Anemias
Terms
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- What IS anemia?
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-reduction below normal Hgb quantity
-reduction in PCV per 100 ml of blood. -
Based on Hgb, what is an anemia
-moderate
-severe -
Mod = < 10 g/dl
Severe = < 7 g/dl -
What are the two most important pieces of info for diagnosing anemia?
-Then? -
Hgb and Hct
Then: RBC indicies, Retic count, iron studies. - What is the effect of anemia?
- reduced oxygen delivery to tissues and organs.
- What are some clinical symptoms of a significant anemia?
-
rapid pulse
sob
pallor
difficulty breathing - what are two ways to classify anemias, which is used more?
-
1. Pathophysiologic - cause
2. Morphologic - used more - what are the 2 pathophysiologic classifications of anemia?
-
1. Relative
2. Absolute - What is a relative anemia?
- an anemia that isn't real - something is making it LOOK like anemia, like increased plasma volume in a pregnant woman.
- What are the 2 types of Absolute anemias?
-
1. Anemia due to decr. RBC production
2. Anemia due to incr. RBC destruction - What are 5 things that decrease RBC production, causing an anemia?
-
1. Defective pluripotent cell
2. Defective unipotent cell
3. Disturbed DNA synthesis
4. Disturbed Hgb synthesis
5. Unknown idiopathic - what are 2 abnormalities that cause Anemia due to incr. destruction?
-
1. Intrinsic abnormalities - spherocytosis or sickle cells
2. Extrinsic abnormalities - mechanical harm like burn, artificial heart valve, thrombopurpura. - what are the 3 types of morphological classification?
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1. Microcytic
2. Normocytic
3. Macrocytic - what are 4 mechanisms for alleviating tissue hypoxia?
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1. O2 diss. curve shift
2. Redistribution of blood
3. Increase cardiac output
4. Increase erythropoeisis - what are the 3 types of Micro/Hypo anemias?
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1. Fe deficiency
2. Sideroblastic
3. Anemia of chronic disease - what is the most common micro hypo anemia?
- iron deficiency
- what is the 2nd most common micro hypo anemia?
- chronic disease.
- what are 4 causes of iron defic. anemia?
-
-inadequate source of Fe
-increased demand
-excessive loss
-maldistribution - what are the clinical features (patient symptoms) of fe defic. anemia?
-
-fatigue/irritable/headache
-pica syndrome
-glossitis/stomatitis
-achlorhydria
-inability to maintain normal body temp - what is pica syndrome?
- the urge to eat all one thing, and that thing is often very strange.
-
what is koilonychia?
-glossitis?
-stomatitis?
-achlorhydria? -
flat fingernails
glossitis = sore tongue
stomatitis = sores/cracks around the mouth.
achlor = lack of stomach acid - What does the b.marrow "QC" do to hemoglobin production in Fe defic. anemia?
- decreases Hgb production - b/c abnormal cells due to lack of Fe can't release into circulation.
- what are three states of Fe defic. anemia that show different sets of lab findings?
-
1. Fe depletion state
2. Fe deficient state
3. Fe deficiency anemia - What are the lab findings in Fe depletion state?
- Mostly normal - except for Ferritin, which shows the body Fe stores decreasing.
- What are the lab findings in Fe Deficient state?
-
Normal CBC still
Decr serum iron
Incr TIBC
Decr. %Transferrin saturation - What are the three stages of Fe deficiency anemia?
-
Early
Intermediate
Severe - What are Lab characteristics of Early Fe defic. anemia?
-
MCV may be normal, RDW only slightly incr., a Few Targets,
Iron studies indicating lack of iron stores. Hgb = 9-12 g/dl - What are Lab characteristics of Intermed. Fe defic. anemia?
-
Same Fe studies as early;
RBCs: poik, targets, hypo b/c the body's less picky now.
-Hgb about 8 g/dl
-RDW is high and MCV is low - What are Lab characteristics of Severe Fe defic. anemia?
-
Hgb is very very low.
RBCs tailed, elliptos, burrs, targets, high RDW. - What are the classic indices seen with an Fe defic. anemia?
-
MCV 53-79
MCH 14-29
MCHC 22-30% - What 3 other factors will contribute to anemia and compound the problems?
-
-Incr. blood flow, shear stress damages.
-Destruction of cells with MCH less than 20 during release (natural QC)
-Bmarrow detainment of hypochromic cells in case they might develop - what are 3 types of treatment for iron def. anemia
-
-oral iron
-IV
-transfusions for very severe - what are 3 indications of a responseto therapy?
-
-increased retics
-dual RBC population
-RDW increase - what are 5 causes of iron deficiency?
-
inadequete Fe intake
inadequate Fe absorption
Increased Fe demand
Maldistribution
Excessive blood loss - what are 2 things that cause inadequate Fe absorption?
-
-achlorhydria - low stomach acid
-gastrectomy -
what may cause
-incr. demand for Fe
-maldistribution -
Increased demand: pregnancy and growth spurts
Maldist: congenital atransferrinemia - what is the main feature of sideroblastic anemia?
- a problem with heme synthesis so there is excess iron - overload
- what is the typical Hgb seen in sideroblastic anemia?
- 3-10 g/dl
- SIDEROBLASTIC ANEMIA - what does the peripheral blood look like?
-
-Very low hemoglobin, HYPOCHROMIC
-Dimorphic population - Macro/micro
-Elliptocytes/Dacrocytes
-More than 10% Basophilic stippling and Pappenheimer bodies - abnormal heme synth.
-Very high RDW
-normal Platelet/WBC - What is seen in the bone marrow during sideroblastic anemia?
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-Erythroid yperplasia
-Over 15% ringed sideroblasts
-may see megaloblastic changes - what are the 3 categories of sideroblastic anemia?
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1. Primary
2. Secondary
3. Toxic exposure - what are the three types of primary siderobl. anemia?
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1. Sex-linked
2. Autosomal recessive
3. Idiopathic (refractory anemia w/ ringed sideroblasts - what characterizes sex-linked siderobl. anemia?
- -usually have enzyme abnormalities like reduced ALA synthetase
- what characterizes autosomal recessive siderobl. anemia?
- other enzyme deficiencies
- what characterizes refractory anemia w/ ringed sideroblasts?
-
CLONAL abnormality of pluripotent stem cell
-myelodysplastic disease - what are two types of secondary sideroblastic anemias?
-
1. Due to medication/treatment
2. Due to infections and neoplasms - Name 4 medications/treatments that can cause iatrogenic sideroblastic anemia.
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1. Anti-parkinson meds
2. Anti-tubercular meds
3. Chloramphenical
4. Long-term blood transfusions - what are 3 causes of toxic sideroblastic anemia?
-
1. Excessive vit/mineral intake
2. chronic alcohol abuse
3. lead poisoning -
what are 3 important points re: lead poisoning pathology?
-Fe storage
-Heme synth
-Erythropoeisis -
-abnormal Fe storage in mitochon
-abnormal heme synthesis by interfering with enzymes.
-ineffective erythropoeisis. - what are features of RBCs seen in toxic exposure sidero anemia?
-
Hypo/micro
Basoph. stippling, pappenheimers
30% decr. MCV and MCH
decreased lifespan of RBC
dual cell population -
how does toxic siderobl. anemia affect:
-Retic index
-Bone marrow
-Fe studies
-Blood lead
-Prophyrins -
Retic index is decr.
Bone marrow: erythroid hyperplasia and ringed sideroblasts
-Fe studies normal-increased
Blood lead: >80ug/dl is BAD
Porph: ALA in urine -
What is anemia of chronic disorcer sometimes called?
Describe cell morphology in
- Advanced cases
- Less severe cases -
Aka, Anemia of inflammation
Advanced: hypo/micro
Less sev: Normo/normo - what are 6 causes of anemia of chronic disorder?
-
-chronic inflammatory disease
-lymphoma
-regional enteritis
-ulcerative colitis
-liver disease
-chronic infection - What 4 changes occur in anemia of chronic disease?
-
1. Fe supply gets decreased.
2. Erythropoeitin level doesn't increase though it needs to.
3. Erythropoeisis actually gets SUPPRESSED by cytokines.
4. Cell destruction is increased - what causes the decreased iron supply in anemia of chronic disease, and what results?
- Release and reutilization of iron is blocked, resulting in decreased Hgb synthesis.
- What suppresses erythropoeisis in chronic disease anemia?
- cytokines, produced by macrophages and lymphs - they are doing their inflammation thing.
-
What are lab findings in anemia of chronic disease?
-Hgb, MCH, MCV, Retic -
Hgb is about 7-11 g/dl
MCH is 31, MCV is 80, Retic is normal. Not a hugely hypo/micro disease, can be normo/normo. - what are iron study results in anemia of chronic disease?
-
Increased ferritin, FEP, BM Fe
Decreased serum Fe, TIBC - How is anemia of chronic disease treated?
- Well if it were treatable it wouldn't be chronic would it.