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37 Cards in this Set
- Front
- Back
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Definition
Size of the erythrocytes and content of hemoglobin are ... Causes are diverse and there may be ..., quite different underlying conditions responsible |
normal
multiple |
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Etiologies:
... loss Hemolysis ... production |
Blood
Decreased |
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Underlying conditions:
-Post-hemorrhagic anemia -Hemolytic anemia -Sickle cell, RBC membrane, or enzymatic defect causing anemia -Anemia of ... disorders -Aplastic or ... anemia -... bone marrow |
chronic
hypoplastic Hyperplastic |
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Post-hemorrhagic Anemia:
Blood loss -Hct ... after acute bleeding; RBC’s and plasma fall together and for 24 to 48 hours blood remains NC/NC (normochromic/normocytic) -If adequate iron stores exist, a few days after blood loss ... (new large cells) are produced raising MCV (size of blood cell on average) and may be observed in peripheral blood |
not reliable
reticulocytes |
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Post-hemorrhagic Anemia:
Blood loss -If hemorrhage causes or occurs with iron deficiency, MCV/MCH may begin to ... quickly and iron deficiency can be confirmed by serum iron, TIBC, and ferritin or bone marrow stains -Iron deficiency should be attributed to ... until proven otherwise |
fall
bleeding |
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Post-hemorrhagic Anemia:
Blood loss -... (nose bleeding), ...(coughing of blood), and hematuria are generally obvious and reported while uterine bleeding or GI bleeding can be overlooked or occult and may present as unexplained anemia |
Epistaxis
hemoptysis |
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Post-hemorrhagic Anemia:
Blood loss -Excessive menstrual bleeding often goes unrecognized unless the patient is asked about the duration of bleeding, presence of clots, ... of the abdomen, overloading of tampons, or the high number of pads used, or inter-menstrual bleeding -GI bleeding is usually an occult process; it may be recognized if it presents as hematochezia or melena before iron deficiency occurs but if the stools appear normal or if bleeding is slow, ... deficiency anemia signs and symptoms may be the presenting manifestations |
cramps
iron |
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Post-hemorrhagic Anemia:
Blood loss -Every patient with iron deficiency should have ... testing -A single negative study ... exclude blood loss because bleeding may be intermittent -A certain ... of blood loss required for positive test -If blood loss proven must identify ... of blood loss by best available technology |
occult GI blood loss
does not rate site |
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Hemolytic Anemia:
Hemolysis -Normal RBC survival is ... days; if survival of RBC’s is decreased and we can directly demonstrate increased destruction, or increased production as compensation for destruction, we can support a diagnosis of hemolysis -Increased destruction is evidenced by ... and increased production is evidenced by ... |
120
hyperbilirubinemia reticulocytosis |
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Hemolytic Anemia:
Hemolysis -Using the presence of anemia to detect hemolysis will overlook most hemolytic destruction; anemia as evidence of hemolysis requires an RBC lifespan of ... days or less -Anemia as a result of hemolysis is only revealed when destruction increases to 6 to 8 fold normal because the ... can increase production by the same capacity |
20
bone marrow |
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Hemolytic Anemia:
Hemolysis -If reticulocytosis and indirect hyperbilirubinemia are used to detect hemolysis, hemolytic process may be evident at an RBC lifespan of 40 to 50 days (a very sensitive test) -All patients with reticulocytosis and indirect hyperbilirubinemia have a hemolytic disorder; patients may have hemolysis but not be recognizable by anemia if the bone marrow is able to respond with a high rate of ... |
reticulocytosis
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Hemolytic Anemia:
Hemolysis -Hemolysis results from both hereditary and acquired defects of the red blood cell -All hereditary hemolytic disorders are a result of ...-corpuscular defects and acquired defects are ...-corpuscular in nature |
intra
extra |
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Hemolytic Anemia:
Hemolysis -... or extra-cellular illnesses or disease that cause RBC destruction include physical agents and trauma, chemicals, infections, liver and kidney disease, cancer, collagen vascular and malignant antibody-mediated diseases |
External
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Hemolytic Anemia:
Hemolysis -Hereditary hemolysis is strongly suggested by the presence of a ... of anemia, jaundice, cholelithiasis, or splenectomy -Interview, examine and review blood smears on family members to confirm suspected hereditary nature -Spherocytes, elliptocytes, and sickle cells are seen in their respective diseases, target cells in Hb C or E disease |
family history
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Hemolytic Anemia:
Hemolysis -The vast majority of RBC enzyme abnormalities are ... deficiency and ... kinase abnormalities -Although a disorder may be hereditary, the ... at which it manifests may not necessarily be early and in G-6-PD deficiency only occurs after exposure to an oxidant drug |
G-6-PD
pyruvate age |
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Hemolytic Anemia:
Hemolysis -Acquired hemolytic disorders vary considerably in severity -... hemolysis occurs as a result of exposure to many different substances; the presence of predisposing diseases may suggest the cause -Antibody-mediated hemolysis include drug-dependent, collagen vascular, post-infectious, and malignant -Idiopathic causes |
Acquired
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Hemolytic Anemia:
Hemolysis -... and folate deficiency may be associated with an element of hemolysis -Rare disorders such as paroxysmal nocturnal hemoglobinuria can now be diagnosed by surface ... studies and demonstrate sucrose lysis |
B12
antigen |
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Hemolytic Anemia:
Hemolysis -When the major causes of hemolysis have been excluded by history, physical examination and laboratory studies, it may not be possible to distinguish between hereditary ...-corpuscular and acquired ...-corpuscular defects -Therapeutic intervention may confirm mechanism |
intra
extra |
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Decreased RBC Production:
ACD (anemia of chronic disorders), hypoplasia or aplasia -Decreased production is accepted as a diagnosis of exclusion when blood loss and hemolysis are ruled out -Inflammation or infection may result in secretion of a number of agents that mediate ... of RBC production |
suppression
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Decreased RBC Production:
Anemia of chronic disorders -Associated with discernable medical problems -Characterized by disturbance of iron reutilization and mobilization and occurs rapidly after the onset of infection, inflammation, or acutely after surgery -... serum iron in the presence of ... serum iron stores as in ACD represents a profound disruption of iron metabolism |
Low
normal |
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Decreased RBC Production:
Anemia of chronic disorders -Though absorption of iron is somewhat abnormal, it is primarily decreased release of iron from macrophages and ... cells that limits iron utilization in ACD -Human studies using radio-labeled RBC’s and hemoglobin directly demonstrate poor reutilization in patients with infection, cancer, and chronic inflammation -RBC production decreases by 20-30 per cent in patients with ... illness |
hepatic
chronic |
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Decreased RBC Production:
Anemia of chronic disorders -A normal bone marrow can compensate for a slight decrease in RBC life span but requires hypoxia-induced ... to accomplish it -In chronic disease EPO production is present but is also blunted compared to degree of ... -... mediators seem to be responsible for blunting EPO creation |
EPO (erythropoietin)
anemia Cytokine |
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Decreased RBC Production:
Anemia of chronic disorders -Caused by ...-corpuscular effect since RBC’s of patients with ACD survive normally in normal recipients -... such as IL-1, TNF-α, and Ifn-γ have been shown to be secreted in a variety of chronic diseases and have been verified as at least some of the mediators of ACD |
extra
Cytokines |
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Decreased RBC Production:
Hypoplasia or aplasia -Many patients will have ... with abnormalities of white blood cells and platelets that are evident on peripheral smear and blood counts -The presence of multiple cell line depression is an indication of possible ... cell or early lineage damage |
pancytopenia
stem |
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Decreased RBC Production:
Hypoplasia or aplasia -When pancytopenia is present, ... aspiration and biopsy is the most valuable test available -The bone marrow allows the categorization of the underlying disorders into three types: aplastic or hypoplastic, hyperplastic, and marrow replaced with non-hematopoietic elements |
bone marrow
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Hypoplasia or aplasia
Aplastic or hypoplastic bone marrow -Drugs and chemicals are common causes and may be ...-related or idiosyncratic -... -related exposures to agents such as arsenic, benzene, radiation, and several chemotherapy agents are associated with pancytopenia -Idiosyncratic agents may cause ... with a small exposure; chloramphenicol can produce pancytopenia but solitary cell line cytopenias occur with sulfonamides or anti-thyroid medications, etc |
dose
Dose cytopenia |
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Hypolasia or aplasia:
Aplastic or hypoplastic bone marrow -Idiosyncratic agents include viral agents, antibiotics, antidepressants, antimicrobials, and antihistamines; paroxysmal nocturnal hemoglobinuria and sickle cell and other diseases -Half of aplastic episodes are ... in origin -Determining the cause of the aplastic anemia may allow for stopping the offending exposure to allow recovery |
idiopathic
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Decreased RBC Production
Hyperplastic bone marrow -Relative bone marrow failure due to severe ... deficiency; usually due to lack of B12, folate, or iron; antifolates and DNA synthesis inhibitors -Relative bone marrow failure due to primary bone marrow stem cell failure/mutation and dysplasia |
nutritional
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Decreased RBC Production:
Hyperplastic bone marrow -Refractory anemia may exist for months or years and may be silent or may be associated with increasing symptoms of fatigue, weakness, asthenia and malaise. -Infiltration of the bone marrow by ... tissue and ... cells that displace normal hematopoietic cells |
fibrous
malignant |
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Decreased RBC Production:
Hyperplastic bone marrow -Extensive bone marrow replacement or stem cell injury ... and alters the production of not only RBC’s but also granulocytes and platelets -Bone marrow replacement may be suspected on the basis of myeloid metaplasia in the peripheral smear; abnormally shaped erythrocytes and normoblasts, immature granulocytes, and large platelets characterize myeloid metaplasia |
reduces
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Hyperplasia, hypoplasia, or aplasia:
Hyperplastic bone marrow -Replacement of the bone marrow with non-hematopoietic cells, fibrosis, or dysfunctional hematopoiesis may stimulate reactivation of fetal sites of blood production such as the ... and liver often associated with organomegaly -... does not occur in aplastic or hypoplastic states |
spleen
Myeloid metaplasia |
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Treatment of Post-hemorrhagic Anemia:
-Confirm bleeding as ... of anemia -Localize site and source of the blood loss -... as may be needed -Replacement of bleeding-induced deficiencies such as iron and supportive therapy to assist ... production such as folate -Surgically or medically repair the problem |
cause
Transfuse RBC |
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Treatment of Hemolytic Anemia
Carefully confirm ... and cause Remove offending agents, support with iron or folic acid where needed, administer immune suppression or consider ... where required Transfuse blood when necessary and with the proper technique; control excess ... |
hemolysis
splenectomy iron |
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Treatment of Anemia of Chronic Disorders:
Carefully exclude other diagnoses or treat concurrent abnormalities ... therapy of the underlying disease Rarely requires ..., usually to minimize co-morbid medical conditions |
Aggressive
transfusion |
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Treatment of Anemia of Hypoplastic or Aplastic Disorders:
-... most helpful in distinguishing underlying disorders; ... often present -Remove offending agents (and see if there is improvement in blood count) -Aggressive immunosuppression -Bone marrow ... |
Bone marrow
pancytopenia transplantation |
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Treatment of Disorders of Hyperplastic Bone Marrow:
Replacement with iron, B12, or folate in deficiency states When the ... is replaced, usually by fibrous tissue or cancer, it generally affects all cell lines; evidenced as atypical bone marrow and blood differential; requires treatment of the underlying disorder |
bone marrow
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Treatment of Disorders of Hyperplastic Bone Marrow:
Withdraw methotrexate or other DNA synthesis ... if present When related to confirmed myelodysplasia, mitigate with EPO or treat with 5-aza-cytidine, decitabine, induction chemotherapy or bone marrow transplant |
inhibitors
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