Hematology - Anemias
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- What is aplastic anemia and its si/sx?
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1) Failure of hematopoiesis --> dec. RBC, neutrophils, platelets
2) Fatigue, pallor, infection, petechiae - What are some causes of aplastic anemia?
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1) Usually idiopathic
2) Drugs (chloramphenicol), toxins (benzene), infections (parvovirus B19, HBV, HCV) radiation, paroxysmal nocturnal hemoglobinuria - How do you Tx aplastic anemia?
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1) bone marrow transplant
2) anti-thymocyte globulin
3) growth factors (GM-CSF) - What is megaloblastic anemia?
- Impaired DNA synthesis with normal RNA & protein synthesis
- What is pathognomonic of megaloblastic anemia on blood smear?
- Hypersegmented neutrophils
- What are some causes of folic acid deficiency?
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1) diet
2) inc. requirements (pregnancy, hemolytic anemia, tumors)
3) drugs (MTX, dilantin)
4) malabsorption - What are some causes of B12 deficiency?
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1) Pernicious anemia
2) gastrectomy, ileal resection
3) Diphylloborthrium latum
4) malabsorption - How do you determine the cause of B12 deficiency?
- Schilling Test: give labelled B12 orally and collect 24-hr urine; if low give again with Intrinsic Factor; if still low give again with antibiotics; if still low then probably absorption problem in small intestine
- Iron is transported to marrow via _____, used by developing RBCs to make _____ and is stored in _____.
- transferrin; hemoglobin; macrophages
- What is a measure of total body iron stores?
- Ferritin
- In iron deficiency anemia, what do you see on peripheral blood smear?
- Hypochromic microcytosis
- Iron deficiency anemia in the elderly is due to _____ _____ until proven otherwise!
- colon cancer
- What do the labs show in anemia of chronic disease?
- Low iron, LOW TIBC, HIGH ferritin
- What is the problem in sideroblastic anemia?
- Problem is accessing stored iron in mitochrondria in the marrow --> high iron. Look for ringed sideroblasts on iron stain of bone marrow!
- What is lead poisoning anemia? Si/sx?
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Microcytic hypochromic, inhibition of heme synthesis.
L= lead lines in gums, epiphyses of long bones
E= encephalopathy, erythrocyte basophilic stippling
A= abdominal pain, anemia
D= wrist/foot drop - How do you treat lead poisoning?
- chelate with EDTA, dimercaprol
- Intravascular hemolysis is characterized by:
- dec. haptoglobin, positive hemosiderin in urine
- Extravascular hemolysis is characterized by:
- spherocytes on blood smear
- Causes of extrinsic hemolysis:
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1) incompatible blood transfusion
2) DIC, TTP, HUS
3) malaria, Clostridium
4) penicillin, a-methyl dopa, quinidine - Causes of intrinsic hemolysis:
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1) hereditary spherocytosis, elliptocytosis, from defective cytoskeletal proteins
2) Paroxysmal Nocturnal Hemoglobinuria: loss of GPI CD55 & CD59 so inc. sensitivity to complement lysis
3) G6PD deficiency - What is Beta Thalassemia?
- Dec. or absent production of hemoglobin beta chains. Blacks and Mediterraneans.
- What do you see in B-thalassemia Major?
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1) homozygous defect
2) high HbF! high HbA2
3) hypercellular marrow
4) anisocytosis, poikilocytosis
5) high reticulocyte count
6) target cells - What do you see in B-thalassemia Minor?
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1) target cells
2) microcytic/hypochromic RBC
3) normal HbF! high HbA2 - What is Alpha Thalassemia?
- Dec. or absent production of hemoglobin alpha chains. Africans, Asians, Mediterraneans.
- What is Barts Hb?
- Beta chain tetramers, when have ZERO alpha chains produced. Fetal hydrops.
- When do you see Howell-Jolly bodies?
- asplenia
- When do you see Heinz bodies?
- G6PD deficiency
- When do you see spur cells/acanthocytes?
- Abetalipoproteinemia, cirrhosis (liver diseases)
- When do you see burr cells/echinocytes?
- Uremia (kidney disease)
- When do you see schistocytes/helmet cells?
- DIC, TTP, HUS