88 Questions
What is the purpose of the fusion sessions?
To encourage practice-based learning
Why are the recordings of fusion sessions not posted?
To encourage attendance and participation
What does RUSM aim to develop through these fusion sessions?
Critical thinking and analytical skills
What is the recommended action if attendees have questions about the content?
Contact faculty via email or office hours
How many attempts are allowed for taking the quiz?
Three attempts
What should attendees do after attending the live session?
Take the quiz again for a final attempt
Which of the following is a characteristic of anemia of diminished erythropoiesis?
Reduced production of red blood cells in the bone marrow
What is the main underlying cause of megaloblastic anemias?
Deficiency of vitamin B12 or folate
What is the primary characteristic of acute posthemorrhagic anemia?
Increased production of new red blood cells to compensate for blood loss
What does diagnosing anemia of diminished erythropoiesis involve?
CBC, PBS, and bone marrow aspirate/trephine
What are the common symptoms of hemolytic anemias?
Fatigue, pallor, jaundice, and splenomegaly
What is the main treatment for megaloblastic anemias?
Addressing nutritional deficiency through dietary changes and vitamin supplementation
What type of anemia is characterized by a gradual and ongoing loss of blood over an extended period?
Chronic blood loss anemia
What type of anemia is primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women?
Chronic blood loss anemia
Which type of hemolytic anemia is primarily caused by immune reactions or trauma to red blood cells?
Anemias with intravascular hemolysis
What are the indices used in the 'iron panel' for diagnosing microcytic hypochromic anemias based on iron panel data?
'Ferritin, total iron binding capacity (TIBC), and transferrin saturation'
What does acute blood loss lead to if the rate exceeds the body's ability to produce new red blood cells?
'Acute posthemorrhagic anemia'
What does a deficiency of vitamin B12 or folate lead to in megaloblastic anemias?
'Disruption in DNA synthesis, inefficient cell division, and delayed maturation of erythroid cells'
Which of the following anemias is characterized by increased RBC destruction and extravascular hemolysis?
Hereditary spherocytosis
Which drug class is used for the treatment of anemia associated with vitamin B12 deficiency?
Vitamin B12 preparations
Which of the following anemias is caused by a lack of intrinsic factor for vitamin B12 absorption?
Anemia due to acute blood loss
Which anemia is associated with a deficiency in the enzyme glucose-6-phosphate dehydrogenase (G6PD)?
G6PD-deficiency anemia
Which drug class is used for the treatment of anemia associated with folate deficiency?
Folic acid preparations
Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?
IgG
Which clinical condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?
Bone marrow failure
Which of the following is a feature of hereditary spherocytosis?
Splenomegaly
Which enzyme deficiency leads to increased susceptibility to drug-induced hemolysis in G6PD-deficiency anemia?
$eta$-glucose-6-phosphate dehydrogenase
What is the mechanism of anemia induced by P. falciparum?
Extravascular hemolysis and diminished erythropoiesis
What is the characteristic feature of RBCs in severe cases of P. falciparum-induced anemia?
Nucleated RBCs and small size
Which type of anemia is characterized by small RBCs without central pallor and increased MCHC?
Hereditary spherocytosis
What is the primary effect of P. vivax on RBCs in contrast to P. falciparum?
Affects only young RBCs leading to less severe anemia
What are the consequences of the release of IFN-γ and TNF-⍺ in P. falciparum-induced anemia?
Inhibition of erythropoietin response and spleen enlargement
What is the distinguishing feature in the peripheral blood smear (PBS) of patients with hereditary spherocytosis?
Small RBCs without central pallor (spherocytes)
Which enzyme deficiency leads to increased susceptibility to drug-induced hemolysis in G6PD-deficiency anemia?
Glutathione reductase deficiency
What type of anemia is primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women?
Iron-deficiency anemia
What does diagnosing anemia of diminished erythropoiesis involve?
Assessing the number of reticulocytes in the blood
Which drug class is used for the treatment of anemia associated with vitamin B12 deficiency?
Vitamin B12 Preparations
What is the primary characteristic of acute posthemorrhagic anemia?
Increased reticulocyte count
What are the indices used in the 'iron panel' for diagnosing microcytic hypochromic anemias based on iron panel data?
Ferritin and total iron binding capacity (TIBC)
Which clinical condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?
$Aplastic anemia
What is the main underlying cause of megaloblastic anemias?
$Deficiency of vitamin B12 or folic acid
What does acute blood loss lead to if the rate exceeds the body's ability to produce new red blood cells?
$Acute posthemorrhagic anemia
Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?
$IgG antibodies
What type of hemolytic anemia is primarily caused by immune reactions or trauma to red blood cells?
$Autoimmune hemolytic anemia
What type of anemia is characterized by a gradual and ongoing loss of blood over an extended period?
$Posthemorrhagic anemia
Which drug is the preferred treatment for chronic iron overload in the absence of anemia?
Deferasirox
What is the mechanism of action of Deferoxamine?
Binds to Fe3+ (ferric) ions to form a complex, which is then excreted in urine
What is the most common adverse effect of Deferasirox?
Acute renal failure, hepatic failure and gastrointestinal hemorrhage
What is the primary clinical use of folic acid?
Supplementation to prevent neural tube defects
Which route of administration is NOT recommended for synthetic forms of vitamin B12 due to poor absorption?
Oral
What is the adverse effect associated with oral iron preparations in most cases?
Constipation, dark stools, nausea
Which medication can reduce iron absorption when taken with iron supplements?
Medications which reduce gastric acid
What is the route of administration for Deferasirox?
Oral
Which condition may lead to paroxysmal nocturnal hemoglobinuria (PNH)?
Excess iron deposited in the heart, liver, pancreas
What is the primary clinical use of Deferoxamine?
Treatment of acute iron toxicity
What is the adverse effect associated with Deferoxamine?
Brown discoloration of skin by IM injection
Which medication is used for the treatment of acute iron overload and chronic iron overload?
Deferoxamine
Which of the following is a characteristic feature of paroxysmal nocturnal hemoglobinuria (PNH)?
Deficiency in CD55 and CD59 on RBCs
What is the gold standard test for diagnosing paroxysmal nocturnal hemoglobinuria (PNH)?
Acidified serum (Ham) test
What percentage of GPI-AP-deficient (PNH) cells is considered indicative of paroxysmal nocturnal hemoglobinuria?
50%
What is a common clinical manifestation of paroxysmal nocturnal hemoglobinuria (PNH) during sleep?
Respiratory acidosis
Which test is carried out on both RBCs and granulocytes for diagnosing paroxysmal nocturnal hemoglobinuria (PNH)?
Flow cytometry
What is the characteristic feature of red blood cells (RBCs) from a patient with paroxysmal nocturnal hemoglobinuria (PNH) as seen in flow cytometry?
Deficiency in both CD55 and CD59
What are the serum tests commonly used to detect intravascular hemolysis in paroxysmal nocturnal hemoglobinuria (PNH)?
Unconjugated hyperbilirubinemia, low haptoglobin, and elevated LDH
What are the complications associated with paroxysmal nocturnal hemoglobinuria (PNH)?
Iron overload and venous thrombosis
What kind of anemia is characterized by fragmented RBCs (schistocytes) in the peripheral blood smear?
Paroxysmal nocturnal hemoglobinuria (PNH)
What is the primary cause of episodic (paroxysmal) hemolysis in paroxysmal nocturnal hemoglobinuria (PNH)?
Complement activation due to respiratory alkalosis during sleep
Which type of antibody is involved in the warm antibody type of immune hemolytic anemia?
IgG antibodies
What is the classification based on the mechanism of intravascular hemolysis characterized by turbulent blood flow and pressure gradient across damaged valves?
Macroangiopathic hemolysis
What is the mechanism of action of Epoetin alfa and Darbepoetin alfa?
Stimulation of erythropoiesis by interacting with erythropoietin receptors
Which iron preparation can be administered both intramuscularly (IM) and intravenously (IV)?
Iron Dextran
What is Deferasirox used for in managing persons who present with acute iron overload?
Chelating excess iron
Which drug may be used to manage persons who have vitamin B12 deficiency?
Cyanocobalamin
What condition may occur if someone has folic acid deficiency?
Megaloblastic anemia
Which type of anemia may best be treated with ferrous sulphate compounds in persons with anemia due to chemotherapy or due to zidovudine used for management of HIV?
Microcytic anemia
What are the characteristics of megaloblastic anemias?
Increased red blood cell size and decreased hemoglobin content
Which enzyme is deficient in glucose-6-phosphate dehydrogenase (G6PD)-deficiency anemia?
Glucose-6-phosphate dehydrogenase
What type of antibody is involved in the warm antibody type of immune hemolytic anemia?
IgG
What is the main underlying cause of megaloblastic anemias?
Deficiency of intrinsic factor for vitamin B12 absorption
What is the classification for RBCs with MCV > 100 fL?
Macrocytic anemia
Which deficiency leads to atrophic glossitis and subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency
What is the cause for vitamin B12 deficiency?
All of the above
Which clinical findings are unique to pernicious anemia (PA)?
All of the above
What are the labs findings in folate deficiency?
Reduced folate level in folate assay
What is the underlying condition for vitamin B12 deficiency in adults over 40 years?
Chronic autoimmune atrophic gastritis with impaired production of intrinsic factor (IF)
Which type of anemia is characterized by pancytopenia due to apoptosis of hematopoietic cells in the BM?
Megaloblastic anemia
What is the biochemical function of cobalamin and folate?
Coenzymes in thymidine synthesis
'5-methyl-THF' donates its methyl group to homocysteine to form what molecule?
Methionine
Study Notes
- Fusion sessions are online learning activities followed by a live session for translating content into practice.
- To participate in a fusion session, complete learning content on Canvas before attending the live session.
- Recordings of fusion sessions will not be posted; prepare accordingly to fully participate.
- Anemia of diminished erythropoiesis:
- Characterized by reduced production of red blood cells in bone marrow.
- May manifest in different forms, such as iron-deficiency anemia, anemia of inflammation, megaloblastic anemia, etc.
- Diagnosis involves comprehensive medical evaluation, including CBC, PBS, and bone marrow aspirate/trephine.
- Treatment strategy depends on identifying underlying cause.
- Hemolytic anemias:
- Accelerated destruction of red blood cells leads to decreased number of circulating red blood cells, hemoglobin, and hematocrit.
- Can be categorized into anemias with extravascular hemolysis (genetic mutations) and anemias with intravascular hemolysis (immune reactions or trauma).
- Common symptoms include fatigue, pallor, jaundice, and splenomegaly.
- Megaloblastic anemias:
- Characterized by abnormally large red blood cells and erythroid precursors in bone marrow.
- Main underlying cause is deficiency in vitamin B12 (cobalamin) or folate (folic acid), leading to disruption in DNA synthesis.
- Diagnosis involves blood tests revealing presence of macrocytes, megaloblasts, and specific deficiencies.
- Treatment typically involves addressing nutritional deficiency through dietary changes and vitamin supplementation.
- Acute blood loss:
- Occurs due to trauma, surgery, gastrointestinal bleeding, pathologic delivery, etc.
- Body attempts to compensate by increasing production of new red blood cells.
- If rate of blood loss exceeds body's ability to produce new red blood cells, acute posthemorrhagic anemia develops.
- Treatment may involve immediate measures to stop bleeding and blood transfusions.
- Chronic blood loss anemia:
- Characterized by gradual and ongoing loss of blood, primarily associated with chronic gastrointestinal bleeding or chronic menstrual bleeding in women.
- Diagnosis requires iron studies.
- Management involves identifying and treating source of blood loss and supplementing with iron to replenish iron stores.
- Learning objectives:
- Compare and contrast aplastic anemia and pure red cell aplasia.
- Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of various anemias, including myelophthisic anemia and anemia of chronic kidney disease.
- Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of iron-deficiency anemia and anemia due to inflammation.
- Explain etiology, pathogenesis, laboratory diagnosis, and clinical features of various hemolytic anemias, including Hereditary spherocytosis, G6PD-deficiency anemia, immune hemolytic anemias, anemia in malaria, Paroxysmal nocturnal hemoglobinuria, and hemolytic anemia resulting from trauma to RBCs.
- Compare and contrast B12- and folate-deficiency megaloblastic anemias.
- Antianemia drug classes:
- Iron preparations: Ferrous sulfate, ferrous gluconate, ferrous fumarate, etc.
- Iron antidotes: Desferoxamine mesylate, deferasirox, etc.
- Vitamin B12 preparations: Hydroxocobalamin, cyanocobalamin, etc.
- Folic acid preparations: Leucovorin, folic acid, etc.
- Erythropoiesis-stimulating agents: Epoetin alfa, darbepoetin alfa, etc.
- Molecular mechanism of action, pharmacological effects, important pharmacokinetic properties, adverse effects, contraindications, and therapeutic uses for each antianemia drug class.
This workshop is part of the Fusion Session for January 2024. It focuses on learning about anemia and antianemia drugs, with a practical live session to follow. Attendance and preparation are crucial as recordings of the session will not be available.
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