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58 Cards in this Set
- Front
- Back
how do you correct a retic count for degree of anemia
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pt Hct/45 x retic count
polychromasia present? divide by 2 |
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ferritin
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circulation form of iron storage- represents amount of iron in bone marrow
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transferrin
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carrying protein for iron, made in the liver
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transferrin vs TIBC
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think of these as the same- transferrin is the carrier protein so the more present, the more iron can be bound (TIBC)
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chronic inflammation and iron stores
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iron stored in macrophages in bone marrow: inflamation= trying to keep iron from bacteria, but keep it away from RBCs as well
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least common microcytic anemias
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sideroblastic anemias.
1. Alcohol 2. lead poisioning |
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rate limiting enzyme in porphyrin synthesis
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ALA synthase
heme is the feedback mechanism |
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dx for microcytic anemia
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iron def
anemia of chronic disease thalassemia sideroblatic anemia |
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ddx for macrocytic anemias
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folate def
vitamin B12 def (neurologic findings) |
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ddx for normocytic anemia with retic index below 3%
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blood loss (<1 week)
early iron def early anemia of chronic dz aplastic anemia renal disease (low epo) |
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normocytic anemia, corrected retic >3% (intrinsic RBC defects)
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Mem defects (H. spherocytosis, H. elliptocytosis, paroxysmal noc hemoglobinuria)
Abnormal Hb (sickle cell dz) Deficient enzymes (G6PD, pyruvate kinase) |
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target cell ddx
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Hem C disease
Asplenia Liver disease (alcoholics) Thalasemia "HALT" |
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ddx for decreased serum ferritin
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iron def (ferritin is iron storage protein)
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ddx for increased serum ferritin
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anemia of chronic disease
Iron overload disease |
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ddx for decreases serum iron
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Iron Def
Anemia of chronic disease serum iron represents transferrin level- coorelated with TIBC |
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common causes of iron def in neonates
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blood loss (meckel diverticulum)
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common causes of iron def in adult males < 50
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Peptic ulcer disease (GI BLOOD LOSS)
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common causes of iron def in women < 50
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menorrhagia
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common causes of iron def in adults > 50
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bloodloss think polyps/colorectal cancer
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clinical and lab findings in iron def anemia
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glossitis, spoon-nails, decreased MCV, decreased iron sat
increased TIBC |
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stages of iron def anemia
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absent iron stores-> decreased serum ferritin-> decreased serum iron, increased TIBC,-> normocytic normochromic anemia-> microcytic hypochromic anemia
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most common anemia in hospitalized patients
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anemia of chronic disease
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where is the iron in anemia of chronic disease?
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in the macrophages - hepcidin is released in response to inflamation and it enters macrophages and prevents release of iron to transferrin
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Lab findings in anemia of chronic disease
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low MCV, low serum iron, low TIBC
increased ferritin |
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epidemiology of thalassemia
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autosomal recessive
alpha- SEasian, blacks beta- greeks, italinians, blacks |
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Hb electropheresis in alpha thal
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normal- decreased alpha (chain that matches with beta(A), gamma (F), delta(A2)
therefore, every type is decreased proportionally |
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black v asian a thal trait
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-a/-a black trait
--/aa asian trait |
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labs in a thal
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low MCV, Hb and Hct
increase RBC count normal serum ferritin and Hb electropheresis |
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Hemoglogin H
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four beta chains- combo of three a gene deletions in alpha thal
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hemoglobin bart
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four gamma chains- combo of 4 a gene deletions in alpha thal- not compatable with life= hydrops fetalis
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labs in beta thal minor
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decreased MCV, Hb, Hct
Hb electrophoresis: decreased HbA, increased HbA2, increased HbF |
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anemia in b thal major vs minor
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minor- mild microcytic anemia
major- severe hemolytic anemia |
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common causes of sideroblastic anemia
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alcoholism (chronic)- leadin cause
Pyridoxine (B6) deficiency (ALA syn cofactor) Lead poisoning (protein denaturization) |
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see a 'ringed sideroblast' - most likely cause?
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Alcoholism; followed by B6 def and Lead poisioning
(sideroblastic anemias) |
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ALA synthase
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enzyme (rate-limiting) in heme synthesis
B6= cofactor- no B6= sideroblastic anemia low B6 (pyridoxine) leading cause - isoniazid therapy for TB |
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see 'course basophilic stippling' think?
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lead poisoning
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abdominal colic w diarrhea in adults
encephalopathy, cerebral edema, growth retardation in children |
lead poisoning
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see increased density in epiphysis on xray, with anemia
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think lead poisoning- Pb deposition
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Fanconi syndrome with anemia
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Pb poisoning- prox RTA-loss of bicarb in urine, aminoacduria, phosphaturia, glucosuria
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Lab findings in sideroblastic anemias
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increased serum iron, increased ferritin
decreased MCV decreased TIBC ringed sideroblasts in bone marrow |
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patients at risk for decreased intake of B12
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vegan diet & infants of vegan dieters
elderly (malnutrition) |
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where is B12 absorbed?
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terminal ileum
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Explain intrinsic factor's role
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secreted by parietal cells (body-fundus) complexes with B12 in duodenum after pancreatic enzymes cleave R-binder. Reabsorbed as a complex with B12 in the termainal ileum
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possible ways to interfere with the intestinal reabsorbtion of B12
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Chron's or Celiac dz of terminal ileum
bacterial overgrowth fish tapeworm (diphyllobothrium latum) pancreatitis (no pancreatic enzyme to remove R-binder) |
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R-binder
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syn. in salivary glands; binds free B12, protects/carries to duodenum, cleaved from B12 by pancreatic enz
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what food is folate in?
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green veggies, animal protein
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folate reabsorption location & blockers
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jejunum-
blocked by alcohol, oral contraceptives |
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most common cause of folate def
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decreased intake:
-malnutrition (infants/elderly) -chronic alcoholics |
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what builds up in the abscence of B12 and/or folate? effects?
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homocysteine
effects- high levels associated with thrombosis/MI |
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ddx for high MCV anemia?
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B12 or Folate def - problem in DNA synthesis (thymidylate synthase) pathway-> cells cannot divide
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pernicious anemia
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autoimmune vs parietal cells: no IF= no B12 absorbtion.
-lack gastric acid -macrocytic anemia - increased gastric adenocarcinoma |
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clinical findings in B12 def
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pernicious anemia (macrocytic)
smooth, sore tongue (glossitis) neurologic symptoms |
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Lab findings in B12 def (other than low serum B12)
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Macrocytic anemia
increased homocysteine (no dna syn) and methylmalonic acid (no odd chain FA metab) SMEAR: pancytopenia, HYPERSEGMENTED NEUTROPHILLS |
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hypersegmented neutrophil DDX
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folate def
B12 def |
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Shilling test basics
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test for etiology of B12 def: replace possible defects in absorbtion until cause is found (IF, antibiotics[bac overgrowth], pancreatic enz)
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differnce in clinical findings: B12 vs folate
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B12 def is only one to result in neurologic defects due to impaired odd chain FA metabolism
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folate & fetal health
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maternal folate def prior to conception -> increased risk of open neural tube defects
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Lab findings in folate def
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hypersegmented neutrophills
macrocytic anemia pancytopenia decreased **RBC folate** best indicator of folate stores ** |