Term
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Definition
| decreased RBC count, HGB, HCT, or O2 carrying capacity of blood |
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Term
| Name some examples of spurious anemia? |
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Definition
| hydremia of pregnancy (physiologic), congestive heart failure, overhydration (excessive IV fluids) |
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Term
| Where do you look for pallor in a pt with anemia? |
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Definition
| mucocutaneous membranes (conunctivae, nailbeds, palmar creases) |
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Term
| What are the symptoms of hyperdynamic circulation that accompanies anemia? |
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Definition
| tachycardia, bounding pulse, systolic flow murmur |
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Term
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Definition
| concave (spoon shaped) brittle nails that accompanies iron deficiency anemia |
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Term
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Definition
| sickle cell anemia, hemoglobinopathies |
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Term
| What bone deformities are associated with anemia? |
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Definition
| expansion of medullary cavity due to erythroid hyperplasia gives the xray a hair-on-end appearance. Happens in thalessemia and sickle cell anemia |
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Term
| How does the body cause a right shift in the HGB/O2 dissociation curve when pt is anemic? |
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Definition
| d/t incresae in 2,3 DPG which decreases O2 affinity by HGB |
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Term
| How do you determine whether a reticulocyte count is an adequate response of the marrow to anemia? |
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Definition
| "correction of the retic count" |
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Term
| What are two causes of hypoproliferative anemia? |
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Definition
| myelophthisic anemia and aplastic anemia |
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Term
| Name 2 examples of maturation defect anemias. |
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Definition
| megaloblastic, myelodysplastic |
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Term
| What is the corrected RC in hypoproliferative anemia. |
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Definition
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Term
| What is the corrected reticulocyte count in maturation defect anemia. |
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Definition
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Term
| What is the corrected retic count in hyperproliferative anemia. |
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Definition
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Term
| What is the corrected retic count in treated nutritional anemias. |
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Definition
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Term
| What are the two major types of macrocytic anemia and how do you differentiate between the two? |
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Definition
| megaloblastic (decreased corrected RC), and nonmegaloblastic (reticulocytosis) |
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Term
| What causes megaloblastic anemia? |
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Definition
| B12/folate deficiency, drugs (folate antagonists like methotrexate, chemotherapy, antiretroviral), myelodysplastic cyndromes |
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Term
| What causes nonmegaloblastic macrocytic anemias? |
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Definition
| hemolysis, hemorrhage, alcoholism, liver disease |
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Term
| What is spurious macrocytosis? |
|
Definition
| falsely elevated MCV due to cold agglutinins |
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Term
| What is the pathogensis of megaloblastic anemia? |
|
Definition
defected nuclear maturation caused by impaired DNA synthesis
"nuclear-cytoplasmic dyssynchrony" |
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Term
|
Definition
| abnormally large hematopoietic precursors that contain relatively immature appearing nuclei compared to the cytplasm |
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Term
| How does the impaired cell division of megaloblastic anemia lead to anemia? |
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Definition
| buildup of DNA and chromosomal instability and frequent destruction int eh marrow (intramedullary hemolysis) results in peripheral cytopenia due to ineffective hematopoiesis |
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Term
| In a patient developing anemia, what happens first, increased 2,3 BPG or erythroid hyperplasia with reticulocytosis? |
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Definition
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|
Term
| B12 is found in what foods? |
|
Definition
| those of animal origin (meat, liver, fish, dairy) NOT in vegetables, fruits or cereals |
|
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Term
| How long do normal body stores of B12 last? |
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Definition
|
|
Term
| What cells produce intrinsic factor? |
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Definition
|
|
Term
| Where is the B12-IF complex absorbed? |
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Definition
|
|
Term
| What protein careies B12 to tissues like the bone marrow and liver for storage? |
|
Definition
| transcobalamin II (TC II) |
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|
Term
| What are three causes of B12 deficiency? |
|
Definition
| MC = malabsorption, dietary deficiency, and drug exposure |
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|
Term
| What causes malabsorption of B12? |
|
Definition
| pernicious anemia, gastrectomy, resection of terminal ileum, inflammatory bowel disease, tropical sprue and gluten sensitive enteropathy, blind loop syndrome and fish tapeworm |
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|
Term
| What is blind loop syndrome? |
|
Definition
| bacterial overgrowth which competes for B12 |
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|
Term
| What parasite can lead to B12 deficiency? |
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Definition
|
|
Term
| What drugs cause B12 deficiency? |
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Definition
|
|
Term
| What antibodies are present in pernicious anemia? |
|
Definition
| anti-parietal cell and anti-intrinsic factor |
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|
Term
| What is the average age of pernicious anemia? |
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Definition
|
|
Term
| Pernicious anemia increases you risk of .... |
|
Definition
| gastric carcinoma; also there is significant association with other autoimmune diseases (Graves disease, and hashimoto's thyroiditis) |
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Term
| What race is at risk for pernicious anemia? |
|
Definition
|
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Term
|
Definition
| leafy green vegetables, fruits, cereals, dairy products and liver (heat labile and destroyed by cooking, unlike B12) |
|
|
Term
| Where is folate absorbed? |
|
Definition
| upper SI (duodenum and jejunum) |
|
|
Term
| How long do the body's stores of folate in the liver last? |
|
Definition
|
|
Term
| What's the most common cause of folate deficiency? |
|
Definition
| inadequate dietary intake (malnutrition, alcoholism) |
|
|
Term
| What causes increased folate requirement? |
|
Definition
| pregnancy, infancy, diseases with rapid cellular proliferation (hemolytic anemia with compensatory erythropoiesis, leukemia, myeloproliferative synd. |
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|
Term
| What drugs cause folate deficiency? |
|
Definition
| folate antagonists (methotrexate), anticonvulsants (dilantin), trimethoprim |
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|
Term
| What are the symptoms of megaloblastic anemia on physical exam? |
|
Definition
| weakness and sore tongue, glossitis may be painful, smooth, and atrophic or beefy red; angular cheilosis, lemon-yellow skin, neurologic impairment |
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|
Term
| What neurological deficits occur with B12 deficiency? |
|
Definition
| 1) subacute combined degeneration (dorsal and lateral column demyelination) 2) peripheral neuropathy (paresthesias and reduced vibration and position sense) 3) uncoordinated gait |
|
|
Term
| What is the purpose of B12 in DNA synthesis? |
|
Definition
| once CH3-folate gets into the cell, B12 helps it turn into tetrahydrofolate |
|
|
Term
| How does B12 deficiency lead to nerve demyelination? |
|
Definition
| B12 turns homocysteine into methionine which allows nerve myelination |
|
|
Term
| Why does B12 cause an increase in methymalonic acid? |
|
Definition
| B12 converts methymalonyl CoA into succinyl CoA. otherwise methymalonyl CoA turns into methymalonic acid (MMA) |
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|
Term
| What is the peripheral blood morphology of megaloblastic anemia? |
|
Definition
| macro-ovalocytes RBCs, hypersegmented neutrophils (> or = 6 lobes), thrombocytopenia |
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|
Term
| What is the first sign to appear and the last sign to disappear in a peripheral blood smear of a pt with megaloblastic anemia? |
|
Definition
| hypersegmented neutrophils |
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|
Term
| Nuclear/cytoplasmic dyssynchrony are seen in bone marrow of patients with ________. |
|
Definition
|
|
Term
| What doyou seen in bone marrow of patients with megaloblastic anemia? |
|
Definition
| erythroid hyperplasia with megaloblastic change (nuclear cytoplasmic dysnchrony), giant bands and metamyelocytes |
|
|
Term
| What are the abnormal chem lab values in patients with megaloblastic anemia? |
|
Definition
| increased LDH and indirect bilirubin d/t hemolysis |
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|
Term
| T/F Low RBC folate is diagnostic of folate deficiency. |
|
Definition
| false; RBC folate usually reflects folate status at time RBCs were produced however it may also be decreased in B12 deficiency |
|
|
Term
| What tests do you order for pernicious anemia? |
|
Definition
| antiparietal cell antibodies (good sensitivity, poor specificity), antiintrinsic factor antibodies (poor sensitivity, good specificity), schilling's test, serum or urine methylmalonic acid |
|
|
Term
| What happens to folate levels in B12 deficiency? |
|
Definition
| normal or increased serum, normal or decreased RBC folate |
|
|
Term
| T/F Serum homocysteine is increased in both B23 and folate deficiency. |
|
Definition
|
|
Term
| How long does it take for replacemnt therapy with B12 or folate to work? |
|
Definition
| retic response in 2-3 days; max retic in 5-7 days; normal bone marrow in 2-4 days; hypersegmented PMNs disappear in 2 weeks; hemoglobin becomes normal in 2-3 months |
|
|
Term
| How does chronic liver disease cause macrocytic anemia? |
|
Definition
| addition of lipids to red cell membrane cuasing an increased surface area |
|
|
Term
Macrocytosis with oval cells means=
with round cells= |
|
Definition
| oval= megaloblastic; round= nonmegaloblastic |
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|
Term
| NRBCs are due to a ______ macrocytic anemia. |
|
Definition
|
|
Term
| Macrocytic anemia + no WBC or platelet abnormalities = |
|
Definition
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