Imported: B&l_Turnicky: Macrocytic Anemia

Front 1

Anemia can be a result of 3 pathophysiologic mechanisms.. what are they?

Back 1

Proliferation Defect: not enough stem cells, or messed up stem cells

Maturation Defect: Most of anemias are maturation problems

Survival Defect: lower survival time of RBC

Front 2

what kind of anemia is associated with


Immune hemolytic anemia
Anemia of acute hemorrhage
Aplastic anemia
End organ failure (endocrinopathy, renal)

what is the MCV and MCHC like in this process?
***

Back 2

Normochromic Normocytic anemia

(normal MCV, Normal MCHC)

Front 3

what kind of anemia is associated with :

Iron deficiency anemia
Thalassemia
Anemia of chronic disease (infrequently)
Long standing disease

what is the MCV and MCHC like in this process?
***

Back 3

Hypochromic, microcytic
(low MCV, low MCHC)

Front 4

what kind of anemia is associated with :

Vitamin B12/ Folate Deficiency
Refractory Anemias/Myelodysplastic Syndrome (MDS)
Liver disease'

what is the MCV and MCHC like in this process?
***

Back 4

Macrocytic , Normochromic anemia

Increased MCV, Normal MCHC

Front 5

Immature, anuclear red cells containing increased ribosomal RNA for hemoglobin synthesis =

Back 5

Reticulocytes

Front 6

hemolytic anemia will have a high or low reticulocyte count?

Back 6

high

Front 7

in anemia, Reticulocytes indicate the degree of effective ______ activity

Back 7

Bone Marrow

e.g is the BM compensating for anemia

Front 8

how do you do a corrected reticulocyte count?

*** ON TEST

Back 8

(% observed Reticulocytes) X (Patients Hct/45)
example:

Anemic individual:
RBC 2 X10e9; Hct 19%; Ret 1%
absolute Retic No. = .01 X 2 x 10e12 = 20 x 10e9/l
Corrected Reticulocyte: 1% X 19/45 = 0.4% (normal 0.8-2.5%)

Front 9

An elevated IRF indicates what in an anemic pt?

**

Back 9

elevated IRF indicates adequate response while normal or subnormal IRF reflects inadequate response

IRF=Immature Reticulocyte fraction

Front 10

B12/Folate deficiency
Chemotherapeutic or retroviral agents
Myelodysplastic syndromes
Drugs associated with impaired absorption of B12/fotate (contraceptives, anticonvulsants)
Toxins (benzene, arsenic)

are associated with what type of anemia?

Back 10

Megaloblastic Macrocytic Anemia

OVAL

Front 11

Alcoholism and Liver disease should make you think what kind of anemia?

Back 11

Round Macrocytosis Non-Megaloblastic

Front 12

DNA replication problem where RNA continues to be translated and transcribed with resulting growth of the cytoplasm while nucleus lags behind. One or more cell divisions are skipped leading to larger than normal cells. This describes what?

Back 12

Oval Macrocytosis Megaloblastic anemia

Front 13

most common cause of oval macrocytosis?

Back 13

Folate/B12 deficiency (you will see HYPERSEGMENTED neutrophils)

(remember this was a problem with DNA replication)

Front 14

HYPERSEGMENTED neutrophils is your first tip off that you have what problem?

Back 14

Oval Macrocytosis


(remember this was a problem with DNA replication)

Front 15

Folate or B12 deficiency will cause what type of macrocytic anemia?

Back 15

OVAL

Front 16

MCV>100 should make you think

Back 16

Macrocytic anemia

Front 17

what must you consider in a child with failure to thrive?

Back 17

B12/folate deficiency

Front 18

what triad will you see in megaloblastic anemia?

Back 18

Triad of oval macrocytes, Howell-jolly bodies and hypersegmented neutrophils

Front 19

a defiency in folic acid causes what?

Back 19

Folic acid deficiency causes a block in the conversion of dUMP to dTMP resulting in DEFECTIVE DNA SYNTHESIS

Front 20

what will be the first sign of anemia associated with a folic acid deficiency?

Back 20

Hypersegmented neutrophils

Front 21

a deficiency in B12 will cause what two problems

Back 21

Necessary for synthesis of methionine, the central reaction in DNA synthesis--Messes up DNA synthesis

Deficient B12 means folate trapped in the n-methyl THF form, meaning B12 deficiency leads to --functional folate deficiency--.

Front 22

a deficiency in Intrinsic factor will lead to what?

Back 22

B12 Deficiency

Front 23

what will a deficiency in IF and consequentially B12 lead to?

what is this secondary to?
associated with?
cause?

Back 23

PERNICIOUS ANEMIA

secondary to gastric atrophy

frequently occurs with other autoimmune diseases

due to Auto-antibodies directed against parietal cell

Front 24

What is the Definitive test to distinguish between B12 malabsorption, dietary deficiency or absence of IF?

how does it work?

Back 24

Schilling test

give person radioactive B12, see if it is absorbed and then urinated out.. if it is not you need to see if it is malabsorption or IF deficiency

Part 2 then gives B12 AND IF, if they then pee it out, you know it was a problem with IF

Front 25

Round rather than oval macrocytes
Hypersegmented PMNs not present
Absence of glossitis and neuropathy

describes what type of macrocytic anemia?

Back 25

Macrocytic Anemia without Megaloblastosis

Front 26

Metabolic inhibitors. All rapidly proliferating cells affected, including hematopoietic cells

describes what type of macrocytic anemia?

Back 26

Macrocytic Anemia with Megaloblastosis

Front 27

Atrophy of mucosal surfaces, tongue, GI, vaginal (impaired DNA synthesis of proliferating cells) may lead to malabsorption

Back 27

This is the clinical presentation of macrocytic anemia

Front 28

Explain what a Rouleaux formation is

Back 28

Seen in Autoantibody production, hyperglobulinemia or cold agglutinins.

RBC clumping and sticking together as they pass the instrument detector

This makes the RDW (cell size variation) seem larger since all the clumped cells are counted as ONE CELL...

Front 29

you see HYPO-segmented PMNs

Back 29

Myelodysplasia