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89 Cards in this Set
- Front
- Back
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What are the 3 types of Macrocytic anemias?
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-Macrocytic
-Megaloblastic -Meegaloblastoid |
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What is the definition of macrocytic anemia?
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An anemia due to morphologic abnormality
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What is the definition of megaloblastic anemia?
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Anemia due to an defect in DNA synthesis.
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What is the definition of megaloblastoid anemia?
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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. |
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What biochemical problem causes Megaloblastic Anemia (DNA defect)?
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The RBCs have unbalanced growth due to impaired synthesis of thymidylate.
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What are the 2 main results of impaired thymidine synthesis?
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-Defective DNA replication
-Retarded nucleus maturation and mitosis. |
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What are the 2 main deficiences that we think of with megaloblastic anemia?
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-Vit B12 deficiency
-Folate deficiency |
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Why is folate important?
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It is necessary to convert deoxyuridlate to thymidylate.
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Why is Vit B12 important?
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It is necessary to convert 5-methyl Tetrahydrofolate to Tetrahydrofolate.
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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. |
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what are the 3 'poeises that you see in megaloblastic anemia?
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-megaloblastic dyserythropoeisis
-megaloblastic granulopoeisis -megaloblastic thrombopoeisis |
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what type of grans are seen in the BM?
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GIANT bands, segs, and metas.
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what happens to the megakaryos in the bone marrow in megaloblastic anemia?
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-decreased granulation of megs and platelets
-hyperlobation of megs. |
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what happens to RBCs and WBCs in megaloblastic anemia in general?
Platelets? |
-RBCs have increased hemolysis - both extra and intravascular.
-WBCs are decreased in general because they can't get out of bmarrow. Decreased platelets. |
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What happens to iron kinetics in megalobl. anemia?
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Iron is recycled in the bmarrow and spleen, but not used by RBCs.
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What blood chemistry test indicates increased cell destruction?
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Lactate Dehydrogenase - LD
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So what 3 chemistries are increased in megalobl. anemia?
What one is decreased? |
-Bilirubin
-Lact. Dehydrogenase -Uric acid. -Haptoglobin is decrease. |
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What is the MEGALOBLASTIC TRIAD?
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The hallmark Periph Blood smear:
-Hypersegmented PMNs -Oval Macrocytes -Increased MCV -howell jollies too |
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For the bonus point, what else is seen in megalobl anemia?
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PANCYTOPENIA - cells too big are not released from bmarrow.
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what are the 2 MAJOR CAUSES of megaloblastic anemia?
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-Folate deficiency
-Vit B12 deficiency |
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What's the daily recomm. folate?
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50 ug
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where and how much folate is stored in the body?
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Liver - 3 to 5 week supply.
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How is folate absorbed?
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by mucosal cells in ilium and jejunem.
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what are 5 clinical features of folate deficiency?
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GWPLS
-glossitis -weight loss -pallor -light headed -slight jaundice |
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what are the lab findings in folate defic?
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decreased serum/RBC folate
normal to decr. b12 |
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what are 5 causes of folate defic?
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-dietary
-impaired absorption -incrased requirement -increased loss -drugs |
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what is folate defic. therapy?
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-oral folate
-normalizes in 4-6 wks |
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What is the B12 MDR?
where is B12 stored? |
1-3 ug
In liver - 3-5 YEAR supply! |
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what 3 things are required for B12 absorption?
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-intrinsic factor
-r proteins -transcobalamins |
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What is the clinical symptoms of Vit b12 defic - diffnc from folate deficn?
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5 - same as b12
6th: neuroogical changes |
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what neurolog. changes occur in vit b12 defic?
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-demyelination of nerves
-gait abnormalities -numbness/tingling -difficult fine motor coordin. -psychosis |
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what might make you think Grandma's crazy?
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MEGALOBLASTIC MADNESS - temporary psychosis due to neurological problems from vitamin b12 defic.
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What is seen in vit b12 defic?
-serum folate -RBC folate -B12 |
normal to increased serum fol
decreased RBC folate decr. b12 |
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what are 5 causes of Vit B12 defic?
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-dietary
-Pernicious Anemia -malabsorption -competition -transport defects |
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what is the most common cause?
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PERNICIOUS ANEMIA
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What is pernicious anemia?
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defective intrinsic factor secretion by stomach parietal cells.
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What type of problem is pernicious anemia, and in who?
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Genetic autoimmune mechanism.
Scandinavians and N. europeans are predisposed. |
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What are the lab findings in pernicious anemia? what 2 extra tests do you do?
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Normal to incr. Serum folate
Decreased RBC folate Decreased Vit B12 Do a IF antibody test and Schillings test if negative. |
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What is the therapy for Pernicious anemia?
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Eat pre-digested meat ummmm
OR Take B12 and IF orally |
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What are 3 causes of Vit B12 Malabsorption?
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-Gastrectomy or abnormal stomach mucosal cells
-Intestinal disorders -Chronic pancreatitis |
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What 2 things compete with you for vitamin b12?
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-Fish tapeworm - D. latum
-Blind loop syndrome - bacteria. |
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When are 4 times you have increased demand for Vit b12?
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-Pregnancy
-Growth spurts -Incr. cell proliferation -Hypererythroid |
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What protein is defective if you have transport deficiency?
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Transcobalamin.
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When is Megaloblastic anemia unresponsive to Folate or B12 therapy?
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In RARE diseases.
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What is macrocytic anemia really?
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Macrocytic anemia of chronic liver disease.
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If you have an anemic alcoholic, what do you think?
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anemia of chronic liver disease.
ACLD |
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What exactly causes ACLD?
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many mechanisms - sideroblastic, iron defic., hemolytic, megaloblastic..
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What are 4 results of Toxic Alcohol?
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-Enzyme defects in heme synth.
-Vacuoles in RBC precursors -platelet dysfunction -low grans - decr. production, incr destruction |
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What are Direct Effects of ACLD?
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-Acute and Chronic blood loss
-Viral suppression of EPO -Dilutional anemia -Hypersplenism -Hemolytic anemia |
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How does a patient w/ ACLD have acute/chronic blood loss?
-What is the cell affected? |
By GI bleeds - causes dysfunctional PLATELETS and coagulation.
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What are 2 indirect effects of ACLD?
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-Malnutrition (alcoholics dont eat)
-Anemia of Chronic inflammation |
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What type of RBC morphology is seen in ACLD?
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-Round, pink macrocytes
-Target cells -Acanthocytes |
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What is the MCV in ACLD?
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110-115
VERY GOOD INDICATION - PAY CLOSE ATTENTION TO MCV!!! |
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How would you know a macrocytic condition is NOT ACLD?
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-If the RDW is increased
-If the MCV is greater than 115 |
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What are the 5 types of NORMO/NORMO anemias?
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HABCM
Hemolytic, Aplastic, Bmarrow failure, Chronic renal Myelopthisic. |
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After acute blood loss, what lab findings will you see within a few hours?
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-Increased platelets
-Increased WBCs |
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What longer-term lab findings will you see?
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-Increased RBC production
-Increased HCT -NORMAL INDICES In a few days |
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What are 2 types of anemia of bond marrow failure?
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-Aplastic
-Pure Red Cell Aplasia PRCA |
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What 2 defects cause Aplastic?
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-Pluripotent defect
-Bone marrow HIM problem |
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What are 3 variations of aplastic?
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-Congenital
-Acquired -Idiopathic |
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What 4 things can cause Acquired aplastic anemia?
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-Drugs:Chloramphenical
-Chems: Benzene, xylene, arsenic -Radiation -Immune responses |
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What is the name for congenital aplastic anemia?
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Fanconi's Anemia
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What types of problems do you have with Fanconi's Anemia?
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-Problems w/ Thumbs and Radii
-Increased Hgb F -Kidney, brain, low progenitors |
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how many aplastic cases are idiopathic?
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50-75%
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What type of onset does the patient have in aplastic?
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Insidious - creeps up on ya
-weird bleeding -skin rash - petechiae -ecchymosis, anemia, weak, short of breath, pallor... |
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What do you DEFINITELY NOT see in the PBsmear in aplastic?
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Retics or polychromasia - it's pancytopenia that's happening.
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What's the therapy for aplastic anemia?
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bone marrow transfusion IF meet the criteria - less than 500 PMNs, <20 x 10'3 platelets, less than 1% retics.
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What are 2 ways you can get PRCA (pure red cell aplasia)?
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-Congenital
-Acquired |
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What are 2 congenital conditions of PRCA?
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-Diamond Blackfan syndrome
-Congenital Dyserythropoeitic Anemia |
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What are clinical indications of PRCA?
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-general signs of anemia
-decr. RBC cnt and HgB -Normal WBC and platelets |
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What is the therapy for PRCA?
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-Give packed RBCs
-But be careful with iron or will cause hemachromatosus. |
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What is anemia of chronic renal disease?
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A buildup of toxic wastes that can't get excreted, and create a hostile environment to current and new cells.
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How many mechanisms are in Anemia of Chronic Renal Disease?
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6
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What 6 mechanisms occur in ACRD?
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1. Hemolysis
2. Hypoproliferation 3. Hydremia 4. Hypersplenism 5. Blood loss 6. AOI |
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What is hypoproliferation?
How does hemolysis occur? |
Decreased EPO production; an unknown inhibitor in plasma.
Hemolysis - toxins affect membrane, forms schistocytes. |
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What is hydremia?
How does Hypersplenism occur? |
-Excess H2O in blood, fluid retention.
-The spleen chews up RBCs during chronic dialysis. |
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How does blood loss occur?
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-From the GI tract
-During dialysis -From so many blood draws |
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What is AOI?
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Anemia of Inflammation - also known as Anemia of chronic disease, if progressed will be Hypo/Micro.
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What is seen on the PB smear in Anemia of chronic renal disease?
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-Burr cells
-Acanthocytes -Schistocytes -nonspecific poikilocytosis -Normo/normo |
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How is Anemia of CRrenalDisease treated?
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-Recomb. human erythropoeitin
-Folate -Iron |
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what is myelopthisic anemia?
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SOMETHING'S IN THE BMARROW THAT'S NOT SUPPOSED TO BE THERE.
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What is the result of myelopth?
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Extramedullary hematopoeisis.
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What 4 things cause myelopthisic anemia?
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-Metastatic cancer
-Neoplasms in the bmarrow -Fibrosis -Tuberculosis TB infection |
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What do you see in the PB smear in myelopthisic anemia?
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YOUNG THINGS
-Immature WBCS and RBCs -nRBCs, Metamyelos, Myelos, Prograns, Micromegakaryos, giant platelets, etc. |
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How is myelopthisic anemia treated?
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By treating whatever's in the bmarrow - the underyling cause.
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What is "Anemia Associated with Endocrine Disease" generally a cause of?
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Decreased EPO
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What are 4 causes of Anem. assoc w/ endocrine disease?
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-Thyroid disease
-Hypogonadism -Pituitary dysfunction -Adrenal insufficiency |
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What is AIO?
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anemia of inflammation - a better name for Anemia of chronic disease.
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What is AIO predominantly, and what can it become?
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Normo/normo, can become hypo/micro.
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