Term
| What is the typical survival of rbc in the circulatory system? |
|
Definition
| It's average life span is 120 days. |
|
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Term
| What is the term for premature breakdown of an rbc? |
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Definition
| This is the definition of hemolysis. |
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Term
| What is the most important role of hbg? |
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Definition
| It's most important role is binding o2. |
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Term
| What are the three qualifications for anemia? |
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Definition
The three qualifications for this condition are:
1) abnml low blood in circulation.
2) low hbg.
3) decreased no of rbc's. |
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Term
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Definition
| No. This is a sign of an underlying dz. |
|
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Term
| What 3 things cause anemia? |
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Definition
| The three causes are: 1) impaired rbc *production* 2) increased rbc *destruction* 3) bood *loss* (acute or chronic) |
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Term
| What are 2 ways anemia can be classified? |
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Definition
| The 2 ways are 1) rbc *morphology* and 2) *mechanism* causing decrease in rbc's |
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Term
| What are some descriptions of blood cell morphology? |
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Definition
| Some descriptions include: acanthosis, poikilocytosis, and anisocytosis |
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Term
| Damage to what 2 organs would cause impaired rbc production? |
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Definition
|
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Term
| What are 6 reasons for increased rbc destruction? |
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Definition
| 6 reasons include: 1) spleen. 2) sickle cell. 3) mechanical valve. 4) meds. 5) autoimmune. 6) sepsis. |
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Term
| What are a few mechanisms for decrease in rbc's? |
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Definition
| Some mechanisms include: traumatic, iron deficiency, decreased absorption of b12 or folic acid, etc. |
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Term
| What is MCV? When would it be high and low? |
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Definition
| *ave* mean corpuscular volume. This measures size. High: megaloblastic anemia (folate or b12 deficiency), myelodysplasia, and antiviral drug use. Low: microcytic anemia (Fe deficiency, thalassemia, anemia of chronic dz) |
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Term
| What is MCHC? When would it be high and low? |
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Definition
| This measures the amt of Hgb in given rbc. High: hereditary spherocytosis. Low: Fe deficiency anemia,, sideroblastic anemia, lead exposure. |
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Term
| What is a retic count? When would it be high or low? |
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Definition
| This measures immature nonnucleated rbcs and parallels bone marrow activity. Increased: hemolytic anemia, acute post hemorrhage, anemia Rx (fe, transfusion, folate, b12), pregnancy. Decreased: inadequate bone marrow prouction (aplastic anemia, sepsis, chemo/rt), chronic dz. |
|
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Term
| What is TIBC? When would it be high or low? |
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Definition
| This measures the capacity of transferrin to bind Fe. Decreased: Pernicious anemia, sickle cell anemia, liver dz, hemolytic anemia. Increased: Fe deficiency anemia. |
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Term
| What is Hct? What are nml ranges? When might it be high or low? |
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Definition
| This ms the volume of packed rbc's. men: 40-54%. women: 38-47% Increased: polycythemia. Decreased: anemia, hemorrhage. |
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Term
| What is MCH? Why might it be high or low? |
|
Definition
| *ave* hgb per cell. High: hereditary spherocytosis. Low: Fe deficiency anemia,, sideroblastic anemia, lead exposure. |
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Term
| What is Hgb and what are nml values? When might it be high or low? |
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Definition
| This is a molecule that contains heme, which transfers O2 through the blood stream. men: 13.5-18. women: 12-16. Increased: polycythemia. Decreased: anemia, hemorrhage. |
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Term
| What is RDW? When might it be high or low? |
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Definition
| This ms how much variation in size exists among RBCs. Increased variation indicates that an underlying cause is more likely the source of the anemia. Decreased: no known cause. |
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Term
What test would you order to get the following information: The number of red blood cells (RBCs),
The number of white blood cells (WBCs),
The total amount of hemoglobin in the blood,
The fraction of the blood composed of red blood cells (hematocrit),
The size of the red blood cells (mean corpuscular volume, or MCV),
Mean corpuscular hemoglobin (MCH),
Mean corpuscular hemoglobin concentration (MCHC), and
The platelet count. |
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Definition
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Term
| What does a ferritin level measure? Why would you order it? |
|
Definition
This measures the amount of iron the body is storing. Ferritin less than 12 mcg/L is dx for Fe deficiency anemia. Increased: Alcoholic liver disease,
Frequent transfusion of packed red blood cells,
Hemochromatosis,
Hemolytic anemia,
Hodgkin's lymphoma,
Megaloblastic anemia. |
|
|
Term
| What 3 categories of factors can interact to increase risk of Fe deficiency anemia? |
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Definition
| The 3 factors are 1) demographic factors, 2) dietary factors, and 3) social/physical factors. |
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Term
| What is chelosis, and what type of anemia would it indicate? |
|
Definition
| This is cracks in the corners of the mouth and other mucous membranes, and indicated Fe deficiency anemia. |
|
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Term
| Pt c/o easy fatigability, tachycardia, palpitations, and tachypnea on exertion. On pe you note nail bed color changes, pale conjunctiva, skin and mucosal changes, smooth tongue, brittle nails, cheilosis, dysphagia w/esophageal webs and pica. What would you order to confirm your dx and what abnml would you expect? |
|
Definition
| These symptoms indicate late Fe deficiency anemia, which is confirmed w/low serum ferritin levels. Other late findings include low hgb and hct, elevated tibc, low mcv (initially nml), low mch. Severe findings include anisocytosis, poikilocytosis, target-shaped cells, pencil-shaped cells, and increased retics. |
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Term
| The following tests come back on a 62 yo f pt who c/o stomach discomfort and has been admitted d/t marked symptoms of anemia: hgb-8, hct-24, platelets-500,000, elevated tibc, low rbc (3.5*10^6), nml wbc (5*10^3), low mcv (60 fl), low mch (22 pg), increased rdw (17%) with anisocytosis, poikilocytosis, target-shaped cells, pencil-shaped cells, and increased retics (16%), and low ferritin levels (8). How do you tx the anemia? |
|
Definition
| These labs indicate severe Fe deficiency anemia. Tx quickly w/blood transfusion of *PRBCs* to include bo rbc and fe. |
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Term
| A pt casually notes on her yearly exam that she feels fatigued, and you order a cbc that shows: Hct-33%, Hbg-11, low RBC (4*10^6), nml WBC (6*10^3), nml platelets (400*10^3), nml mcv (82 fl), nml mch (27 pg), nml mchc (33%), nml rdw (13%), nml retic ct (2%). Ferritin was nml and tibc was slightly increased. What do you dx and how do you tx? |
|
Definition
| These lab results indicate mild Fe deficient anemia, which shold be tx w/oral tx: ferrous sulfate starting low and slowly working up to 325 mg tid. |
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|
Term
|
Definition
| This is a variation of RBC *size*. Seen in Fe deficiency, thalassemias, and B12 deficiency. |
|
|
Term
|
Definition
| This is variation of RBC *shape*. Seen in Fe deficiency, B12 deficiency, and thalassemias. |
|
|
Term
| What might spherocytes indicate? |
|
Definition
| This might indicate hereditary spherocytosis, hemolytic anemias (autoimmune), alcoholism. |
|
|
Term
| What might target cells indiate? |
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Definition
| This might indicate hemoglobinopathies, thalassemia, *severe Fe deficiency anemia*. |
|
|
Term
| What might schistocytes indicate? |
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Definition
| microangiopathyic hemolytic anemias (immune, dic, tp, hus, hemangiomas, metastatic ca . . . ), prosthetic heart vlaves, glomerulonephritis. |
|
|
Term
| What might howel jolly bodies indicate? |
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Definition
| These might indicate post splenectomy, hemolytic anemias, thalassemia. |
|
|
Term
| What might heinz bodies indicate? |
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Definition
| These might indicate hemolytic anemia, hmoglobinopathies, oxidation, g6pd deficiency, post splenectomy. |
|
|
Term
| What might stippling indicate? |
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Definition
| This might indicate Pb or As poisoning, hemolysis, thalassemia. |
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Term
| What tx causes anaphylaxis? What alternate is preferred d/t this ade? When is this tx considered? |
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Definition
| This side effect is why NaFeGluconate is preferred to Fe dextran for parenteral tx of Fe deficiency anemia and why pareneteral tx is only considered if pt is 1) intolerant to po tx, 2) refractory to po tx, or 3) has longstanding gi dz. |
|
|
Term
| What are 3 causes of anemia of chronic dz? |
|
Definition
| Three causes include: 1) absolute or relative epo deficiency. 2) direct inhibition of erythropoiesis. 3) Fe: poor incorporation, blocking Fe or Fe stores from gettin into developing rbcs. |
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|
Term
| What 6) categories should be considered as causes of anemia of chronic dz? |
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Definition
| 4 categories include: 1) chronic inflammatory 2)infectious 3)malignant and 4) autoimmune dz 5) liver dz 6)kidney dz. |
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|
Term
| What is the MOST COMMON microcytic anemia? |
|
Definition
| Fe deficiency anemia is most common worldwide. |
|
|
Term
| What is a nml platelet ct? |
|
Definition
| Nml values for men and women are: 150-450 *10^3 |
|
|
Term
| What is the MOST COMMON cause of Fe deficiency anemia? |
|
Definition
| The MC cause is blood loss. |
|
|
Term
| Is more Fe present in hgb of circulating rbcs or in storage? |
|
Definition
| 70-95% is present in hgb of circulating rbcs. The rest is stored in "storage pool" of ferritin or hemosiderin. |
|
|
Term
| Do most women have a storage pool of ferritin or hemosiderin? |
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Definition
| Yes, 75% of women do. Only 25% do not have one. |
|
|
Term
| Is most dietary Fe ingested absorbed? |
|
Definition
| No, only 10-20% is absorbed. |
|
|
Term
| What is the physiologic excretion mechanism for Fe? |
|
Definition
| None exists; it is lost by desquamation of epithelium. |
|
|
Term
| What type of anemia initially involves a normocytic, normochromic smear that eventually becomes hypochromic and microcytic? |
|
Definition
| This smear is typical of anemia of chronic dz. |
|
|
Term
| What type of anemia involves decreased rbc survival, with bone marrow unable to compensate d/t decreased Fe available, causing total rbcs to decrease? |
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Definition
| This is the reason total RBCs decrease w/anemia of chronic dz. |
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Term
| A 59 yo m pt w/rheumatoid arthritis w/easy fatigability, tachycardia, palpitations, and tachypnea on exertion. What tests do you order to account for his symptoms and what abnml do you expect? |
|
Definition
| This symptoms of this pt indicate anemia of chronic dz secondary to inflammation d/t ra. A CBC might show: hct 37, hgb 12, low red cell ct (4 * 10 ^6), nml wbc (7,000), nml platelets (200,000), nml mcv (81), slightly decreased mchc (31%), nml retics (1%). TIBC would be low (15%). |
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|
Term
| A 61 yo m dialysis pt has the following lab results: hct 37, hgb 12, low red cell ct (4 * 10 ^6), nml wbc (7,000), nml platelets (200,000), low mcv (70), low mchc (30%), nml retics (1%). TIBC is low (15%), and ferritin is nml (20). What do you suspect and how do you tx? |
|
Definition
| This lab work-up and hx indicates anemia of chronic dz secondary to renal failure and would be tx w/iv epo. (Pts undergoing hemodialysis regularly lose bo iron and folate during dialysis). In most cases, no tx is necessary, but in cases of renal failure and secondary anemias, *mainstay of tx is epo replacement (epoetin alpha-procrit/epogen)*: purified recombinant epo stimulates bone marrow to produce rbcs. |
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Term
| What is the most common tx for anemia of chronic dz? What is the next common tx and what is it's major drawback? |
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Definition
| In most cases, no tx is necessary. In renal failure, or secondary anemias, mainstay of tx is epo replacement (epoetin alpha-procrit/epogen). very expensive: 8 wk tx for 70 kg ca pt @ 150u/kg tiw ~$3000+. |
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|
Term
| In thalassemias, what is caused by decrease of globun chains? |
|
Definition
| Decrease in globin chains causes decrease in hgb *synthesis*. |
|
|
Term
| What form is 98% of adult hg? Of what is it composed? |
|
Definition
| Most is hgbA, composed of 2 alpha and 2 beta chains. |
|
|
Term
| What form is 1-2% of hgb? Of what is it composed? |
|
Definition
| 1-2% of hgb is a2: alpha2delta2 |
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|
Term
| What form is <1% of adult hgb? Of what is it composed? |
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Definition
| <1% hgb F- alpha2lambda2- major hgb of fetal life. |
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Term
| Which thalassemia typically occurs w/pts of se asia or chinese descent? |
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Definition
| Pts from these areas typically present w/Thalassemia A. |
|
|
Term
| What genetic abnormality results in thalassemia A? |
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Definition
| This is results from a deletion of a gene at *Chromosome 16*, causing reduced alpha-globin chain synthesis. |
|
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Term
| How many beta genes and chains exist in adult hgb a? |
|
Definition
| This globin has 2 genes and 2 chains. |
|
|
Term
| How many alpha genes and chains exist in adult hgb a? |
|
Definition
| This globin has 2 chains and 4 genes. |
|
|
Term
| What type of hgb forms d/t xs beta chains in alpha thalassemia? |
|
Definition
|
|
Term
| What is the genetic makeup of a nml individual w/o alpha thalassemia? |
|
Definition
| This individual will have 4 alpha chains. |
|
|
Term
| What is the genetic makeup of a silent carrier of alpha thalassemia? What abnml will this pt have/ |
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Definition
| This individual will have 3 alpha-globin genes, and their labs will be nml. |
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Term
| What is the genetic makeup of a pt w/alpha thalassemia minor? What symptoms will this pt have? |
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Definition
| This pt will have 2 alpha-globin genes and will have mild anemia w/nml life expectancy. |
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|
Term
| What is the genetic makeup of a pt w/HgB H dz? What symptoms will this pt have? |
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Definition
| This pt will have 1 alpha globin gene and will have *chronic* hemolytic anemia, pallor, splenomegally, and possible splenectomy. |
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Term
| What is the genetic makeup of a pt w/hydrops fetalis? |
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Definition
| This pt will have 0 alpha globin chains and will be stillborn d/t anemia complications, abnml fluid overload, hypoxia, heart failure, and breakdown of rbcs. |
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Term
| How do you differentiate sickle cell anemia from thalassemia? |
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Definition
| These two have similar presentations, but you can differentiate w/a blood smear. |
|
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Term
| What genetic abnml results in beta-thalassemia? What are the results of this abnml? |
|
Definition
| This is a result of chain formation termination- point mutation- leads to decreased or absent beta-blobin chain synthesis. XS alpha-globin chain leads to unstable, damaging chains, which cause hemolysis and hyperplastic bone marrow. |
|
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Term
| What type of thalassemia usually occurs in pts of mediterranean descent, w/lesser asian, chinese, and black descent? |
|
Definition
| This heritage is typical of beta-thalassemia. |
|
|
Term
| What genetic make-up causes thalassemia major? |
|
Definition
| homozygous-missing beta globin chains. |
|
|
Term
| A mother from Somalia gives birth to a healthy child. However, 9 mos later her mother returns w/the child who has developed bony deformities in her head, abdominal swelling, and fx her arm. Her CBC reveals severely low hct, severly low hgb, severly low rbc ct, nml wbc, nml platelets, low mcv, low mchc and increased retics. Peripheral blood smear reveals stippling of rbcs, target cells, and ovalocytes. How do you tx? |
|
Definition
| This pt hx and lab results indicate beta-thalassemia major, which should be tx w/regular blood transfusions with iron chelation to prevent overload. The tx of choice for beta-thalassemia major is allogenic bone marrow transplantation, and is well-tolerated in children who have not yet experienced Fe overload and chronic organ toxicity. |
|
|
Term
| What genetic abnml causes Beta thalassemia minor? |
|
Definition
| This is caused by one copy of beta-thalassemia gene, hetrozygous. |
|
|
Term
| A child moves with his parents to the states from Corfu, Greece. Several weeks after the move he develops tachycardia, palpitations, tachypnea on exertion and fatiguability after becoming ill with the flu. CBC reveals slightly decreased hbg and hct, increased wbc, nml platelets, decreased mcv, nml mchc, nml rdw. His transferrin levels are nml, his tibc is nml, and his ferritin is nml. What do you suspect and how do you tx the anemia? |
|
Definition
| This clinical description indicates beta-thalassemia intermedia: homozygous for more mild form of beta-thalassemia. These pts require no tx for anemia, however the condition should be noted in medical records to indicate risk of Fe overload. |
|
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Term
| What is another name for B12 and for what is it necessary? What occurs cellularly w/decreased B12 levels? |
|
Definition
| Cobalamin is necessary for DNA synthesis and *formation of RBCs and maintenance of NS*. Decrease results in nucleus maturation arrest. |
|
|
Term
| Where is cobalamin bound, absorbed, and stored? |
|
Definition
| This is bound with IF, absorbed from terminal ileum, and stored in the liver. |
|
|
Term
| Where does the body obtain vitamin B12? |
|
Definition
| All is obtained from the *diet*, from foods of animal origin. |
|
|
Term
| In what population is B12 deficiency usually seen? What is the MOST COMMON cause? |
|
Definition
| This is usually seen in vegans. It is also seen s/p abdominal sx, esp gastrectomy, resection, and gi dz. Occasionally d/t pancreatic dz. Most commonly d/t pernicious anemia: lack of if. |
|
|
Term
| An 45 yo m pt w/no pmi who works as a chicken farmer presents w/easy fatigability, tachycardia, palpiations, tachypnea on exertion, and paresthesias. On pe you note smooth tongue. What do you suspect, what do you order to confirm, and how do you tx? |
|
Definition
| This clinical presentation indicates pernicious anemia. Order CBC, which might show markedly elevated MCV, smear w/macro-ovalocytes and hypersegmented neutrophils. Order serum b12. If abnml, order serum methylmalonic A. Tx w/parenteral b12 indefinitely. |
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|
Term
| A 18yo f pt w/no pmi who calls herself a "picky eater" presents w/symptoms of anemia. CBC shows hgb-10, hct-30, decreased rbc, platelet-300,000, nml wbc, markedly elevated mcv, nml mchc, decreased retics, and increased rbc distribution. Smear reveals macro-ovalocytes and hypersegmented neutrophils. What do you suspect and how do you tx? |
|
Definition
| This clinical scenario indicates vitamin B12 or folic acid deficiency possibly d/t diet. Take serum B12 and folate levels to distinguish. Tx B12 deficiency indefinitely w/b12 either parenterally or orally (follow to see if po tx is effective to r/o pernicious anemia). Tx folic acid deficiency w/ folic acid 1mg/day po and cont to monitor levels to continue prn. |
|
|
Term
| How do you confirm Pernicious anemia if serum B12 levels are nml? |
|
Definition
| Confirm this with methylmalonic acid. |
|
|
Term
| What is the MOST COMMON cause of tx failure w/Fe deficiency anemia? |
|
Definition
| The most common cause is pt noncompliance w/medications. |
|
|
Term
| What is the MOST COMMON cause of folic acid deficiency anemia? |
|
Definition
| The most common cause is poor dietary intake. |
|
|
Term
| Alcohol abuse, poor dietary intake, anorexia, gi dz and medications, chronic hemolytic anemia, PREGNANCY, skin dz, and dialysis can all cause what type of anemia? |
|
Definition
| These are causes of folic acid deficiency. |
|
|
Term
| On a cellular level, what does Folic acid do? Where is it present? |
|
Definition
| This is responsible for many carbon transfer rxns, and is important for certain steps of DNA synthesis. It is present in most fruits and vegetables w/levels very dependent on diet. |
|
|
Term
| When must folic acid levels be supplemented to reduce incidence of serious neural tube defects such as spina bifida? |
|
Definition
| This must be supplemented at least 1 mo prior to pregnancy. |
|
|
Term
| *What percentage of pregnancies in the US are planned?* |
|
Definition
|
|
Term
| What population should be encouraged to take folic acid? |
|
Definition
| All women of childbearing age should be encouraged to consum 400 mcg/day. |
|
|
Term
| What is the no. one drug that causes drug-induced megaloblastic anemia? |
|
Definition
| ETOH- is the number one cause. Other drugs include methotrexate, sulfa drugs, purine and pyrimidine analog chemotherapeutic agents, antiviral agents. *Each work by a different mechanism.* |
|
|
Term
| What might pencil shaped cells indicate? |
|
Definition
| This smear abnml might indicate Fe deficiency anemia. |
|
|
Term
| Book question: What do acanthocytes indicate? |
|
Definition
| This smear result indicates thalassemia. |
|
|
Term
| What is indicated by hypersegmented neutrophils (mean lobe count grerater than 4 or the finding of a 6 lobed neutrophil)? |
|
Definition
| This smear abnml indicates Vit B12 deficiency. |
|
|
Term
| What is the order of neural deficits in B12 deficiency? |
|
Definition
| The order of neural deficits is: 1) *peripheral nn involved first: paresthesias*, which progresses to 2) posterior columns: balance difficult, which progresses to 3 neuropsychiatric pathology, dementia, decreased vibration/position sense, major mm deterioration, weakness. |
|
|
Term
| What is the hallmark symptom of vitamin b12 deficiency? |
|
Definition
| The hallmark symptom is megaloblastic anemia. |
|
|
Term
| Book question: What anemia occurs w/elevated ldh and indirect bilirubin, and involves a possible tx complication of hypokalemia? |
|
Definition
| This is involved w/B12 deficiency. |
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|
