• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/23

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

23 Cards in this Set

  • Front
  • Back
DDx for microcytic anemia.
Mneumonic: TAILS

T - thalessemia
A - anemia of chronic diseases
I - iron deficiency
L - lead poisoning
S - sideroblastic anemia
What is the definition of thalessemia? Distinguish between ALPHA-thal and BETA-thal.
= decrease or absence of normal GLOBIN chains of hemoglobin

ALPHA-thal = mut'n in ≥1 of the 4 genes coding for alpha-hemoglobin

BETA-thal = mut'n in ≥1 of the 2 genes coding for beta-hemoglobin
Among which ethic groups is thalessemia more common?
- African
- Middle Eastern
- Asian
How is thalessemia diagnosed?
- hemoglobin electrophoresis + DNA studies

Note - electrophoresis will be normal in alpha-thal
What are 3 root causes of iron deficiency anemia?
1. Increased iron demand - e.g. pregnancy

2. Decreased supply
- cow's milk diet among infants
- tea 'n' toasters among elderly
- malabsorption among IBD, celiacs
- post-gastrectomy

3. Increased loss
- hemorrhage
- hemolysis
Symptoms and signs of iron-defiency anemia.
Symptoms: fatigue, weakness, pica, h/a, irritable, exercise intolerant, syncope, dyspnea, cold, postural dizzy

Signs: brittle nails/hair, koilonychia (spoon-shaped nails), pallor, glossitis

*can be asx is anemia develops slowly
What is Plummer-Vinson Syndrome?
Triad of:

1. DYSPHAGIA (secondary to esophageal webs)
2. GLOSSITIS
3. IRON-DEF'Y ANEMIA

*may see angular stomatitis (inflammation/fissures at corners of mouth)
What investigations should be done if one suspects a pt has iron-defiency anemia?
1. Fe indices - ferritin <45 ug/L = Fe-def anemia*

2. Peripheral smear - hypochromic microcytosis, target cells

3. BM - gold standard (rarely done) would find dec'd iron in macrophages and erythroid precursors (Prussian blue stain for iron)

*ferritin is an acute phase reactant, :. elevated in inflammatory conditions, liver disease
Treatment of Fe-def' anemia?
1. Treat underlying cause.

2. Supplement.
- PO: ferrous sulphate 325 mg TID ...
- PO: ferrous gluconate 300 mg TID ...
- PO: ferrous fumerate 300 mg TID ... until N ferritin
- IV: iron sucrose or iron dextran ... anaphylaxis risk

3. Monitor response to Fe:
- retic count should inc' w/n 1 wk
- Hb should stabilize 10 g/L/wk
What is the pathophysiology of 'anemia of chronic disease'?
Infection/malignancy/inflammation/autoimmune/renal disease/live disease/endocrine diseases cause an anemia of UNDERPRODUCTION secondary to impaired iron utilization.

Impaired iron utilization is due to either:

- iron trapping within enterocyte
- iron trapping within macrophage
- BM is unrspnsive to N/elevated EPO
How is anemia of chronic disease diagnosed?
= a diagnosis of exclusion

- ass'd w/ acute phase reactants (ESR, CRP, fibrinogen)
- often co-exisits with Fe-def'y
- peripheral smear is usu:
- normocytic & normochromic if mild
- microcytic & normochromic if moderate
- microcytic & hypochromic if severe
What is sideroblastic anemia?
Normally erythrocytes have iron-containing granules scattered through-out the cytoplasm.

In sideroblastic anemia a defect in the heme biosynthesis of erythroid precursors leads to iron deposition in the mitochondria. These are large, abn granules that can be seen as a 'ring' around the nucleus.
List 3 causes of sideroblastic anemia.
1. Hereditary - X-linked, survival ~10 yr

2. Idiopathic Acquired - subtype of MDS

3. Reversible - drugs, etoh, lead, Cu def, hypothyroid
Symptoms and signs of sideroblastic anemia.
Sx - typical of anemia

Signs - hepatosplenomegaly, Fe-overload syndrome
Diagnosis of sideroblastic anemia?
1. Serum Fe indices:
- inc'd serum Fe
- inc'd ferritin
- inc'd sTfR

2. Peripheral blood film
- ringed sideroblasts
- hypochromic & micro/normo/macrocytic
What are 4 causes of NORMOcytic anemia?
Mnemonic: ABCD

A - aplastic anemia
B - blood loss
C - chronic disease
D - destruction (hemolysis)
Define aplastic anemia.
= destruction of hematopoietic cells of the BM l/t hypocellular BM and pancytopenia
List >5 causes of aplastic anemia.
Congenital - Fanconi's, Shwachman-Diamond syndrome

Acquired - chemo, toxins (DDT), idiopathic T-cell med'd

Ionizing radiation

Post-viral infection - parvovirus B19, EBV, HIV, HHV6

Autoimmune - SLE
Sx and signs of aplastic anemia.
Sx - typical of anemia/thrombocytopenia

Signs - NO hepatosplenomegaly
Diagnosis of aplastic anemia?
1. CBC
- anemia, neutropenia, thrombocytopenia, +-
pancytopenia, dec'd retics

2. Peri smear - dec'd number of N RBCs

3. BM:
- aplasia or hypoplasia with FAT replacement
- dec'd cellulariy
Treatment of aplastic anemia?
1. Treat underlying cause

2. RBC, plt transfusions

3. Immunosuppression:
- anti-thymocyte globulin or
- cyclosporin

4. Allogenic BM transplant
How can the etiologies of normocytic anemia be subcategorized? What is the DDx of each category?
1. INHERITED
(a) Hemoglobinopathy
- sickle cell, thalessemia
(b) Membrane
- spherocytosis
(c) Metabolic
- glycolytic pathway

2. ACQUIRED
(a) Immune (:. Coombs-postive)
- cold-agglutin, drug-induced
(b) Infection
- malaria
(c) Microangiopathic hemolytic anemias
- DIC, HUS, TTP, HELLP
(d) Oxidative/drug-related
How can the etiologies of macrocytic anemia be subcategorized? What is the DDx of each category?
1. MEGALOBLASTIC (DNA-synthesis problem)
- B12 def'y
- folate def'y
- drugs that impair DNA synth. (MTX, sulfa, chemo)

2. NON-MEGALOBLASTIC (membrane abn d/t cholesterol metabolism problem)
- liver disease
- etoh-ism
- hypothyroidism
- myelodysplasia