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89 Cards in this Set

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  • Back
What are the 3 types of Macrocytic anemias?
What is the definition of macrocytic anemia?
An anemia due to morphologic abnormality
What is the definition of megaloblastic anemia?
Anemia due to an defect in DNA synthesis.
What is the definition of megaloblastoid anemia?
An anemia resulting from a stem cell defect - this will cause a CLONAL disorder, affecting all cells.

Also can be due to an idiopathic cause.
What biochemical problem causes Megaloblastic Anemia (DNA defect)?
The RBCs have unbalanced growth due to impaired synthesis of thymidylate.
What are the 2 main results of impaired thymidine synthesis?
-Defective DNA replication

-Retarded nucleus maturation and mitosis.
What are the 2 main deficiences that we think of with megaloblastic anemia?
-Vit B12 deficiency
-Folate deficiency
Why is folate important?
It is necessary to convert deoxyuridlate to thymidylate.
Why is Vit B12 important?
It is necessary to convert 5-methyl Tetrahydrofolate to Tetrahydrofolate.
What type of Bone marrow morphology do you see in megaloblastic anemias?
(3 changes)
1. HYPERCELLULAR!! hyperplastic
2. Increased myelo:erythro ratio
3. Dyspoeisis of RBC/WBC and megakaryocytes.
what are the 3 'poeises that you see in megaloblastic anemia?
-megaloblastic dyserythropoeisis
-megaloblastic granulopoeisis
-megaloblastic thrombopoeisis
what type of grans are seen in the BM?
GIANT bands, segs, and metas.
what happens to the megakaryos in the bone marrow in megaloblastic anemia?
-decreased granulation of megs and platelets

-hyperlobation of megs.
what happens to RBCs and WBCs in megaloblastic anemia in general?
-RBCs have increased hemolysis - both extra and intravascular.

-WBCs are decreased in general because they can't get out of bmarrow. Decreased platelets.
What happens to iron kinetics in megalobl. anemia?
Iron is recycled in the bmarrow and spleen, but not used by RBCs.
What blood chemistry test indicates increased cell destruction?
Lactate Dehydrogenase - LD
So what 3 chemistries are increased in megalobl. anemia?

What one is decreased?
-Lact. Dehydrogenase
-Uric acid.

-Haptoglobin is decrease.
The hallmark Periph Blood smear:
-Hypersegmented PMNs
-Oval Macrocytes
-Increased MCV
-howell jollies too
For the bonus point, what else is seen in megalobl anemia?
PANCYTOPENIA - cells too big are not released from bmarrow.
what are the 2 MAJOR CAUSES of megaloblastic anemia?
-Folate deficiency
-Vit B12 deficiency
What's the daily recomm. folate?
50 ug
where and how much folate is stored in the body?
Liver - 3 to 5 week supply.
How is folate absorbed?
by mucosal cells in ilium and jejunem.
what are 5 clinical features of folate deficiency?
-weight loss
-light headed
-slight jaundice
what are the lab findings in folate defic?
decreased serum/RBC folate
normal to decr. b12
what are 5 causes of folate defic?
-impaired absorption
-incrased requirement
-increased loss
what is folate defic. therapy?
-oral folate
-normalizes in 4-6 wks
What is the B12 MDR?

where is B12 stored?
1-3 ug

In liver - 3-5 YEAR supply!
what 3 things are required for B12 absorption?
-intrinsic factor
-r proteins
What is the clinical symptoms of Vit b12 defic - diffnc from folate deficn?
5 - same as b12
6th: neuroogical changes
what neurolog. changes occur in vit b12 defic?
-demyelination of nerves
-gait abnormalities
-difficult fine motor coordin.
what might make you think Grandma's crazy?
MEGALOBLASTIC MADNESS - temporary psychosis due to neurological problems from vitamin b12 defic.
What is seen in vit b12 defic?
-serum folate
-RBC folate
normal to increased serum fol
decreased RBC folate
decr. b12
what are 5 causes of Vit B12 defic?
-Pernicious Anemia
-transport defects
what is the most common cause?
What is pernicious anemia?
defective intrinsic factor secretion by stomach parietal cells.
What type of problem is pernicious anemia, and in who?
Genetic autoimmune mechanism.
Scandinavians and N. europeans are predisposed.
What are the lab findings in pernicious anemia? what 2 extra tests do you do?
Normal to incr. Serum folate
Decreased RBC folate
Decreased Vit B12
Do a IF antibody test and Schillings test if negative.
What is the therapy for Pernicious anemia?
Eat pre-digested meat ummmm
Take B12 and IF orally
What are 3 causes of Vit B12 Malabsorption?
-Gastrectomy or abnormal stomach mucosal cells
-Intestinal disorders
-Chronic pancreatitis
What 2 things compete with you for vitamin b12?
-Fish tapeworm - D. latum

-Blind loop syndrome - bacteria.
When are 4 times you have increased demand for Vit b12?
-Growth spurts
-Incr. cell proliferation
What protein is defective if you have transport deficiency?
When is Megaloblastic anemia unresponsive to Folate or B12 therapy?
In RARE diseases.
What is macrocytic anemia really?
Macrocytic anemia of chronic liver disease.
If you have an anemic alcoholic, what do you think?
anemia of chronic liver disease.

What exactly causes ACLD?
many mechanisms - sideroblastic, iron defic., hemolytic, megaloblastic..
What are 4 results of Toxic Alcohol?
-Enzyme defects in heme synth.
-Vacuoles in RBC precursors
-platelet dysfunction
-low grans - decr. production, incr destruction
What are Direct Effects of ACLD?
-Acute and Chronic blood loss
-Viral suppression of EPO
-Dilutional anemia
-Hemolytic anemia
How does a patient w/ ACLD have acute/chronic blood loss?
-What is the cell affected?
By GI bleeds - causes dysfunctional PLATELETS and coagulation.
What are 2 indirect effects of ACLD?
-Malnutrition (alcoholics dont eat)
-Anemia of Chronic inflammation
What type of RBC morphology is seen in ACLD?
-Round, pink macrocytes
-Target cells
What is the MCV in ACLD?

How would you know a macrocytic condition is NOT ACLD?
-If the RDW is increased

-If the MCV is greater than 115
What are the 5 types of NORMO/NORMO anemias?
Bmarrow failure,
Chronic renal
After acute blood loss, what lab findings will you see within a few hours?
-Increased platelets

-Increased WBCs
What longer-term lab findings will you see?
-Increased RBC production
-Increased HCT
In a few days
What are 2 types of anemia of bond marrow failure?
-Pure Red Cell Aplasia PRCA
What 2 defects cause Aplastic?
-Pluripotent defect
-Bone marrow HIM problem
What are 3 variations of aplastic?
What 4 things can cause Acquired aplastic anemia?
-Chems: Benzene, xylene, arsenic
-Immune responses
What is the name for congenital aplastic anemia?
Fanconi's Anemia
What types of problems do you have with Fanconi's Anemia?
-Problems w/ Thumbs and Radii
-Increased Hgb F
-Kidney, brain, low progenitors
how many aplastic cases are idiopathic?
What type of onset does the patient have in aplastic?
Insidious - creeps up on ya
-weird bleeding
-skin rash - petechiae
-ecchymosis, anemia, weak, short of breath, pallor...
What do you DEFINITELY NOT see in the PBsmear in aplastic?
Retics or polychromasia - it's pancytopenia that's happening.
What's the therapy for aplastic anemia?
bone marrow transfusion IF meet the criteria - less than 500 PMNs, <20 x 10'3 platelets, less than 1% retics.
What are 2 ways you can get PRCA (pure red cell aplasia)?
What are 2 congenital conditions of PRCA?
-Diamond Blackfan syndrome
-Congenital Dyserythropoeitic Anemia
What are clinical indications of PRCA?
-general signs of anemia
-decr. RBC cnt and HgB
-Normal WBC and platelets
What is the therapy for PRCA?
-Give packed RBCs

-But be careful with iron or will cause hemachromatosus.
What is anemia of chronic renal disease?
A buildup of toxic wastes that can't get excreted, and create a hostile environment to current and new cells.
How many mechanisms are in Anemia of Chronic Renal Disease?
What 6 mechanisms occur in ACRD?
1. Hemolysis
2. Hypoproliferation
3. Hydremia
4. Hypersplenism
5. Blood loss
6. AOI
What is hypoproliferation?

How does hemolysis occur?
Decreased EPO production; an unknown inhibitor in plasma.

Hemolysis - toxins affect membrane, forms schistocytes.
What is hydremia?

How does Hypersplenism occur?
-Excess H2O in blood, fluid retention.

-The spleen chews up RBCs during chronic dialysis.
How does blood loss occur?
-From the GI tract
-During dialysis
-From so many blood draws
What is AOI?
Anemia of Inflammation - also known as Anemia of chronic disease, if progressed will be Hypo/Micro.
What is seen on the PB smear in Anemia of chronic renal disease?
-Burr cells
-nonspecific poikilocytosis
How is Anemia of CRrenalDisease treated?
-Recomb. human erythropoeitin
what is myelopthisic anemia?
What is the result of myelopth?
Extramedullary hematopoeisis.
What 4 things cause myelopthisic anemia?
-Metastatic cancer
-Neoplasms in the bmarrow
-Tuberculosis TB infection
What do you see in the PB smear in myelopthisic anemia?
-Immature WBCS and RBCs
-nRBCs, Metamyelos, Myelos, Prograns, Micromegakaryos, giant platelets, etc.
How is myelopthisic anemia treated?
By treating whatever's in the bmarrow - the underyling cause.
What is "Anemia Associated with Endocrine Disease" generally a cause of?
Decreased EPO
What are 4 causes of Anem. assoc w/ endocrine disease?
-Thyroid disease
-Pituitary dysfunction
-Adrenal insufficiency
What is AIO?
anemia of inflammation - a better name for Anemia of chronic disease.
What is AIO predominantly, and what can it become?
Normo/normo, can become hypo/micro.