3Rd Year - Anemia

Front 1

Kidney derived hormone that increases RBC production

Back 1

erythropoietin (EPO)

Front 2

Things that increase EPO production

Back 2

hypoxemia, severe anemia, left shift in O2 binding curve, high altitude

basically anything that decreases oxygenation of your tissues

Front 3

Things that decrease EPO production

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anything that increases O2 content (such as polycythemia vera)

Front 4

Abnormal things that make EPO

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renal cell carcinoma
hepatocellular carcinoma

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Where is EPO made?

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endothelial cells of peritubular capillaries

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Effective erythropoiesis is measured by

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reticulocyte count

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normal retic count percentage

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< 3%

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In anemia, retic count percentage is falsely...

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elevated

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Formula to correct retic count in anemia

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Corrected retic = (actual Hct/45) x retic count

Front 10

Anemic person with low retic count means

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poor BM response (ineffective erythropoiesis)

Front 11

Anemia + low retic count

Causes?

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Fe def
aplastic

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Extramedullary hematopoiesis occurs when?

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intrinsic BM disease (myelofibrosis)
increased EPOesis (sickle cell, etc)

Front 13

Extramedullary hematopoiesis can occur where?

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spleen
liver

Front 14

Findings on PE for EMH?

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hepatosplenomegaly

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Findings in radiograph for EMH?

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expanded marrow cavity
hair on end appearance of skull

Front 16

types of globin chains found in HbF

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alpha (a)
gamma (y)

Front 17

increased HbF causes what kind of O2 binding curve, which will cause what?

Back 17

left shift

increased EPO

Front 18

How does an infant get rid of HbF?

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splenic macrophages


hence the physiologic jaundice

Front 19

how does testosterone affect erythropoiesis?

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increases EPOesis

Front 20

MCV < 80

this is called

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microcytic

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MCV > 100

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macrocytic

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causes of microcytic anemias

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Fe def
anemia of chronic disease
thalassemias
sideroblastic anemia

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key lab finding with Fe def anemia

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inc RDW

Front 24

most common anemia

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Fe def

Front 25

causes of macrocytic anemia

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folate def
B12 def

Front 26

If normocytic anemia w/ corrected retic < 3%, name 5 causes

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acute blood loss
early Fe def
early anemia of chronic disease
aplastic
renal disease

Front 27

If normocytic anemia w/ corrected retic >/= 3%, it can be due to one of two general things...

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intrinsic RBC defect or extrinsic RBC defect

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Name some intrinsic RBC defects

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membrane defects
abnl Hb
Enzyme def

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Name some extrinsic RBC defects

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blood loss > 1 week
immune hemolytic anemia
micro/macroangiopathic hemolytic anemia
malaria

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end product of Hb degradation in macrophage

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unconjugated bilirubin

Front 31

Primary Fe storage protein

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ferritin

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Primary storage site of ferritin

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BM macrophages

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Effect of inflammation on ferritin synthesized by macrophages

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increased

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Decreased serum ferritin is diagnostic of

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Fe deficiency

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Increased serum ferritin can indicate

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anemia of chronic disease
Fe overload

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Serum Fe is bound to

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transferrin

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organ that makes transferrin

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liver

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Normal serum Fe

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100 ug/dL

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TIBC correlates directly with

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tranferrin levels

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normal TIBC

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300 ug/dL

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effect of decreased ferritin on transferrin

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increased synthesis

Front 42

Formula for Fe saturation

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Fe Sat = serum Fe/TIBC x 100

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Fe sat represents

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the percentage of binding sites on transferrin occupied by Fe

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Normal Fe sat

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33%

Front 45

Dec Fe sat indicates

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Fe def
anemia of chronic disease

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inc Fe sat indicates

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Fe overload

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most common cause of Fe def anemia

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bleed

Front 48

Disease caused by chronic Fe deficiency

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Plummer Vinson syndrome (esophageal web, achlorhydria, glossitis, spoon nails)

Front 49

Fe def lab findings (MCV, serum Fe, Fe sat, ferritin, TIBC, RDW)

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MCV dec
serum Fe dec
Fe sat dec
ferritin dec
TIBC inc
RDW inc

Front 50

most common cause of blood loss in women < 50 years

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menorrhagia

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most common cause of blood loss in men < 50

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PUD

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Most common cause of blood loss in people > 50

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polyps/colorectal ca

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Most common cause of Fe def in young kids

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decreased intake

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Daily Fe requirement during preggo

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3.4 mg/day

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Daily Fe requirement during lactation

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2.5-3mg/day

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Sequence of Fe def

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absent Fe stores
dec serum ferritin
dec serum Fe
inc TIBC
dec Fe sat
normocytic normochromic anemia
microcyto hypochromic anemia

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Most common anemia in hospitalized pt's

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anemia of chronic disease (ACD)

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common causes of ACD

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chronic inflammation
alcoholism
malignancy

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most common causes of ACD

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alcoholism and malignancy

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relationship of hepcidin and ACD

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acute phase reactant protein released by liver in response to inflammation --> enter macrophage --> prevent release of Fe to transferrin --> increased Fe stores in BM macros

Front 61

Lab findings of ACD (MCV, serum Fe, TIBC, Fe sat, serum ferritin)

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MCV dec
serum Fe dec
TIBC dec
Fe sat dec
serum ferritin inc

Front 62

4 y-chains (Hb Bart) is assoc w/

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a-thalassemia (4 a-gene deletions -/- -/-. Incompatible w/ life)

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B-thal caused by DNA splicing defect tends to be

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mild

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B thal caused by stop codon tends to be

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severe

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B/B+ thal is which category of B thal?

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minor

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B thal minor characteristics

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mild microcytic anemia
mild protection against falciparum malaria (due to shorter RBC life span)
dec MCV, Hb, Hct
inc RBC
nl RDW, serum ferritin
Dec HbA and inc HbA2/HbF in Hb electrophoresis

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B0/B0 thal is known as

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B thal major

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Hb electrophoresis findings in B thal major

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no HbA
inc HbA2
inc HbF

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Clinical presentation of B thal maj

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hemolytic anemia (a chain inclusions removed by macros in spleen = hemolysis = inc unconjugated Hb)
extramed EPOesis
inc RDW/retic

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Tx B thal maj

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long term transfusion

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danger of long term blood transfusion

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Fe overload (hemosiderosis)

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Causes of sideroblastic anemia (SBA)

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chronic alcoholism
pyridoxine def
Pb poison

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most common cause of SBA

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chronic alcoholism

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pathogenesis of sideroblastic anemia

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defective heme synth in mitochrondria = Fe accumulate in mito of young RBC's = ringed sideroblasts

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what type of anemia is SBA?

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Fe overload

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Most common cause of B6 def

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INH

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Most common causes of Pb poisoning

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paint
batteries

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pathogenesis of Pb poisoning

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denature ferrochelatase = can't bind Fe to protoporphyrin = accumulate protoporphyrin

denature ALA dehydrase = inc delta-ALA

denature ribonuclease = can't degrade ribosomes = persist in RBC = basophilic stippling

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PE findings of Pb poisoning

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abdominal colic + diarrhea (visible Pb on plain film)
encephalopathy (delta-ALA = neuron damage, inc vessel permeability, demyelination)
growth retardation in children (Pb deposit in epiphysis of growing bones)
periph neuropathy in adults (foot drop, etc)
nephrotoxicity (Fanconi's syndrome = prox tubular acidosis, aminoaciduria, phosphaturia, glucosuria)
Inc whole blood and urine Pb levels

Front 80

Best screening/confirmatory test for Pb poisoning

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blood/urine Pb

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Lab findings of sideroblastic anemia

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inc serum Fe, Fe sat, ferritin
dec MCV, TIBC
BM aspirate = ringed sideroblasts

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Most common cause of macrocytic anemia

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folate or B12 def

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B12 malabsorption due to

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dec IF (ie pernicious anemia)
dec gastric acid (can't activate pepsinogen to release B12)
dec GI reabsorption (any destruction of terminal ileum, bact overgrowth, fish tapeworm, chronic pancreatitis = can't cleave off R-binder)

Front 84

who's more likely to be deficient in B12: pure vegan, elderly, or pregnant/lactating?

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pure vegan

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most common cause of folate def

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dec intake

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most common cause of inc homocysteine

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folate def

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effect of inc homocysteine

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endothelial cell damage --> thrombosis

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Distinguish between folate def and B12 def anemia

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B12 def has neuro problems

Front 89

someone with an enlarged, smooth, red tongue, hx of alcoholism, and poor diet will most likely show what on microscopic exam of blood?

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macrocytosis w/ basophilic stippling
hypersegmented neutrophils
low retic count

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Most common METABOLIC disorder of RBCs

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G6PD def

Front 91

G6PD def lab values for
periph smear
CBC
retic
haptoglobin
Coombs

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periph smear - schistocytes, microcytosis, Heinz bodies
CBC- anemia, reticulocytosis
haptoglobin - low
Coombs - neg

Front 92

Things that bring out G6PD def

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oxidative stress (sulfa drugs, infection, DKA, etc)