2/14 - Anemia I

Front 1

MCC of anemia for hospitalized patients?

Back 1

ACD

Front 2

2 uses of iron?

Back 2

1)O2 transport

2)Some enzymes of metabolic pathways dependent on (ie cytochrome c & krebs cycle)

Front 3

T/F Iron is poorle extracted from our diets?

Back 3

T

might need supplements, but excess can by TOXIC

Front 4

Majority of iron-protein complex is in form of what? The rest?

Back 4

67%, hemoglobin found in RBC and precursors

30% of iron-protein complex is located in storage form (hemosiderin, ferritin)

Front 5

___% of RBC content is hemoglobin?

Back 5

34, makes RBC picks

if lacking hemoglobin, RBC is pale

Front 6

Size of a RBC is roughly equivalent to size of ____

Back 6

lymphocyte (~8 microns)

Front 7

What are the two storage forms of iron? Difference?

Back 7

1) Ferritin - dynamic, more accessible (available for Hb syn) (main one measured for iron stores)

2) Hemosiderin - more static (BLUE staining!)

Front 8

What are the 2 storage sites of iron?

Back 8

1)Bone marrow - mostly in macrophages

2)Liver - both in parenchymal and Kupffer cells (macrophages)

Front 9

Best indirect measure of total body iron?

Back 9

Serum ferritin iron levels

Front 10

one molecule of transferrin binds to how many iron atoms?

Back 10

2

Front 11

Total Iron Binding Capacity (TIBC) in iron deficiency?

Back 11

Reflects the AVAILABLE binding sites on transferrin protein

goes ^ in iron deficiency

TIBC v in hemachromatosis & anemia of chronic dz

Front 12

With infection such as anemia of chronic disease, what is the problem?

Back 12

you have enough iron, but not enought SYNTHESIS of RBC

^ferritin but v TIBC, can mask anemia

-resembles the normal proportion of satuation, but the total hemoglobin of the patient is much lower

Front 13

Most of iron is absorbed where?

What promotes/lowers absorption?

Back 13

proximal duodenum

heme iron (protein bound is absorbed beter than elemental iron

acidic pH & Vit C promote absorption

Gastric problems can lead to deficiency by v acid production & tannates/phylates in diet can block iron absoption

Front 14

Transporters that facilitate absorption across the mucosal wall are (2)?

Back 14

Heme transporter for iron-bound heme

Divalent metal transproter (DMT1) for non-heme iron

both go to mucosal ferrin and hephaestin for delivery to the plasma transferrin

Front 15

Protein secreted by liver that modulates mucosal iron uptake?

Back 15

Hepcidin, it modulates hephaestin

Front 16

What is the transferrin receptor on the red cell precursor?

What happens to iron afterwards?

Back 16

CD71 is the transferrin receptor

afterwards, iron is internalized by erythroblast and ends up in the MITOCHONDRIA of the where Hb is synthesized (80%)

The remaining 20% of iron remains in cell as hemosiderin

Front 17

Iron is normally lost through what mech?

Back 17

sloughing of Epithelial cells (skin and GI)

very balanced process with absoption and excretion of 1mg/day (imbalace is there are bleeds, etc)

Front 18

Hb syn suppression caused by?

Back 18

MC is toxins: lead poisoning, chemotherapy

Also malignancy can cause v Hb syn

Hb syn v and hemosiderin accumulates in macrophages

Front 19

Anemai can be masked in what condition?

Back 19

Chronic infection (cant really on ferritin which is normal, must look at TIBC)

Front 20

Reticulocytes are what?

Back 20

young RCB; have more RNA so look bluer

Front 21

MCV <80

Back 21

microcytic anemia

"TAILS":

Thalassemia, Anemia of Chronic Dz, Iron deficiency, Lead toxicity & Sideroblastic Anemia

Front 22

macrocytic anemia is MCV of what?

Back 22

>100

think of B12 or Folate deficiency, Alcoholism, Myelodysplasia, Aplasic Anemia or Reticulocytosis

Normocytic: MCV of 80-100

Front 23

RDW tells you what?

Back 23

Red cell distribution width - the variation of size fo the RBCs

Younger cells are LARGER & Older cells are SMALLER

RDW goes up whenever there is an abnormality in the bone marrow

Front 24

Central pallor sign of?

Back 24

Microcytic (hypochromic) cell, meaning theres not much hemoglobin there

Not the case for spherocytes

Front 25

A few of the main causes of iron deficiency anemia?

Back 25

v Iron intake

Chronic blood loss ESP GI TRACK BLEED

Malignancy such as colon cancer

Malabsoption

Intravascualr hemolysis (rare) (paroxysmal nocturnal hemoglobinuria (acquried intrinsic defect of cell mem), DIC, etc)

Front 26

Clinical signs of iron deficiency anemia?

Back 26

low Hb

Koilonychias (spoon-shaped nails)

Patient becomes pale

Glossitis of tongue

Front 27

Reduced erythropoietin due to TNF and hepcidin describes what condition?

Back 27

Anemia of Chronic Dz

caused by any chronic condition form infection to malignancy

must treat underlying chronic condition

Front 28

Non-funcional bone marrow describes what anemia?

Caused by?

Back 28

Aplastic anemia

Drug or Viral association (esp Parvovirus)

MUST take 3 bone marrow samples spaced withing 3-4 month period to declare someone aplastic