anemia (AIHA)
  2. Microangiopathic Hemolytic Anemia (MAHA)
  3. Mechanical
  4. Infection
19
Q

What 2 normocytic hemolytic anemias are due to membrane defects (intrinisic)?

A
  1. Heriditary spherocytosis
  2. Paroxysmal Noctural Hemoglobinuria
20
Q

When do we see Aplastic Crisis via Parvovirus B19?

A

Chronic hemolytic anemias

  1. Sickle Cell Anemia
  2. Hereditary Spherocytosis
  3. Beta-thalassemia major
21
Q

When do you see back/abdominal pain in anemia?

A
  1. Paroxysmal Nocturnal Hemoglobinuria
  2. G6PD Deficiency
22
Q

Anytime RBC is damaged, it is removed via _____

A

Spleen (extravascular hemoloysis)

23
Q

Extravascular hemolysis is due to what?

A
  1. Damage to membrane
  2. Poor deformability
  3. Opsinozation
24
Q

Intravascular Hemolysis is due to what?

A
  1. Mechanical trauma (narrow vessels or mechanical heart valves)
  2. Compliment fixation
  3. Intracellular parasites (malaria)
  4. Extracellular toxins
25
Q

Types of Normocytic Hemolytic anemias that undergo

Extravascular Hemolysis

A
  1. Hereditary Spherocytosis
  2. Sickle cell disorder
  3. G6PD Deficiency (extravascular + intravascular)
  4. Autoimmune hemolytic anemia (AIHA)
26
Q

Types of Normocytic Hemolytic anemias that undergo

Intravascular Hemolysis

A
  1. Mechanical hemolysis
  2. Paraoxysmal Nocturnal Hemoglobinuria
  3. Microangiopathic Hemolytic Anemias (DIC, TTP, HUS)
27
Q

Findings in intravascular hemolysis

A
  1. Schistocytes
  2. Hemoglobinuria + hemoglobinemia + hemosiderinuria
  3. ↓ Haptoglobins
  4. ↑ Unconjugated BR
28
Q

Findings in extravascular hemolysis

Treatment

A
  1. Spherocytes
  2. No hemoglobinuria/hemosiderinuria
  3. Anemia + splenomegaly + jaundice
  4. Treatment = splenectomy
29
Q

Pt has no RBC in urine, but (+) Hgb, what do they have?

A
  1. Hemolysis
  2. Rhadomyolysis
30
Q

Findings in Hereditary Spherocytosis

A
  1. ↑ RDW
  2. NL - ↓ MCV
  3. ↑ MCHC (because RBC is smaller, but same volume)
  4. ↑ fragility to osmotic fragility test
  5. Spherocytes + Howell Jolly Bodies
31
Q

Findings in G6PD Deficiency

A

Stress makes me eat bites of fava beans with Heinz Ketchup

  1. Heinz bodies: RBC with dark areas due to oxidized Hgb that has precipitated
  2. Bite cells
32
Q

Complications of PNH

A
  1. Venous thrombosis
  2. AML
33
Q

Diagnosis and treatment of PNH

A
  1. Flow cytometry to detect RBC deficient in GPI-linked proteins ; (-) Combs test
  2. Eculizimab: monoclonalAB used to prevent C5 => C5a conversion, reduce risk by 90%
34
Q

Does sickling occur in Sickle Cell Trait?

A

Only under SEVERE hypoxia and in renal medulla (↑ risk of renal medullary carcinoma)

35
Q

Histology in B-thalassemia

A
  1. Microcytosis
  2. Hypochromoia
  3. Anicysotiss (↑RDW)
  4. Poikilocytosis
  5. Basophilic stippling: aggregation of RNA due to toxic injury (seen in thalassemias + lead poisoning)
  6. Nucleated RBC
  7. Target cells (HALT, said the hunter to his target)
36
Q

Which value is diagnostially useful in W of childbearing age who are at risk for both B-thalassemia and iron deficiency?

A

HbA2: ↑ in-thalasemia minor

37
Q

Cause sof Warm IHA (IgG Ab)

A
  1. Idiopathic (MC)
  2. AI Disorder: SLE
  3. Drugs (Methyldopa, Penicillin, Cephalosporin)
  4. Lymphoid neoplasms: NHL and CLL
38
Q

Causes of Cold IHA (IgG Ab)

A
  1. Myoplasma pneumonia
  2. EBV
  3. CLL =>
39
Q

Findings in IHA

A
  1. Spherocytes (MC in WARM)
40
Q

Findings in Microangiopathic Hemolytic Anemia

A

Schistocytes

SBL Test 1 (15 decks)

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