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Hematology Lecture 14: LMU

Terms in this set (36)

What are the Micro-Hypo Anemias?
-Chronic Blood Loss
-Chronic Disease/ Inflammation Anemia
-Sideroblastic Anemia
-Iron Deficiency Anemia (IDA)
-Thalassemia
Chronic Blood Loss
Problem: Chronic blood loss leads to chronic iron loss
Key Point: IDA in men; chronic GI bleed
Chronic Disease / Inflammation Anemia
Problem: Immune response affects iron metabolism
Key Point: Mild anemia in patients with a prolonged immune response
Sideroblastic Anemia
Problem: Defective heme synthesis
Key Point: Presence of ringed sideroblasts and siderocytes
Iron Deficiency Anemia (IDA)
Problem: Insufficient amounts to iron to complete the heme ring
Key Point: Most common type of anemia, especially in women
Thalassemia
Problem: Decreased products of normal globin chains for the HgB molecule
Key Point: Alpha and Beta forms exist
70% of the body's total iron is in ______.
HgB
What is ferrireductase?
An enzyme on the brush border of the enterocyte reduces Fe3+ to Fe2+.
Iron circulates in RBCs in the ______ form of Hgb.
ferrous (Fe2+)
What is the best measure of stored iron in the body?
Ferritin
What micro-hypo anemias have a high FEP level?
-IDA
-Lead Poisoning
-Sideroblastic Anemia
What is transferrin?
Iron Transport protein
What is the transferrin saturation equation?
Serum iron / TIBC x 100
What is the TIBC?
-Total Iron Binding Capacity
*Measures the capacity of the serum transferrin to bind iron
*Correlates with transferrin levels
Hemochromatosis
-Excess accumulation of iron
-The body first reaction is to store excess iron in the form of hemosiderin.
-When the storage system is overwhelmed, liver, heart, and/or pancreas damage occurs.
-High Fe, High Ferritin, Low TIBC
Iron Overload: Hemochromatosis
Congenital Hemochromatosis
-Genetic mutations affecting iron metabolism.
-Treatment: Therapeutic phlebotomy
--HgB levels are monitored and mild anemia is sought and maintained.

Acquired Hemochromatosis
-Hemosiderosis: Transfusion related hemochromatosis
-Seen in patients who need repeated transfusions for the treatment of anemia such as thalassemia.
-Treatment: Desferroxamine:
--Treatment of choice
--Binds iron and makes it readily excreted in the urine
Causes of Anemia:
-Impaired RBC production
-RBC life span is shortened
-Frank loss of RBCs
What is the most common of all anemias?
IDA
IDA is typically seen in:
-Babies
*Most common anemia in babies 6-24 months of age
*Poor dietary intake, "milk-fed babies"
-Rapidly growing adolescents
-Women: Pregnancy, poor diet
-Men: Chronic G.I. bleed
IDA:
-Low iron
-High TIBC
-High FEP
-High Plt
-Prussian Blue Bone Marrow: Negative
-Pica: craving for unusual foods such as ice,dirt, or clay
Groups More Prone to IDA:
Groups More Prone to IDA:
-Menstruating women
-Adolescent girls
-Pregnancy / nursing mothers
-Growing children
-Men: GI problems (bleeding ulcers)
-Hookworm infections
-Soldiers and long-distance runners
--"Marching Anemia": RBCs are hemolyzed by food-pounding trauma and iron is lost as hemoglobin in the urine
IDA Hematology Results:
-Low MCV, MCH, MCHC
-"Rules of 3" does not apply:
---RBC count is slightly higher than expected for the HgB level.
---For Example: A IDA patient may have a RBC of 4.0 M/uL and a HgB of 10 g/dL.
-High RDW
-Retic is usually normal at diagnosis, then increases when the patient is placed on iron therapy.
-The platelets are usually small and increased in number.
-Free Erythrocyte Protoporphyrin level (FEP) is increased.
IDA Diff Results:
-Microcytic-hypochromic RBCs
-Moderate anisocytosis
-Poikilocytosis (mixture of RBC morphology)
RBC become microcytic first, than hypochromic.
IDA Bone Marrow Results:
-Mild erythroid hyperplasia with evidence of dyserythropoiesis (abnormal, ineffective erythropoiesis).
-NRBC often have scanty cytoplasm and appear smaller than normal ("scrawny").
Pressian Blue iron stain show no iron stores in the marrow!
Chronic Blood Loss
Same Lab results as IDA
-Black Tarry Stools
*Males: GI Loss
*Females: Menstrual
What is the number one cause of IDA in males?
Chronic Blood Loss
Clinical Picture of Chronic Blood Loss:
-Mircocytosis occurs first followed by hypochromia
-Low MCV, MCH, MCHC
-All other symptoms of IDA apply here
Chronic Disease / Inflammation
-Low Fe
-Normal to Low TIBC
-High FEP
-Mild Anemia
-No improvement with iron therapy
-Lactoferrin
Anemia of Chronic Disease / Chronic Inflammation
-Most common anemia among hospitalized patients.
-HCT rarely falls below 30%. (Mild Anemia)
-Begins as a normocytic-normochromic anemia; progresses to hypochromic first, then microcytosis.
-Associated with systemic diseases, including chronic inflammatory conditions such as:
**Arthritis
**Chronic infections such as tuberculosis
**Malignancies
Lactoferrin:
-Lactoferrin in an iron-binding protein in the granules of neutrophils.
-Lactoferrin prevents phagocytized bacteria from using intracellular iron.
-During infection and inflammation, neutrophil lactoferrin is released into the plasma.
-Good News:
*Bacteria can't use the iron
-Bad News:
*RBCs don't have lactoferrin receptors, and hence, can't use the iron either.
Lab Results in Chronic Disease Anemia
-Low MCV, Low MCH, Low MCHC
-Mild anemia (mildly low H/H)
-Low iron
-Normal to low TIBC
-High ferritin
-High FEP
-Normal RDW
-Normal to low retic count
-NO IMPROVEMENT WITH IRON THERAPY
Bone Marrow Results in Chronic Disease Anemia
-Bone Marrow shows erythroid hypoplasia.
-Prussian blue stain shows abundant storage iron in macrophages, but NOT in the RBC precursors.
-Anemia does respond to therapeutic EPO
Sideroblastic Anemia
-High Fe
-High Ferritin
-Low TIBC
-Basophilic Stippling (RNA)
-Pappenheimer Bodies
-Iron Overload
Alpha Thalassemia
-Bart Hgb (4 gamma)
-HgB H (4 beta)
**When incubated with Brilliant Cresyl Blue with HgB H acquire finely disbursed granular inclusions resembling a golf ball (denaturated beta globin chains)
Beta Thalassemia
-Severe anemia
-Monogoloid face
-VERY HIGH NRBC
-High HgB F
-Codocytes
Summary Sheets to Study:
-Micro Hypo Anemia Sheets
-HgB Sheets
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