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Questions and Answers
What are the three main categories of causes that can lead to anemia?
What are the three main categories of causes that can lead to anemia?
Which of the following is NOT a common manifestation of anemia?
Which of the following is NOT a common manifestation of anemia?
What is the main consequence of anemia?
What is the main consequence of anemia?
Which of the following is a type of hemolytic anemia?
Which of the following is a type of hemolytic anemia?
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Which of these is an example of chronic blood loss that could lead to anemia?
Which of these is an example of chronic blood loss that could lead to anemia?
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What is the typical size of red blood cells in iron deficiency anemia?
What is the typical size of red blood cells in iron deficiency anemia?
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Which of the following laboratory tests would be most helpful in diagnosing iron deficiency anemia?
Which of the following laboratory tests would be most helpful in diagnosing iron deficiency anemia?
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What cellular change is characteristic of megaloblastic anemias?
What cellular change is characteristic of megaloblastic anemias?
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Which of the following is NOT a cause of chronic disease anemia?
Which of the following is NOT a cause of chronic disease anemia?
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What is the primary function of the bone marrow aspiration procedure?
What is the primary function of the bone marrow aspiration procedure?
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Which of the following laboratory tests is used to assess B12 absorption?
Which of the following laboratory tests is used to assess B12 absorption?
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What is the primary characteristic of aplastic anemia?
What is the primary characteristic of aplastic anemia?
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Which of the following is a possible cause of iron deficiency anemia?
Which of the following is a possible cause of iron deficiency anemia?
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Which of the following is NOT a characteristic of thalassemias?
Which of the following is NOT a characteristic of thalassemias?
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What is the primary cause of bone deformities in individuals with β-thalassemia?
What is the primary cause of bone deformities in individuals with β-thalassemia?
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In β-thalassemia, the imbalance between alpha and beta chains leads to the formation of:
In β-thalassemia, the imbalance between alpha and beta chains leads to the formation of:
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What is the primary mechanism responsible for the development of splenomegaly in individuals with β-thalassemia?
What is the primary mechanism responsible for the development of splenomegaly in individuals with β-thalassemia?
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Which of the following populations is most commonly affected by β-thalassemia?
Which of the following populations is most commonly affected by β-thalassemia?
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What is the main consequence of defective alpha chain synthesis in α-thalassemia?
What is the main consequence of defective alpha chain synthesis in α-thalassemia?
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Which of the following statements is TRUE about the inheritance of thalassemias?
Which of the following statements is TRUE about the inheritance of thalassemias?
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Which of the following factors contributes to the elevated iron levels observed in individuals with β-thalassemia?
Which of the following factors contributes to the elevated iron levels observed in individuals with β-thalassemia?
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Which of the following is NOT a symptom of Iron-deficiency anemia?
Which of the following is NOT a symptom of Iron-deficiency anemia?
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Which of the following conditions can cause Vitamin B12 deficiency anemia?
Which of the following conditions can cause Vitamin B12 deficiency anemia?
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What is the primary treatment for Vitamin B12 deficiency anemia?
What is the primary treatment for Vitamin B12 deficiency anemia?
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What term describes the irregular shape of red blood cells?
What term describes the irregular shape of red blood cells?
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Which of the following is NOT a possible cause of Iron-deficiency anemia?
Which of the following is NOT a possible cause of Iron-deficiency anemia?
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Which of the following statements is TRUE about Vitamin B12 deficiency anemia?
Which of the following statements is TRUE about Vitamin B12 deficiency anemia?
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What is the primary reason why Vitamin B12 is necessary for red blood cell production?
What is the primary reason why Vitamin B12 is necessary for red blood cell production?
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What characteristic feature distinguishes Vitamin B12-deficiency anemia from Iron-deficiency anemia?
What characteristic feature distinguishes Vitamin B12-deficiency anemia from Iron-deficiency anemia?
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What is the most common cause of aplastic anemia?
What is the most common cause of aplastic anemia?
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Which of the following is NOT a symptom of aplastic anemia?
Which of the following is NOT a symptom of aplastic anemia?
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What is the primary problem with the red blood cells in aplastic anemia?
What is the primary problem with the red blood cells in aplastic anemia?
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Which of the following is a treatment option for aplastic anemia?
Which of the following is a treatment option for aplastic anemia?
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Which of the following describes the pathophysiology of Aplastic Anemia?
Which of the following describes the pathophysiology of Aplastic Anemia?
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What is the expected outcome of an individual with aplastic anemia who receives a bone marrow transplant?
What is the expected outcome of an individual with aplastic anemia who receives a bone marrow transplant?
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Hemolytic anemia is characterized by what condition?
Hemolytic anemia is characterized by what condition?
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Which of the following can result from hemolysis of red blood cells?
Which of the following can result from hemolysis of red blood cells?
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What type of inheritance pattern does Sickle Cell Disease follow?
What type of inheritance pattern does Sickle Cell Disease follow?
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What is the key difference between a sickle cell carrier and someone with sickle cell disease?
What is the key difference between a sickle cell carrier and someone with sickle cell disease?
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What does the Coomb's test detect?
What does the Coomb's test detect?
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What is the primary consequence of the abnormal HbS in sickle cell disease?
What is the primary consequence of the abnormal HbS in sickle cell disease?
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What is a potential consequence of pulmonary infarction in sickle cell disease?
What is a potential consequence of pulmonary infarction in sickle cell disease?
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What is the primary difference between a diagnosis of sickle cell disease in a newborn versus a prenatal diagnosis?
What is the primary difference between a diagnosis of sickle cell disease in a newborn versus a prenatal diagnosis?
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Why are blood transfusions used in the treatment of sickle cell disease?
Why are blood transfusions used in the treatment of sickle cell disease?
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Why are antibiotics and immunizations particularly important for individuals with sickle cell disease?
Why are antibiotics and immunizations particularly important for individuals with sickle cell disease?
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Study Notes
Anemia Overview
- Anemia is characterized by an abnormally low level of hemoglobin or circulating red blood cells (RBCs), or both.
- This leads to a decreased oxygen-carrying capacity of the blood.
Causes of Anemia
- Impaired RBC production:
- Nutritional deficiencies
- Aplastic anemia
- Increased RBC destruction:
- Hemolytic anemia
- Sickle cell
- Thalassemia
- Hemolytic anemia
- Massive or chronic blood loss:
- Trauma
- Gastrointestinal (GI) bleed
General Manifestations of Anemia
- Low hemoglobin
- Hypoxia (deficient oxygen transport)
- Compensatory mechanisms to increase oxygen delivery
Diagnostic Tests for Anemia
- Complete Blood Count (CBC):
- Hemoglobin (Hgb)
- Hematocrit (Hct)
- RBC count
- RBC size (MCV) and color (MCHC) to differentiate anemia types
- Blood Smear: Stained smear of blood viewed under a microscope
- Bone Marrow Aspiration: If the blood smear is abnormal, a bone marrow aspiration is performed to view bone marrow samples. Possible sites for this are the posterior iliac crest or sternum.
CBC- MCV and MCHC
- MCV (mean corpuscular volume):
- ↓ MCV = microcytic (small cell) anemia
- ↑ MCV = macrocytic (large cell) anemia
- Normal MCV = normocytic anemia
- MCHC (mean corpuscular hemoglobin concentration):
- ↓ MCHC/colour = hypochromic
- ↑ MCHC/colour = hyperchromic
- Normal MCHC/colour = normochromic
Additional Diagnostic Tests for Specific Anemias
- Iron level (including ferritin and total iron-binding capacity (TIBC))
- Serum B12 level
- Gastric acid levels
- Antibodies to intrinsic factor
- Schilling test (B12 excretion)
Anemias of Deficient RBC Production
- Iron Deficiency Anemia: Often caused by blood loss or dietary deficiency.
- Megaloblastic Anemias: Vitamin B12 deficiency (pernicious anemia)- Impaired DNA synthesis causes enlarged red blood cells.
- Aplastic Anemia: Bone marrow depression
- Chronic Disease Anemias: Chronic inflammation, renal failure, or chronic infections.
Iron-Deficiency Anemia
- Decreased iron for hemoglobin synthesis results in decreased oxygen-carrying capacity.
- RBCs are hypochromic and microcytic, with poikilocytosis (irregular shape) and anisocytosis (irregular size).
Iron-Deficiency Anemia: Etiology and Treatment
- Etiology: Chronic blood loss, deficient diet, increased demand
- Treatment: Improved diet, iron supplements, identify cause of blood loss.
Iron-Deficiency Anemia: Symptoms
- Fatigue, lethargy, weakness, pallor (paleness), cold intolerance, loss of concentration, irritability, and loss of appetite.
Vitamin B12 Deficiency Anemia
- Megaloblastic anemia- RBCs are large and often oval-shaped.
- Poikilocytosis (irregular shapes) and teardrop shapes are common as well.
B12-deficiency anemia: Etiology, Treatment and Prognosis
- Etiology: Vitamin B12 deficiency, pernicious anemia (from atrophic gastritis).
- Treatment: Regular Vitamin B12 injections.
- Prognosis: Good with treatment.
B12-deficiency anemia: Manifestations
- Classic anemia symptoms plus neurologic symptoms like numbness, tingling, burning in hands and feet.
Aplastic Anemia
- RBCs are normal in size and shape, but there are not enough due to failure of the red bone marrow.
- Bone marrow is fatty and cannot produce sufficient RBCs.
Aplastic Anemia: Etiology, Pathophysiology and Manifestations
- Etiology: Congenital, industrial chemicals (e.g., benzene), infections, chemotherapy drugs, idiopathic.
- Pathophysiology: Exposure leads to decreased bone marrow function, thus reducing RBC, WBC, and platelet production
- Manifestations: Insidious onset characterized by fatigue, weakness, pallor, petechiae, ecchymosis, bleeding, and increased risk of infection.
Aplastic Anemia: Diagnosis and Treatment
- Diagnosis: CBC and bone marrow biopsy, which reveals the presence or absence of bone marrow activity.
- Treatment: Correction of the underlying cause, red blood cell transfusions, medications like erythropoietin and corticosteroids, and sometimes bone marrow transplantation.
Hemolytic Anemia
- Excessive hemolysis (destruction) of abnormal or fragile RBCs by the liver, spleen, and bone marrow.
- Pathophysiology- RBC destruction results in excess byproducts (iron, bilirubin), decreased circulating RBCs, decreased oxygen-carrying capacity, and increased clumping resulting in potential embolisms/clots.
Hemolytic Anemia: Manifestations
- Mild- classic anemia symptoms
- Severe- Jaundice, hemoglobinuria, hemoglobinemia, hypotension, dyspnea, splenomegaly, back and joint pain.
Hemolytic Anemia: Diagnosis and Treatment
- Diagnostics- Additional diagnostic tests including LDH and Coomb's test. These check for antibody presence on RBC and tissue damage.
- Treatment- Determined by the cause of the hemolytic anemia.
Sickle Cell Disease
- Recessive inheritance pattern.
- Mutation in beta chains (HbS) of hemoglobin causes sickling when oxygen is low, resulting in long protein rods in deoxygenated red blood cells.
Sickle Cell Disease: Pathophysiology
- When hemoglobin is deoxygenated, beta chains link, forming long protein rods that deform the red blood cells into a sickle shape.
Sickle Cell Disease: Consequences
- Vessel occlusion- ischemia, acute pain crisis, infarctions (Chronic damage in the liver, spleen, heart, kidneys, bones)
- Pulmonary infarction, acute chest syndrome, cerebral infarction that leads to stroke.
Sickle Cell Disease: Diagnosis
- Screening programs (heel-stick samples for electrophoresis to separate HbS from HbA and HbF)
- Neonatal diagnosis: clinical findings and hemoglobin electrophoresis
- Prenatal diagnosis: amniocentesis
Sickle Cell Anemia: Treatment
- No cure, treatment aims to reduce symptoms, avoid triggers, and manage pain.
- Pain control, hydration, transfusions, antibiotics, and immunizations are treatments.
- Hydroxyurea is used to prevent complications and pain crises.
Thalassemias
- Inherited disorders of hemoglobin synthesis (absent or defective a or β chains of adult hemoglobin)
- Results in abnormal hemoglobin and premature RBC destruction.
- Develops hypochromic, microcytic anemia.
- Decrease in Hgb and therefore RBC production. RBCs are abnormal in shape and short-lived, leading to excessive hemolysis.
Thalassemias: Subtypes and Populations Affected
- Two main subtypes based on defective chain—α and β thalassemia. Populations affected are geographically defined. Asians are often affected by α-thalassemia while Mediterranean and other similar regions are affected by β-thalassemia.
Thalassemias: Pathogenesis (β-thalassemia)
- Beta chains are defective and fewer in number. Excess alpha chains lead to abnormal cell membranes, premature RBC lysis, ineffective hematopoiesis, and increased erythropoietin causing marrow expansion.
Thalassemias: Pathogenesis (α-thalassemia)
- Gene deletions result in defective alpha-chain synthesis
- Deletions cause unstable hemoglobin chains.
Thalassemias: Manifestations (β-thalassemia)
- Usual signs of anemia, bone deformities, splenomegaly, hepatomegaly, high iron levels, low Hgb causing blood and tissue oxygen issues, and increased risk of thrombotic events such as strokes.
Thalassemias: Diagnosis and Treatment (β and α -thalassemia)
- Diagnosis: Microscopic exam of RBCs showing microcytes and hypochromic cells, high iron levels, and increased erythropoietin levels.
- Treatment: Bone marrow and stem cell transplantation, splenectomy, iron chelation therapy (for high iron levels), and possible future transfusion dependence in severe cases.
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Description
This quiz explores the different types and causes of anemia, including diminished red blood cell production and increased destruction. Understand the diagnostic tests and manifestations associated with this condition to gain a comprehensive view of anemia.