Week 9 - anemia Flashcards by Siobhan Woods

What precursor blood cells are OK to find in peripheral blood?

Bands and segmented granulocytes

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What are general symptoms of anemia

Fatigue, pallor, muscular weakness, shortness of breath

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What is the Hb threshold for needing a blood transfusion?

Hb<70

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What conditions have elliptocyte RBCs?

Iron deficiency anemia

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What are acanthocytes?

RBCs that lost central pallor and have irregular cytoplasmic projections

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What conditions have acanthocytes?

Liver disease, hyposplenism

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What conditions have target cells?

Liver disease, alcohol, thalassemia, hyposplenism, seveer iron deficiency

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What conditions have bite cells?

G6PD deficiency and oxidative stress

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What conditions have schistocytes?

DIC, TTP, HUS

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What conditions have spherocytes?

Hereditary spherocytosis, AIHA, general hemolytic anemia

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What conditions have teardrop cells?

Myelofibrosis, thalassemia, myelophthisis,

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What conditions have rouleaux?

severe inflammation/infection, myeloma

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What conditions have RBC agglutination?

cold AIHA

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What gene variants are responsible for SCD?

HbS (glu -> val) and HbC (glu -> lys)

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What are some effects of sickle trait?

Hematuria, glaucoma, dehydration, medullary renal carcinoma

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What causes veno occlusive crises? How to do you treat?

HbS agglutination. Treat with O2, NSAIDs, fluids, treat underlying cause

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What are the causes of microcytic anemia

Iron deficiency, anemias of chronic inflammation, sideroblastic anemia, lead poisoning, thalassemia

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How does Iron def anemia present?

pica, brittle nails, tachycardia, heart murmurs, glossitis, spoon nails

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What are cellular features of iron def anemia?

Anisocytosis, poikilocytosis, hypochromia

Low ferritin, Tf saturation and RBC
High Tf, RDW, platelets

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What are cellular features of anemias of chronic inflammation

Low/normal ferritin, low Tf and Tf saturation, high cytokines and hepcidin

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What is the management for anemia of chronic inflammation?

infection workup, treat underlying cause.
In severe cases, need BM transplant, transfusions, EPO

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What are some causes of sideroblastic anemia

B6 deficiency, drugs/toxins, lead poisoning, alcohol abuse or congenital (X-linked)

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What are cellular features of sideroblastic anemia?

Basophilic stippling and Pappenheimer bodies, high RDW

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How is sideroblastic anemia treated

BM biopsy, treat underlying disease. Transfusions for severe cases

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What are some clinical features of thalassemia

Poor erythropoiesis, short stature, hemolysis, jaundice, splenomegaly

What are cellular features of thalassemia

Basophilic stippling, teardrop cells, target cells, nucleated RBCs, narrow RDW

What are treatments for thalassemia?

Fe chelation with deforoxamine, Fe transfusions

What are 2 main umbrella causes of normocytic anemia?

Decreased RBC production and increased RBC turnover

What are 4 types of normocytic anemia relating to decreased RBC production?

Pure red cell aplasia, aplastic anemia, myelophthisis, anemia of chronic inflammation

What are 3 types of normocytic anemia relating to increased RBC turnover?

SCD, RBC loss, hemolytic anemia

What are causes of pure red cell aplasia?

Diamond Blackfan anemia, autoimmune, MDS, marrow toxins

How does pure red cell aplasia present?

normochromia with no splenomegaly

How is pure red cell aplasia treated?

BM transplant, immunosuppressive therapy. Careful of Febrile neutropenia (Abx)

What are causes of aplastic anemia?

Hereditary, idiopathic, marrow toxins

How does aplastic anemia present?

Fanconi anemia (short stature, triphalangeal thumb, skin and heart defects) and dyskeratosis congenita (lacy skin)

What are cellular features of aplastic anemia?

Pancytopenia Hypocellularity of BM fat cells

How is aplastic anemia treated?

BM transplant, immunosuppressive therapy. Careful of Febrile neutropenia (Abx)

What is myelophthisis? Cellular features?

When BM is replaced by another cell type due to cancer and myelofibrosis, resulting in decreased RBC prodcution. Cell features: teardrop cells and leucoerythroblastic picture

How is SCD treated?

Folate supplements, hydroxyurea, prophylactic peniccilin

What are the 2 main classes of macrocytic anemia?

Megaloblastic and non-megaloblastic

What are 2 types of megaloblastic anemias?

B12 and folate deficiency

What are cell features of megaloblastic anemia?

anisocytosis, neutropenia, thrombocytopenia, pancytopenia Also oval macrocytes and hypersegmented neutrophils

What are causes of non-megaloblastic macrocytic anemia?

liver disease, hypothyroidism, reticulocytosis, pseudo-macrocytosis

Describe pseudo-macrocytosis

RBC clump together due to cold agglutinin disease or multiple myeloma, gives false reading of low RBC

What are cellular features of liver disease non-megaloblastic anemia?

Target cells, reticulocytes

What are causes of reticulocytosis?

Blood loss

What are cellular features of reticulocytosis?

MArkers of hemolysis: high bilirubin and LDH, low haptoglobin

What are 2 main branches of hemolytic anemia?

Hereditary or qcquired

What are 3 types of hereditary hemolytic anemias?

Enzymopathies, membrane defects, and Hb abnormalities

What is a type of enzymopathic hemolytic anemia? Describe presentation and cell features

G6PD deficiency, which causes oxidative stress and anemia. Presents as bite cells, blister cells, Heinz bodies, increased reticulocytes

How do you treat G6PD deficiency?

Folate and splenectomy

What are generally presentations/signs of hemolytic anemia?

Jaundice (due to inc bilirubin from RBC degradation)

How do membrane defect-related hemolytic anemias pressent?

Spherocytes and elliptocytes

How do you treat membrane-defect related hemolytic anemia?

Folate, prophylactic peniccilin

What are some non-immune causes of hemolytic anemia?

Mechanical heart valves, physiological damage (e.g., burns), and membrane abnormalities (e.g. PIFA mutation)

What are 3 types of immune-mediated hemolytic anemia?

infection, autoimmune, and alloimune

How do immune-mediated hemolytic anemias present?

Spherocytes

How do you diagnose immune-mediated hemolytic anemia?

DAT test

Which Ig is linked with cold vs warm AIHA?

warm AIHA = IgG cold AIHA = IgM

How do you treat immune related hemolytic anemia?

Steroids, immunosuppresive drugs, splenectomy, cold avoidance (for cold AIHA)

Compare oxygen affinity of Mb vs HbA vs HbF

Mb > HbF > HbA

How does Hepcidin block iron transport?

Via ferroportin

What are symptoms of MDS?

anemia, thrombocytopenia, neutropenia, progression ot AML

How is MDS managed?

Transfusions if low Hb, EPO, BM transplant in severe cases

When is EPO contraindicated?

With CKD, AIDS, chemotherapy