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Heme / Onc > SM_245b: Approach to Anemias > Flashcards

SM_245b: Approach to Anemias Flashcards

1
Q

Describe erythropoiesis

A

Erythropoiesis

  • Occurs in bone marrow
  • Erythrocyte gets smaller and nucleus shrinks and is extruded during maturation
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2
Q

Describe a reticulocyte

A

Reticulocyte

  • Larger than mature RBC (higher MCV), no central pallor
  • Bluish collor on Wright Giemsa stain due to retention of ribosomal network
  • Normally spend about 3 days in marrow and 1 day in peripheral circulation
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3
Q

Immature erythroid forms of RBCs are present in circulation when ____, ____, ____, or ____

A

Immature erythroid forms of RBCs are present in circulation when

  • Normal in newborns ≤ 5 days old
  • Brisk hemolysis
  • Myelodysplasia
  • Extramedullary hematopoiesis
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4
Q

Describe mature RBCs

A

Mature RBCs

  • Anucleate
  • Biconcave / discoid
  • Cytoplasm: rich in iron containing Hb for O2 transport
  • Normal adult Hgb is 97% HgbA: a2B2
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5
Q

___ stimulates RBC production

A

Erythropoietin stimulates RBC production

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6
Q

Describe RBC production and loss

A

RBC production and loss

  • Erythropoietin stimulates production
  • Circulate for 110-120 days
  • Rate of production = rate of loss
  • Production capacity in anemic states reflected in reticulocyte production
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7
Q

In anemic states, high reticulocyte count indicates ____

A

In anemic states, high reticulocyte count indicates adequate marrow response (e.g. bleeding)

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8
Q

In anemic states, low reticulocyte count indicates ___

A

In anemic states, low reticulocyte count indicates inadequate marrow response (e.g. aplastic anemia)

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9
Q

Anemia is ___

A

Anemia is reduction in absolute number of RBCs

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10
Q

Describe parameters to evaluate for anemia

A

Parameters to evaluate for anemia

  • Hemoglobin (Hgb): concentration of Hb in whole blood
  • Hematocrit (Hct): percent of a sample of whole blood occupied by RBC
  • RBC count: number of RBCs in a particular volume of whole blood
  • Mean cell volume: average size of RBC
  • RBC distribution width
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11
Q

Decreased plasma volume leads to ___

A

Decreased plasma volume leads to artificially increased RBC concentration

  • Dehydration, vomiting / diarrhea, over-diuresis, and burns
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12
Q

Increased plasma volume leads to ____

A

Increased plasma volume leads to artificially decreased RBC concentration

  • Pregnancy, CHF, renal insufficiency
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13
Q

Compensatory mechanisms to anemia are ____, ____, and ____

A

Compensatory mechanisms to anemia are increased cardiac output, increased EPO, and increased 2,3 DPG

  • Fick equation: O2 delivery = blood flow x Hgb x (Arterial SaO2 - venous SaO2)
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14
Q
A
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15
Q

RBC size is determined using ___

A

RBC size is determined using MCV

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16
Q

Describe causes of normocytic anenmia

A

Normocytic anemia

  • Anemia of chronic disease
  • Blood loss
  • Hemolytic anemia
  • > 1 etiology
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17
Q

Describe causes of macrocytic anemia

A

Macrocytic anemia

  • Folate or B12 deficiency
  • Liver disease
  • Hemolysis
  • Myelodysplasia
  • Hypothyroidism
  • Hemolysis
  • > 1 etiology
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18
Q

Describe causes of microcytic anemia with low RBC count

A

Microcytic anemia with low RBC count

  • Iron deficiency
  • Sideroblastic
  • Hemolytic anemia
  • Lead poisoning
19
Q

Describe causes of microcytic anemia with high RBC count

A

Microcytic anemia with high RBC count

  • Thalassemia (alpha or beta, trait or disease)
20
Q

Mentzer Index = ____ + ____

A

Mentzer Index = MCV + RBC count

21
Q

Mentzer Index < 13 indicates ___

A

Mentzer Index < 13 indicates thalassemia is more likely than iron deficiency

22
Q

Describe examples of how anemia can result from ≥ 1 process

A

Anemia can result from ≥ 1 process

  • Iron and B12 deficiencies -> microcytosis and macrocytosis -> average MCV is normal
  • Higher RDW
  • Iron, B12, and folate levels should be low
23
Q

Under the kinetic approach, anemia can result from ____, ____, or ____

A

Under the kinetic approach, anemia can result from decreased RBC production, blood loss, and RBC destruction

24
Q

Describe variation in symptoms of anemia

A

Anemia symptoms

  • Acute: signs and symptoms more likely - orthostatic dizziness, headache, tachycardia
  • Insidious onset / chronic anemia: hemodynamic symptoms such as lightheadedness less common due to expansion of plasma volume, often able to tolerate lower Hb levels due to body adaptations
25
Q

Describe common symptoms of anemia

A

Anemia symptoms

  • Fatigue
  • Dyspnea
  • Cold intolerance
  • Palpitations
  • Lightheadedness
  • Orthostatic hypotension
26
Q

Describe physical findings of anemia

A

Anemia physical findings

  • Tachycardia
  • Low BP
  • Orthostatic hypotension
  • Flow murmur
  • Pallor
  • Jaundice
27
Q

Laboratory evaluation of anemia involves ___, ___, and ___

A

Laboratory evaluation of anemia involves CBC, reticulocyte count, and peripheral blood smear

28
Q

Low Hgb, low MCV, normal WBC / platelets indicates ___

A

Low Hgb, low MCV, normal WBC / platelets indicates iron deficiency anemia

29
Q

Low Hgb, high MCV, and low WBC indicates ____

A

Low Hgb, high MCV, and low WBC indicates B12 / folate / thyroid deficiencies

30
Q

Low Hgb, high MCV, low / normal platelets indicates ____

A

Low Hgb, high MCV, low / normal platelets indicates end-stage liver disease

31
Q

Low Hgb, normal MCV, high RDW indicates ____

A

Low Hgb, normal MCV, high RDW indicates mixed iron and B12 deficiency anemia

32
Q

Low Hgb, high MCV, and low platelet count indicates ___

A

Low Hgb, high MCV, and low platelet count indicates possible primary bone process such as myelodysplastic syndrome or aplastic anemia

33
Q

Hereditary spherocytosis involves ____

A

Hereditary spherocytosis involves mutations in RBC membrane proteins

34
Q

Echinocytes and canthocytes are seen in ____, ____, ____, ____, and ____

A

Echinocytes and canthocytes are seen in Vitamin E deficiency, hypothyroidism, post-splenectomy, liver disease, abetalipoproteinemia

35
Q

Echinocytes (burr cells) have ____

A

Echinocytes (burr cells) have more regular projections

  • Usually artifact due to preparation of slide
  • Can be seen in CKD, liver disease
36
Q

Acanthocytes (spur cells) have ___

A

Acanthocytes (spur cells) have more irregular projections

  • Anorexia, nutritional deficiency
37
Q

Describe schistocytes

A

Schistocytes

  • Helmet cells
  • RBC schrapnel
  • Intravascular destruction
    • Intravascular hemolysis: complement-mediated / IgM hemolysis, enzyme deficiency (G6PD)
    • Shearing and mechanical damage: artificial heart valve, mechanical circulation, DIC, TMA, HTN
38
Q

Describe target cells

A

Target cells

  • Due to excess RBC membrane relative to volume
  • Macro-target cells: liver disease
  • Micro-target cells: hemoglobinopathy: thalassemia, hemoglobin E and C disease
39
Q

Describe Vitamin B12 deficiency

A

Vitamin B12 deficiency

  • Pernicious anemia, gastric surgery, vegan diet, celiac disease, tapeworm
  • Treat with IM Vitamin B12
40
Q

Pernicious anemia is an ___ due to ___ that results in ___

A

Pernicious anemia is an autoimmune disease due to anti-intrinsic factor antibodies that results in Vitamin B12 deficiency

41
Q

___ is a temporary way to treat anemia and the underlying cause should be treated

A

Transfusion is a temporary way to treat anemia and the underlying cause should be treated

42
Q

In patients with hemolytic anemia, RBC transfusion can cause ____

A

In patients with hemolytic anemia, RBC transfusion can cause increase hemolysis

43
Q

If RBC parameters are abnormal, the next step is to look at the ___

A

If RBC parameters are abnormal, the next step is to look at the peripheral smear

Heme / Onc (41 decks)

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