Term
| Anemia is a decrease in the __ of __ __ __ __ and thereby a decrease in __ __ __. It is the most common hematological disorder and almost always a secondary disorder. |
|
Definition
- count of circulating red blood cell mass
- oxygen carrying capacity |
|
|
Term
| Three ways anemia can be classified: |
|
Definition
- according to onset: acute vs. chronic
- according to reticulocyte count: adequate or inadequate reticulocytosi
- according to size |
|
|
Term
| How to classify anemia according to size: |
|
Definition
- Macrocytic (MCV greater than or equal to 100 fl)
- Normocytic (MCV of 81-99 fl)
- Microcytic (MCV of less than or equal to 80fl) |
|
|
Term
| Most common cause of microcytic anemia: |
|
Definition
|
|
Term
| Most common cause of macrocytic anemia: |
|
Definition
|
|
Term
| In general, anemia presents with what symptoms: |
|
Definition
- easy fatigue and loss of energy
- rapid heart beat, especially with exercise
- SOB and headache, especially with exercise
- difficulty concentrating
- dizziness
- pale skin
- insomnia |
|
|
Term
| Additional symptoms for iron deficiency anemia: |
|
Definition
- PICA
- koilonychias (spoon nails)
- soreness of the mouth with cracks at corners
- dysphagia (Plumber-Vinson Syndrome) |
|
|
Term
| Additional symptoms of B12 deficiency anemia: |
|
Definition
- parasthesias
- loss of sense of touch
- wobbly gait/difficulty walking
- clumsiness and stiffness in arms and legs
- dementia
- hallucinations, paranoia, and schizophrenia |
|
|
Term
| Additional symptoms of anemia caused by chronic lead poisoning: |
|
Definition
- blue black line on gums called the lead line
- abdominal pain
- constipation
- vomiting |
|
|
Term
| Additional symptoms of anemia caused by chronic RBC destruction (hemolysis): |
|
Definition
- Jaundice
- Brown/red urine
- leg ulcers
- failure to thrive in infancy
- gallstone symptoms |
|
|
Term
| Sickle cell anemia symptoms: |
|
Definition
- fatigue
- susceptibility to infection
- delayed growth and development in children
- episodes of severe pain, especially in joints, abdomen, and limbs |
|
|
Term
| Symptoms of anemia caused by sudden RBC destruction: |
|
Definition
- abdominal pain
- red/brown urine
- jaundice
- small bruises under the skin
- seizures
- kidney failure symptoms |
|
|
Term
| Basic etiology of anemia: |
|
Definition
- not making enough
- losing too much |
|
|
Term
| Example of decreased production causing anemia: |
|
Definition
|
|
Term
| For males, a Hemoglobin less than __ is considered anemic. |
|
Definition
|
|
Term
| For females, a Hemoglobin less than __ is considered anemia. |
|
Definition
|
|
Term
|
Definition
evidence of recent bleeding
health changes recently
medication changes
changes in energy level, fatigue |
|
|
Term
| Clinical signs of anemia upon PE: |
|
Definition
- skin/mucosal pallor
- skin dryness
- bald tongue/glossitis
- mouth ulcers/rectal exam
- jaundice/purpura
- lymphadenopathy
- hepato-splenomegaly
- breathlessness (RR above 20 is high)
- tachycardia, CHF
- bleeding, occult blood |
|
|
Term
| Possible labs for anemia workup: |
|
Definition
- CBC w/ diff
- Peripheral smear
- Reticulocyte count
- Iron studies
- B12
- Folate |
|
|
Term
| A wide RBC distribution width (RDW) is called: |
|
Definition
|
|
Term
MCV = Mean corpuscular volume
> 100 macrocytic anemia
81–99 normocytic anemia
< 80 microcytic anemia |
|
Definition
|
|
Term
| what does a plain CBC include: |
|
Definition
- RBC count
- WBC count
- HGB
- HCT
- MCV
- MCH
- MCHC
- Platelets |
|
|
Term
| MCHC measures __ __. The terms __ and __ refer to changes in __ __ in the red cells. |
|
Definition
- hemoglobin concentration
- hyperchromic and hypochromic
- hemoglobin concentration |
|
|
Term
| Measurement on CBC that refers to Hemoglobin concentration in the RBCs: |
|
Definition
|
|
Term
| A large RDW suggests large __ in sizes of RBCs. This is called ___. This value is calculated by: |
|
Definition
- variability
- anisocytoses
- RDW= (standard deviation of red cell volume/MCV)x100 |
|
|
Term
| The __ __ is an indirect assessment of bone marrow function and offers information about newly released cells. Normally, __ can be seen for about 24 hours after release before they turn into RBCs. |
|
Definition
- reticulocyte count
- reticulocytes |
|
|
Term
| Normal Reticulocyte Count for Adults: |
|
Definition
|
|
Term
Reticulocyte count is representative of bone marrow
function
1. RBC production increased, Retic count increases
2. RBC production decreases, Retic count decreases |
|
Definition
|
|
Term
| Disease states with increased Reticulocyte counts: |
|
Definition
- Hemolytic anemias
- After acute hemorrhage
- Pernicious anemia or iron deficiency anemia after treatment |
|
|
Term
| Disease states with decreased reticulocyte counts: |
|
Definition
- Aplastic anemia
- Iron deficiency anemia before treatment
- Pernicious anemia before treatment |
|
|
Term
| 4 causes of Microcytic Anemia: |
|
Definition
- Iron Deficiency Anemia
- Thalassemia
- Sideroblastic Anemia
- Anemia of chronic disease |
|
|
Term
If HGB and HCT are low> anemia
If MCV< 80 = microcytic
Now what? |
|
Definition
Check for iron deficiency by ordering:
- Serum iron- non-heme iron, variability day to day
- Ferritin- best for iron stores
- Total Iron Binding Capacity- good sensitivity for low iron but low specificity
- Fe or Transferrin saturation- serum iron/TIBC |
|
|
Term
| How to calculate Fe saturation? |
|
Definition
|
|
Term
| Ferritin is also an __ __ _, like CRP and sed rate. These are all non-specific indicators of inflammation. So if ferritin is up, inflammation could be going on. |
|
Definition
|
|
Term
|
Definition
| primary iron storage protein in body. Serum ferritin is an indirect reflection of total iron stores. Free iron is toxic due to catalyzation of hydrogen peroxide into free radicals so binding to ferritin is essential. |
|
|
Term
| TIBC measures the extent to which iron binding sites in the serum can be __ . It is an indirect measure of ___ and ___ related to ___ saturation. |
|
Definition
- saturated
- transferrin
- inversely related to transferrin saturation |
|
|
Term
|
Definition
- serum iron/TIBC x100
reflects the amount of iron immediately available for Hgb synthesis |
|
|
Term
| Iron deficiency anemia causes problems with ___ ___. This is the most common anemia worldwide and most common anemia in children. |
|
Definition
|
|
Term
| pregnancy would likley result in what type of anemia: |
|
Definition
| iron deficiency b/c of increased demand |
|
|
Term
| Iron deficiency anemia summary: |
|
Definition
Microcytic MCV < 80 fl, RBC < 6 µ
RDW Widened and shifted to left
Hypochromic MCH < 27 pg, MCHC < 30%
Retic. count May be > 2 %
Serum ferritin Very low < 33 (p mols/L)
TIBC Increased > 340 (µg/dL)
BM Iron stain Iron is low to Absent
Response to Fe Rx. Excellent |
|
|
Term
| Erythropoietin made in the kidneys drive RBC production, you generate more erythropoeitin due to hypoxia (anemia> carry less oxygen> hypoxia> erythropoietin secreted from kidneys> make more RBCs). |
|
Definition
|
|
Term
| IRON SUPPLEMENTS MAKE YOU CONSIPATED, SO TELL THEM TO EAT MORE FIBER, AND MORE WATER |
|
Definition
|
|
Term
Absorption of Heme Iron > ionized forms of iron
Food, Phytates, Ca, Phosphate, antacids ↓absorption
Ascorbic acid ↑absorption
Oral iron Rx. is the best – with food, stool softener
FeSO4 is the better than other forms of iron. Reserve parenteral Rx.
Packed cell transfusion in emergency
Continue Fe Rx at least 2 months after normal Hb
1 gram ↑in Hb every week can be expected |
|
Definition
|
|
Term
| continue iron supplement for at least __ __ after normal Hb |
|
Definition
|
|
Term
| What if there is microcytic anemia, but the iron studies are normal? What is the next step? |
|
Definition
|
|
Term
Microcytic Anemia
Normal Iron Studies
Normal RBC and FHx of anemia
What are thinking? |
|
Definition
|
|
Term
Microcytic anemia
Normal Iron studies
Low RBC count
What are you thinking? |
|
Definition
- Sideroblastic anemia
- Anemia of chronic disease |
|
|
Term
| Distribution of thalassemia parallels that of __ __. |
|
Definition
| Plasmodium falciparum (malaria): Mediterranean, Africa, Western and SE AsiaIndia, Burma |
|
|
Term
| Thalassemia is a ___ defect in hemoglobin in which the patient cannot make enough _ or __ chains. This results in a __ __ anemia. The RBC count will be __ or __. Serum iron will be __ to __. RDW is usually __. Need to get a __ __. |
|
Definition
- quantitative defect
- alpha or beta chains
- hypochromic microcytic
- normal or increased
- normal or increased
- normal
- Hgb electrophoresis |
|
|
Term
| Quantitative defect in hemoglobin: |
|
Definition
|
|
Term
| Qualitative defect in hemoglobin: |
|
Definition
|
|
Term
| Cooperativity: as you bind more oxygen, the ability to bind more oxygen increases, so 4 sites for oxygen to bind on HGB and affinity for O2 increases with each binding of O2 molecule |
|
Definition
|
|
Term
| With thalassemia the RBC count is normal to increased b/c __> erythropoeitin released> increased RBCs. |
|
Definition
|
|
Term
| In thalasesemia you have all the iron, but you don’t have all the proteins necessary to bind oxygen to its best capability |
|
Definition
|
|
Term
|
Definition
| one beta gene, increased HbA2/HbF |
|
|
Term
|
Definition
| 2 beta genes, severe, failure to thrive, sig HbF |
|
|
Term
| Beta thalassemia major usually presents __ to __ months after birth when adult Hgb replaces fetal Hgb. Characteristics include; |
|
Definition
- 3 to 6 months
- Severe anemia in first year of life
- Juandice b/c of breakdown of Hgb
- Stunted growth and development> hypogonadal dwarf
- gross hepatosplenomegaly due to extramedullary hematopoiesis
- Hb catabolism> gall stones |
|
|
Term
| Most common causes of death in patients with beta thalassemia major: |
|
Definition
- untreated anemia
- infections
- hemochromatosis- too much iron in the system poisons the liver |
|
|
Term
| Sideroblastic anemia is caused by an abnormality in RBC __ __. It can be __ or __. |
|
Definition
iron metabolism
genetic or aquired |
|
|
Term
| Acquired causes of sideroblastic anemia: |
|
Definition
- drugs
- LEAD EXPOSURE
- collagen vascular disease
- neoplastic disease |
|
|
Term
| ringed sideroblasts are seen with what type of anemia? |
|
Definition
|
|
Term
| If someone has lead poisoning, what type of anemia do they likely have? |
|
Definition
|
|
Term
| Test results of sideroblastic anemia: |
|
Definition
- low hemoglobin
- microcytic
- normal iron
- LOW RBCS |
|
|
Term
| get rid of lead poisoning by chelating with __. |
|
Definition
|
|
Term
| main difference b/w labs of thalassemia and sideroblastic anemia: |
|
Definition
- Thalassemia: normal or increased RBCs
- Sideroblastic anemia: low RBCs |
|
|
Term
| An enzyme disorder in which the body has adequate iron but is unable to incorporate it into hemoglobin? |
|
Definition
|
|
Term
| Defects in either the alpha or beta chains of hemoglobin, leading to ineffective erythropoiesis and hemolysis |
|
Definition
|
|
Term
| The end result of sideroblastic anemia is ineffective ___. The iron enters the developing RBC but ___ in the mitochrondria b/c it cannot be used for hemoglobin synthesis. This gives the nucleus a ringed appearance. |
|
Definition
- erythropoiesis
- accumulates |
|
|
Term
| Acquired sideroblastic anemia is most common and is usually in those 65 and older. The primary cause is __ __ which accounts for 10% of cases, and the secondary cause is usually __ like __ which block the incorporation of iron into heme. Drugs like __ and __, and alcohol can also cause sideroblastic anemia. |
|
Definition
preleukemic phenomenon toxins like lead
isoniazid
chloramphenicol |
|
|
Term
| Symptoms of sideroblastic anemia caused by lead poisoning: |
|
Definition
- blue-black line on gums known as lead line
- abdominal pain
- constipation
- vomiting |
|
|
Term
| Sideroblastic anemia requires a __ __ __ for diagnosis. This will show __ __. |
|
Definition
- bone marrow assessment
- ringed sideroblasts |
|
|
Term
| What will iron indices show in sideroblastic anemia? |
|
Definition
Iron overload:
- increased serum iron
- increased ferritin
- normal TIBC
- normal RDW |
|
|
Term
| Sideroblastic anemia caused by lead tmt: |
|
Definition
Lead poisoning
Lead lines on gingivae and epiphyses of long bones on Xray
Encephalopathy and Erythrocyte basophilic stippling
Abdominal colic and microcytic Anemia
Drops: wrist and foot drop.
Dimercaprol and EDTA as first line of treatment
Red cell transfusion – Vit B6 to reverse the anemia
desferrioxamine (deferoxamine) - iron chelator |
|
|
Term
|
Definition
- lead line on gums and epiphyses
- encephalopathy
- erythrocyte basophillic stippling
- wrist and foot drops
first line tmt: Dimercaprol and EDTA |
|
|
Term
| Anemia of chronic disease may be __ or __. It is caused by __ __, __ __ __, __, or chronic __ __. It results in impaired __ __ and __. Iron is held out of the serum, so __ and __ are decreased. |
|
Definition
- microcytic or normocytic
- chronic infection
- chronic immune activation
- malignancy
- chronic renal failure
- iron utilization/availability
- iron and transferrin |
|
|
Term
Microcytic anemia
Low iron levels
Low transferrin
Decreased TIBC
Normal to increased ferritin |
|
Definition
| anemia of chronic disease |
|
|
Term
| Thalassemia all iron is normal, RBCs are normal to high. Sideroblastic anemia, all iron is normal, RBcs are low. Anemia of chronic disease, serum iron is low, transferrin is low, TIBC is low, and ferritin is normal to high. |
|
Definition
|
|
Term
| With anemia of chronic disease, iron cannot be transferred into the plasma, so the stores are high. Based off of this describe an iron panel of a patient with anemia of chronic disease: |
|
Definition
- low serum iron
- low transferrin
- low TIBC
- normal to increased ferritin |
|
|
Term
| With anemia of chronic disease there is often a mild __ component. Erythropoietin levels are normal to high, but still low considering level of anemia. This is a diagnosis of exclusion. Must first rule out __ __. |
|
Definition
- hemolytic
- iron deficiency |
|
|
Term
Cell morphology of anemia of chronic disease:
Mild microcytic to normocytic RBCs
May be hypochromic or normochromic
Increased storage iron |
|
Definition
|
|
Term
| treatment of anemia of chronic disease: |
|
Definition
- treat underlying cause
- erythropoietin can be effective but is expensive |
|
|
Term
| lab of pt with beta thalassemia major: |
|
Definition
- low hcg and hct
- mcv less than 80 fl= microcytic
- hypochromic
- normal iron levels
- normal to high RBC count
- low RDW
- family history |
|
|
Term
|
Definition
After diagnosis of microcytic anemia check:
1. Iron studies: low ferritin and high RDW> iron deficiency anemia
2. Check RBC count
- high RBC, low RDW: Thalassemia
- low RBC> sideroblastic or anemia of chronic disease
(sideroblastic anemia tends to have normal iron studies. anemia of chronic disease will have low serum iron and transferrin and TIBC, but high ferritin) |
|
|
Term
| See patient is anemia, but the size is between 81 and 100 fl. Now what? |
|
Definition
Normocytic anemia
Next check reticulocyte count |
|
|
Term
| Anemia with MCV between 81 and 100 fl. Reticulocyte count is increased. Lactic acid dehydrogenase and Indirect unconjugated bilirubin is detected. Whats going on? |
|
Definition
| - Normocytic, increased retic so bone marrow is responding, presence of LDH indicates> HEMOLYTIC ANEMIA |
|
|
Term
| Anemia with MCV b/w 81 and 100 fl. Reticulocyte count is increased. Lactic acid dehydrogenase(LDH) is not found. Whats going on? |
|
Definition
| Normocytic> increased retics means bone marrow is responding> lack of LDH means there is no hemolysis> RECENT BLEED RESULTING IN NORMOCYTIC ANEMIA |
|
|
Term
| How do you check for hemolsyis? |
|
Definition
| look for LDH (lactic acid dehydrogenase) |
|
|
Term
| Anemia with MCV b/w 81 and 100 fl. Reticulocyte count is normal or decreased. Whats going on? |
|
Definition
- anemia of chronic disease
- primary bone marrow problem |
|
|
Term
MCV between 81 and 100 fl
Increased reticulocyte count
No evidence of bleeding
Indirect (unconjugated) bilirubinemia |
|
Definition
| Normocytic hemolytic anemia |
|
|
Term
| Intrinsic causes of normocytic hemolytic anemia: |
|
Definition
- G6PD deficiency
- Sickle cell anemia
- Hereditary spherocytes |
|
|
Term
| Extrinsic Hemolytic Anemia: |
|
Definition
- drug reactions
- prosthetic heart valves (mechanical) |
|
|
Term
| G6PD deficiency is a __ __ disease that affects __ of African American and Meditteranean descent. You will see __ __ on the smear. |
|
Definition
- x-linked
- males
- Heinz bodies |
|
|
Term
| Heinz bodies on a blood smear in an AA male patient? |
|
Definition
| G6PD normocytic hemolytic anemia |
|
|
Term
| Drugs that cause normocytic hemolytic anemia: |
|
Definition
- Sulfa agents: nitrofurantoin
- Quinidine/quinine |
|
|
Term
| what should you NOT give an AA male for UTI? |
|
Definition
- nitrofurantoin (sulfa agent)
give them cipro instead |
|
|
Term
| Sickle cell is __ __ and results in __ __ anemia. 10% of African Americans have the heterozygous trait. |
|
Definition
autosomal recessive
normocytic hemolytic |
|
|
Term
| symptoms of Sickle cell anemia: |
|
Definition
- chronic: jaundice, hepatosplenomegaly
- acute: triggered by infection and dehydration, bone pain in chest and back, abdominal pain, priapism, stroke |
|
|
Term
| Hereditary spherocytosis is an intrinsic cause of mild__ __ anemia. It is the only anemia that is ___. It is an __ __ disease, thus there will be a family history. |
|
Definition
- mild normocytic hemolytic anemia
- hyperchromic
- autosomal dominant
- |
|
|
Term
| With Hereditary spherocytosis hemolysis occurs due to trapping of __ __ cells. There will be an __ RDW due to ___ retics and spherocytes. |
|
Definition
- stiff rigid cells
- increased RDW due to increased spherocytes and retics |
|
|
Term
| Treatment of hereditary spherocytosis: |
|
Definition
- splenectomy
- folate replacement |
|
|
Term
| The only anemia that is hyperchromic: |
|
Definition
| Hereditary spherocytosis> normocytic hemolytic hyperchromic anemia |
|
|
Term
| Clinical manifestations of B12 deficiency: |
|
Definition
- Megaloblastic anemia
- Pancytopenia
- Paresthesias
- Peripheral neuropathy
- Demyelination of corticospinal and dorsal column tracts
- Irritability
- Personality changes
- Possible increased risk of stroke/MI |
|
|
Term
|
Definition
|
|
Term
| A Cobalamin level less than __ is considered a B12 deficiency. |
|
Definition
|
|
Term
| Vitamin B12 is needed for __ synthesis. |
|
Definition
|
|
Term
| Vitamin B12 must bind to __ __ in the small intestine to be absorbed. Antibodies against __ __ cause __ __. This is diagnosed by checking __ __ or the __ __. |
|
Definition
- intrinsic factor
- intrinsic factor
- pernicious anemia
- ab level
- Schilling test |
|
|
Term
Deficiency can result in neuropsychiatric symptoms
Spastic ataxia, psychosis, loss of vibratory sense, dementia |
|
Definition
Vitamin B12 deficiency
Frequently not reversible with cobalamin replacement |
|
|
Term
| Treat pernicious anemia: take extra amount of B12 to overcompensate |
|
Definition
|
|
Term
Lab values for B12 deficiency:
KNOW THIS |
|
Definition
- Cobalamin less than 200 pg/ml
- elevated serum methylmalonic acid
- elevated homocysteine |
|
|
Term
| Lab values for folate deficiency macrocytic anemia: |
|
Definition
- low folate
- normal methylmalonic acid
- elevated homocysteine |
|
|
Term
| Folate is normally absorbed in the ___ and __ __. Deficiencies are seen with __ __, ___, __, __ __ __, and ___. |
|
Definition
- dudodenum
- proximal jejunum
- celiac disease
- amyloidosis
- pregnancy
- sickle cell anemia
- alcoholics |
|
|
Term
| Both b12 and folate deficient anemias are macrocytic and have __ __. |
|
Definition
| hypersegmented neutrophils |
|
|
