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Questions and Answers
What are some symptoms of acute anemia and their corresponding conditions?
What are some symptoms of acute anemia and their corresponding conditions?
10-15% --> hypotension and decreased organ perfusion; > 30% --> postural hypotension + bradycardia; > 40% --> hypovolemic shock
What are the symptoms associated with chronic anemia when Hb is less than 70-80 g/L?
What are the symptoms associated with chronic anemia when Hb is less than 70-80 g/L?
Fatigue, loss of stamina, dyspnea, tachycardia, weakness, pallor, palpitations, tinnitus
Which conditions are associated with microcytic anemia (MCV < 80fl)?
Which conditions are associated with microcytic anemia (MCV < 80fl)?
Hyperchrome is a type of anemia where RBCs are paler than normal.
Hyperchrome is a type of anemia where RBCs are paler than normal.
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Match the following causes with the corresponding types of anemia:
Match the following causes with the corresponding types of anemia:
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What percentage of iron in the body is in the functional form?
What percentage of iron in the body is in the functional form?
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What is the primary mechanism of iron excretion from the body?
What is the primary mechanism of iron excretion from the body?
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Which protein regulates iron absorption in the gut?
Which protein regulates iron absorption in the gut?
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What is the primary function of transferrin in iron metabolism?
What is the primary function of transferrin in iron metabolism?
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What is the storage form of iron in the liver?
What is the storage form of iron in the liver?
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Which of the following is an acute phase reactant and non-specific tumor marker?
Which of the following is an acute phase reactant and non-specific tumor marker?
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What is the estimated amount of iron lost during pregnancy?
What is the estimated amount of iron lost during pregnancy?
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Which of the following conditions is associated with increased demand for iron?
Which of the following conditions is associated with increased demand for iron?
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What is the primary cause of iron deficiency anemia in the pre-latent stage?
What is the primary cause of iron deficiency anemia in the pre-latent stage?
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What is the laboratory finding that indicates impaired erythropoiesis?
What is the laboratory finding that indicates impaired erythropoiesis?
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What is the characteristic of red blood cells in iron deficiency anemia?
What is the characteristic of red blood cells in iron deficiency anemia?
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What is the significance of increased transferrin saturation in iron studies?
What is the significance of increased transferrin saturation in iron studies?
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What is the triad associated with an increased risk of esophageal SCC?
What is the triad associated with an increased risk of esophageal SCC?
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What is the laboratory finding that indicates depletion of iron stores?
What is the laboratory finding that indicates depletion of iron stores?
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Study Notes
Clinical Manifestation of Anemia
- Symptoms and severity of anemia depend on the absolute value of Hb, speed of onset, age, and overall performance of the patient
- Acute anemia is often due to acute blood loss
- 10-15% blood loss leads to hypotension and decreased organ perfusion
- >30% blood loss leads to postural hypotension and bradycardia
- >40% blood loss leads to hypovolemic shock (confusion, dyspnea, diaphoresis, hypotension, tachycardia)
- Chronic anemia has different symptoms based on Hb levels
- Hb > 70-80 g/L: no signs or symptoms due to intrinsic compensatory mechanisms
- Hb < 70-80 g/L: anemic syndrome (fatigue, loss of stamina, dyspnea, tachycardia, weakness, pallor, palpitations, tinnitus)
Morphological Classification of Anemia
Based on MCV
- Microcytic anemia (MCV < 80fl)
- Iron deficiency
- Anemia of chronic disease
- Globin deficiency (Thalassemia)
- Sideroblastic anemia
- Macrocytic anemia (MCV > 100 fl)
- Megaloblastic: B12 / B9 deficiency
- Non-megaloblastic: chronic liver disease, alcoholism, aplastic anemia
- Normocytic anemia (MCV 80-100 fl)
- Hemolytic
- Corpuscular (intrinsic)
- Membrane defects: hereditary spherocytosis
- Enzymopathy: pyruvate kinase, Glc-6-P DH
- Hemoglobinopathy: thalassemia, sickle cell disease, methemglobinemia, HbC, HbD, HbE
- Extracorpuscular (extrinsic)
- Mechanical/physical cause: heart valve, hemoglobinuria, microangiopathic hemolytic anemia
- Metabolic cause: liver disease, alcoholism, hypophosphatemia, malnutrition, Cu overload, Wilson’s disease
- Chemical substances: oxidative agents, snake venom
- Infections: malaria, septicemia (clostridium perfringens), leptospira, borelia
- Corpuscular (intrinsic)
- Non-hemolytic
- Primary impairment of blood marrow: aplastic, MDS (some), PNH, myelofibrosis
- Secondary impairment of blood marrow: infiltration, infection, endocrinological and systemic diseases, acute kidney disease
- Acute hemorrhage
- Hemolytic
Based on MCHC
- Hyperchrome
- Normochrome
- Hypochrome (RBCs are paler than normal): iron deficiency, anemia of chronic disease, sideroblastic anemia, lead poisoning
Based on Reticulocyte Count
- Lowered number
- Normal number
- Increased number
Iron Deficiency Anemia (IDA)
- Form of hypochromic microcytic anemia
Iron Metabolism
- Functional iron: 75% of total iron, mainly in hemoglobin (70%) and myoglobin (4%)
- Storage iron: 25% of total iron, mainly in liver as ferritin and hemosiderin
- Dietary intake: 10-20mg, with 1-2mg absorption in gut, and loss of iron via epithelial desquamation
- Pregnancy: 500-1000mg loss of iron
Iron Cycle
- Hepcidin: regulates iron absorption in duodenum and upper jejunum
- Hepcidin is regulated by HFE protein, which is low in iron deficiency
- Acidic conditions in stomach release iron from food protein
- Ferrireductase converts Fe3+ to Fe2+, which then enters enterocyte through DMT1
- Vitamin C increases iron absorption, while calcium decreases it
- Iron-containing heme enters via HCP1 and reaches plasma via ferroportin
- Transferrin transports iron in plasma, converting Fe2+ to Fe3+ with ferroxidase (ceruloplasmin)
- Ferritin stores iron in liver, mainly as Fe3+, with an outer protein shell and apoferritin
- Hemosiderin is an insoluble protein-iron complex formed from ferritin in macrophages
Etiology of Iron Deficiency Anemia
- Increased demand: growth, pregnancy, breastfeeding, EPO therapy
- Increased loss: chronic bleeding, GIT ulcers, hookworm infestation, malignancy, diverticulitis, respiratory tract, UGT, NSAIDs, hemodialysis
- Decreased intake/absorption: malnutrition, post-gastrectomy, Crohn's disease, celiac disease, SBD, achlorhydria/hypochlorhydria, H.pylori associated gastritis
Stages of Iron Deficiency Anemia
- Pre-latent: negative iron balance, mobilization from reticuloendothelial storage sites
- Latent: depletion of iron stores, gradual increase in TIBC
- Manifestation: impaired erythropoiesis, decrease in Hb and hematocrit, hypochromia and microcytosis
Laboratory Findings
- CBC: Hb < 120 g/L, low hematocrit, thrombocytosis (50% of patients)
- Red blood cell indices: RDW > 15%, MCV < 80fl, MCH < 25pg, reticulocyte count normal or decreased
- Peripheral blood smear: anisocytosis, hypochromasia
- Iron studies: ferritin < 20ug/l, transferrin increased with saturation < 15%, TIBC increased, serum iron decreased (< 50 μg/dL)
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Description
Learn about the morphological classification of anemia and its clinical manifestations, including symptoms and severity factors. This quiz covers acute and chronic anemia, including hypotension, hypovolemic shock, and other related topics.
