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Hematology (Packet #1 Macrocytosis, Microcytosis, and Normocytosis)
I did not get to finish this packet. Only got up to macrocytic
Terms in this set (67)
What is macrocytosis clinically?
What is megaloblastic anemia?
anemia characterized by many large immature and dysfunctional red blood cells (megaloblasts) in the bone marrow, can be caused by macrocytic anemias
What are the 2 most common reasons for macrocytosis?
B12 and Folate deficiency
B12 and Folate deficiency are the most common reasons for macrocytosis, but what are some other important causes that we will see in the field?
In normal metabolism what is B12 used for?
nuclear maturation and DNA synthesis
leads to slow cell division
Vitamin B12 is found in meats, cheese, eggs and milk. So who do we see alot of B12 deficiency in?
vegetarians and vegans
How does the body absorb vitamin B12?
parietal cells in the stomach produce intrinsic factor, which binds to B12 transporting it to terminal ileum where it can be absorbed and stored in the liver for years
What are some causes of vitamin B12 deficiency?
Malabsorption Syndrome (crohn's, sprue)
Bacterial overgrowth or tapeworm
Increased need as in pregnancy and neoplasms
Medications-Proton Pump Inhibitors, Metformin
What type of B12 deficiency is an autoimmune disorder that is due to a problem with intrinsic factor or parietal cells?
What clinical signs will you see in people with a vitamin B12 deficiency?
same as all anemias plus:
glossitis-red, beefy tongue
loss of memory(may not come back)
Paresthesias and numbness in extremities(1st sign)
decreased vibratory sense
weakness and ataxia
What is the first sign of vitamin b12 deficiency?
paresthesias and numbness in extremities
What will your lab findings be with vitamin B12 deficiency?
MCV >110 remember MACROCYTIC-Howell Jolly bodies
WBC=hypersegmented > 5 lobes
Platelets=Large decreased in #
Serum B12=decreased <200pg/dl
Anti-Intrinsic factor antibody=Positive
Anti-parietal cell antibody=Positive
What is the Shillings test?
Radioactive B12 is given. When urine is tested if the radioactive B12 is detected, then intrinsic factor is present. If no B12 is found then consider missing intrinsic factor or malabsorption
When adding labeled B12 to the body, what would B12 in urine indicate during a Shillings test?
would indicate problem with absorption or intrinsic factor
After recieveing a positive B12 in urine during a shilling's test, how can you differentiate between an absorption problem and an intrinsic factor problem?
add radiolabeled B12 with intrinisc factor
if B12 found in urine then its an absorption problem
-If no intrinsic factor or B12 in urine then it is an intrinsic factor problem because IF did not tranport B12 to the ileum
What are the treatments for vitamin B12 deficiency?
-treat underlying cause
-parenteral B12(injection)-check for increased reticulocytes in 7 days
*Neuro symptoms may not resolve
What are some sources of folic acid?
eggs, milk, yeast, and liver
green, leafy vegetables
-synthesized by many microorganisms
Where does absorption of folic acid take place?
How much folic acid do humans need a day from their diet?
How long will it take to become folate deficiency by decreased intake in your diet?
3-4 months of decreased intake in diet
also seen in alcoholics
What types of increased need patients could have afolic acid deficiency?
pregnancy-breast feeding too
What type of poor absorption conditions can cause a folic acid deficiency?
What type of drug is a folate antagonist and may cause a folate deficiency?
-she said to highlight this one
Clinically Folic acid deficiencies will present like B12 deficiencies but also have these symptoms?
**cheilosis-fissures on the corners of the mouth
**glossitis-inflammation of tongue
What are your clinical lab findings for folic acid deficiency?
Platelets Large and decreased in #
Serum folate=low <4ng/ml
Elevated homocysteine but NOT elevated methylmalonic acid
What is the treatment for folic acid deficiency?
folate 1-5 mg/day PO for 1-4 months
monitor reticulocyte rise in 7 days
What is extremely important to rule out before giving someone folic acid?
-due to the fact that folate can reverse some hematological abnormalities of B12 def while the patients neuro symptoms get worse
Why is there an elevated MCV in hemolytic anemia?
because there are increased reticulocytes which are large cells
What are some causes of anemia with liver disease?
anemia of chronic disease
Iron deficiency 2nd to GI blood loss
Vitamin B12/Folate def
Hypersplenism with pooling
Marrow suppression by alcohol
What are 3 results of congestion during liver disease?
This is a group of bone marrow disorders that are characterized by the insufficient production of one or more types of blood cells due to dysfunction of the bone marrow?
What are some suggestive tests for myelodysplastic syndrome?
dyplsatic changes of precursors
increased % of blasts
clonal cytogenic anomalies
(she skipped right over this in lecture and just mentioned the next slide and then went on a tangent so i dont know if this important)
This is the confirmatory test for anemia with Myelodysplastic syndrome?
Bone marrow aspiration and biopsy required for definitive diagnosis
What are 3 things that can generally cause microcytosis?
reduced iron availability
reduced hem synthesis
reduced globin production
What can cause reduced iron availability?
severe iron def
anemia of chronic disease
What is anemia of chronic disease?
Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin.
What can cause reduced heme synthesis?
congenital/acquired sideroblastic anemia
What is heme again?
iron-containing nonprotein portion of the hemoglobin molecule
What can cause reduced globin production?
What is globin?
a colorless protein obtained by removing heme from hemoglobin
What is the MCV for microcytic anemia?
presence of small red blood cells
Hemoglobin content with in the RBC is ________ in reguards to microcytic anemia.
Decreased hemoglobin content in RBC will also have a parallel reduction in these two CBC values?
What is the most common cause of microcytic anemia?
alpha/beta thalassemia minor
anemia of chronic disease (less often)
What are some causes of iron deficiency?
1)inadequate iron intake(diet)
3)pathological blood loss(GI tract)
4)increased requirement in women and children-prego,puberty,lactation
What types of malabsorption conditions are associated with causes of iron deficiency?
Gastrectomy/short bowel syndrome
Pancreatic Insufficiency-Cystic Fibrosis
What is the most common reason for iron deficiency?
chronic blood loss
Where does iron absorption happen?
duodenum and upper jejunum
What transports iron, and what is it stred as?
transported by transferrin
stored as ferritin and hemosiderin
The "transport protein" that moves iron to the bone marrow
a storage form of iron found primarily in the intestinal mucosa, spleen, bone marrow, and liver
This is an iron-containing pigment derived from hemoglobin from disintegration of red blood cells. It is one form in which iron is stored until it is needed for making hemoglobin.
Early on there are no symptoms of iron deficiency, what are some clinical manifestations when they do start?
spooning/curling of nails (koilonychia)
Pica-eats stuff like laptops displaying quizlet webpage
What is plummer-vinson syndrome?
Esophageal webs with iron deficiency anemia
What is Geophagia?
What is pagophagia?
eats ice cubes
What is Kookiphagia?
What will show iron stores are low during diagnosis of iron deficiency?
low serum ferritin and low serum iron
What will the lab values look like for iron deficiency?
Total Serum Iron <30
Percent Saturated <10
What is the gold standard test to test for iron deficiency?
bone marrow aspirate of iron stores using prussian blue stain
Why is total iron binding capacity high with iron deficiency?
well you see there is lack of iron so there are plenty of available spaces to carry iron, if iron were present
What is the treatment for iron deficiency?
300 mg elemental iron per day PO
-best absorbed between meals and better tolerated with food
-vitamin C helps absorption
-caffiene and xanthine decreases absorption
-causes constapation, GI upset, nausea
When will we see a rise in reticulocyte count and when will iron stores be replaced?
2-3 months to replace stores
When should non-pregnant women and girls 12-18 be screened for iron def?
These women should start taking low dose oral iron as primary prevention of iron deficiency?
pregnant women during first prenatal visit
These are a group of heterogenous disorders in which there is a defect in synthesis of one or more of globin chains in the hemoglobin?
alpha or beta thalassemias
Who is prone to have thalassemia?
mediterranean(beta more common), asians, africans
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