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54 Cards in this Set
- Front
- Back
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what is the CR for microcytic anemias. why
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CR is is in range or low, this is pathological and indicates insufficient RBC production
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List the 4 types of Microcytic hypochromatic anemias
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1. Fe Deficiency: no Fe so low HgB
2. Anemia of Chronic Disease: decreased serum Fe, low HgB 3. Sideroblastic anemia: decreased protoporphoryn synthesis, low HgB 4. hemoglobinpathies: decreased globin synthesis, decreased HgB Fx (thalassemia) |
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Hypoproliforative anemia
Hyperproliforative anemia |
Hypo: underproduction of RBC, low CR, IDA & ACD (insuficient erythropiosis)
Hyper: increased destruction/loss of RBC, elevated CR, SA & thalessemia |
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IBIL
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indirect bilirubin
**from degradation of RBC, indicates premature destruction of RBC **often is increased in sideroblastic anemia and thalassemia |
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what types of anemia are due to insufficient erythropoisiss, ineffective?
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Insufficient: Fe deficiency anemia, anemia of chronic disease
Ineffective: sideroblastic anemia, thalassemia (RBC prematurely destroyed) |
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Symptoms of anemia:
glossitis stomatisis angular cheilits anisocytosis poikilocytosis target cells koilonychia |
pallor, rapid pulse, SOB, headache, dizzy, fatigue, iritabile
glossitis: inflam of tongue stomatisis: inflam of tummy angular cheilits: inflam of corners of mouth anisocytosis: RBC size varies poikilocytosis: RBC shape varies target cells: dark center and light ring koilonychia: concave nails |
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other than bleeding what are common causes of Fe deficiency
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malnutrition
increased need decreased absorption **similiar reasons for deficiency of all vitamins |
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characterize the different stages of Fe deficiency Anemia
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I: use up stores of Fe. Ferritin falls, transferrin receptor increases, HgB WNL
II: Serum Fe falls, transferrin increases, HgB decreases-normochromatic normocytic anemia III: additional reduction in HgB synthesis, hypochromatic, microcytic anemia, hematocrit and RBC count drop |
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TIBC measures
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total iron binding capacity
measures total transferrin |
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what is nutritional adaptation
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Fe ABS increases when stores are low
**as Fe decerases, liver will decrease hepcidin, decreased hepcidin allows ferroportin to remain in the enterocyte and allow lots of Fe to be ABS |
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is anemia a disease
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NO! its a symptom, it is imperative to determine what causes anemia and treat that
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how does hypoferremia occur
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low levels of Fe available in the BM for erythropioesis
**during inflammation Fe levels are reduced. Macrophages secrete IL1 and IL6, IL1 causes neutrophiles to secrete lactoferrin which is a HIGH affinity Fe transporter. IL6 causes the liver to make lots of hepcidin. RESULT: take all of the Fe into macrophages and lock the door **Fe stores increase, increased ferritin |
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other than stimulating lactoferrin production by neutrophiles what other effect does IL1 have
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1. increases rate of phocytosis of RBC, decrease RBC life cycle from 120 to 90 days
2. slow erythropoiesis **minimize number of RBC (increase destructionand decrease production). prevent buggies from attacking RBC to hijack the Fe |
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Name 2 ways to increase Hepcidin
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increased fe levels
infection |
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Name three ways to decrease hepcidin
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hypoxia
decreased Fe levels increased erythoid demand *** the money one, will outcompete others |
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what happens to serum ferritin in IDA and ACD
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IDA: decreased
ACD: normal to increased **serum ferritin assess stores |
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what happens to serum Fe in IDA and ACD
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IDA: decreased
ACD: decreased **in ACD Fe desreases bc of hapcidin and lactoferrin, Fe leaves serum and enters storage in macrophages **in IDA Fe stores are low bc you arent eating enough Fe, supplementation will help |
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what happens to TIBC in IDA and ACD
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IDA: normal to increased.
ACD: normal to decreased *measures transferrin. In FDA we need lots of transferrin, in ACD we have lots of Fe in storage so TIBC will decrease |
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what happens to transferrin saturation in IDA and ACD
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IDA: decreased
ACD: decreased **in both cases a decrease in serum Fe will reduce Fe transferrin saturation. Keep in mind the reason for low serum Fe is different in both cases |
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what happens to free erythrocyte protoporphyrin in IDA and ACD
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IDA: increased
ACD: increased **last step before heme synthesis **in both cases protoporphyrin synthesis is normal and so will increase because there is a lack of Fe to add to the ring. |
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what happens to Cr in IDA and ACD
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IDA: normal to decreased
ACD: normal to decreased **a normal CR in anemia is pathological. We SHOULD have increased erythropioesis **IL1 decreases erythropioesis in ACD |
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what is sideroblastic anemia
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Fe is sufficient
the problem lies with heme synthesis (protoporphoryin deficiency) |
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what are 2 ways to get sideroblastic anemia
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1. inherited: ALA S2. decreases heme, this causes the liver to decrease hepcidin and abs more Fe
2. acquired: Pb poisioning or alcoholism (destroy B6 which is required for step 2) |
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what happens in cases of anemia when heme synthesis is impaired
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Fe accumulates
ringed sideroblasts |
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what are pappenheimer bodies
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leftover sideroblastic mitochondria in circulating RBC
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what is the morphology in severe sideroblastic anemia
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microcytic: small, low MCV
hypochromatic: low HCT anisocytosis: weird size poikliocytosis: weird shape |
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if sideroblastic anemia fesults from increased B6 Km for ALAS2 what can be done
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high Km means low affinity, increase B6 levels
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what does Pb poisioning lead to? why?
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sideroblastic anemia: 1st and last step in protoporphoryin synthesis uses Zn, Pb can block this and decrease heme synthesis
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what type of anemia is seen in alcoholics? why?
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sideroblastic anemia
alcohol destroys B6, B6 is required by ALA-S1 (first step in heme synthesis) |
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what are the distiuguishing lab tests for sideroblastic anemia
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increased transferrin saturation
bone marrow sideroblasts increased serum ferritin increased serum Fe decreased TIBC decreased erythrocyte protoporphoryin |
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why do pts with sideroblastic anemia increase Fe abs?
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increased erythroid demand
**this will cause liver to decrease hepcidin so more Fe is ABS. in an anemia caused by low Fe this is an appropriate resopnse |
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what is one way for ppl with sideroblastic anemia to not abs as much Fe
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dont drink vit C
eat polyphenols, oxolate, phytates... |
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how does vit c affect Fe
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reduces ferric to ferrous
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the increase in serum Fe is twofold in sideroblastic anemia
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1. decreased Fe use bc there is no heme to use it on
2. the liver decreases hepcidin so more Fe is abs (this also increases serum Fe) |
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why does TIBC decrease in sideroblastic anemia
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decreased bc Fe stores are high
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how does transferrin change when Fe stores are high, low
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when Fe stores are HIGH: transferrin decreases
LOW: transferrin increases |
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what happens to MCV in sideroblastic anemia? why
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decreases due to decreased hemoglobin
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name 2 hemoglobinpathies are their effect
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1. Sickle cell: structurally abnormal globin chain
2. thalassemia: globin chain isnt produced |
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is thalassemia hyper or hypo proliforative. what does this do to CR
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hyper
increased CR |
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what anemias are hyper/hypoproliforative. why
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Hypo: ACD and IDA, not all of the building blocks are there so insufficient erythropioesis and CR is normal
Hyper: thalessemia is hemolytic so erythropoisis will increase and CR increases. sideroblastic anemia. increases IBIL |
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how do you determine % saturation of transferrin
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serum Fe/TIBC X 100= transferrin saturation
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explain TIBC in ACD and IDA
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IDA: increased, Fe stores are low so we want to bind lots of Fe
ACD: decreased, Fe stores are normal so we dont need to bind everybit of Fe |
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what value is used to determine hyper/hypo chromatic
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MCHC
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target cells
anisocytosis polikiocytosis are morphological charactterizations of what anemia |
IDA
**also severe forms of sideroblastic |
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how can you determine if anemia is due to GI bleed
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check the poo for blood
hemoccult |
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Classify IDA test values
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serum Fe low
TIBC high transferrin sat low ferritin low |
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Give the distinguishing morphologies of the anemias
IDA ACD Sideroblastic Hemoglobinopathies |
IDA: aniso, poklio, target
ACD: nothing really Sideroblastic: ringed sideroblasts, pappenheimer body Hemoglobinopathy: ascino, target more prominent than IDA |
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serum Fe will be high in what anemias, low
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LOW: IDA ACD
HIGH: sideroblastic, hemoglobinopathy |
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in what anemia will TIBC be high? what happens with TIBC in all other types of anemia
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HIGH: IDA
LOW: all others |
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for % sat waht are the anemias for high, low, normal
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HIGH: sideroblastic
LOW: IDA ACD Normal: hemoglobinopathy |
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ferritin, when is it:
HIGH LOW NORMAL to HIGH |
HIGH: sideroblastic
LOW: IDA Normal to High: ACD, hemoglobinopathy |
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when distinguishing anemias first look at....
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Serum Fe
High: sideroblastic Low: Fe Deficiency or ACD Normal: Globinopathy |
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to distinguish ACD and IDA look at...
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serum ferritin levels
High: ACD Low: IDA |
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what should you look at first? what shoud you look at second>?
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first: serum Fe (high in sidero, low in ACD and IDA, normal in hemoglobinopathy
second: look at ferritin to distinguish ACD and IDA ferritin is high in ACD ferritin is low in IDA |
