Anemia Overview and Morphologies

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Questions and Answers

Which symptom is most likely indicative of severe iron deficiency or pernicious anemia?

Smooth tongue (correct)

Cardiac murmur

Pallor under the eyelids

Petechiae

What is the significance of high RDW in microcytic anemia?

It is a sign of aplastic anemia.

It indicates thalassemia minor.

It points towards iron deficiency anemia. (correct)

It suggests hereditary spherocytosis.

Which of the following conditions is NOT associated with normocytic anemia?

Thalassemia (correct)

Hereditary spherocytosis

Anemia of chronic disease

Hemolytic anemia

Which physical examination finding can indicate liver disease, leukemia, or myelofibrosis?

Hepatosplenomegaly Signup and view all the answers

What is a common laboratory finding in cases of severe anemia visible on a smear?

Rouleaux formation Signup and view all the answers

Which option best describes the primary reason for the condition of hypoxia in anemia?

Deficiency in number of healthy red blood cells Signup and view all the answers

What morphological change is commonly observed in most types of anemia?

Hypochromia Signup and view all the answers

What do critical levels of hemoglobin below 60 g/L indicate?

Requires immediate intervention due to potential complications Signup and view all the answers

Which of the following factors is NOT considered when discussing anemia?

Travel history Signup and view all the answers

In the context of bone marrow response to anemia, what change occurs in the erythroid to myeloid ratio when anemia is present?

Decreases to about 1:1 Signup and view all the answers

Which symptom is most commonly associated with hemolytic episodes?

Dark urine Signup and view all the answers

What impact can chronic blood loss have on identifying the cause of anemia?

The cause can be harder to determine due to gradual symptoms. Signup and view all the answers

Which condition can lead to sudden drops in hemoglobin levels?

Toxic exposure from drugs or occupational hazards Signup and view all the answers

What form of iron is absorbed better in the body?

Ferrous iron (Fe 2+) Signup and view all the answers

Which of the following is true regarding vitamin C in relation to iron?

It converts ferric iron to ferrous iron. Signup and view all the answers

What is the primary role of transferrin in the body?

To transport iron in the bloodstream. Signup and view all the answers

When might a blood transfusion be necessary for a patient with iron deficiency anemia (IDA)?

Hgb level is less than 80 g/L with significant symptoms. Signup and view all the answers

Which of the following statements regarding iron recycling in the body is correct?

Iron is recycled to maintain sufficient iron levels. Signup and view all the answers

Which factor is identified as an inhibitor of iron absorption?

Tannins from red wine Signup and view all the answers

What is the primary consequence of GI bleeds in relation to iron?

Increased iron loss Signup and view all the answers

What is the first-line treatment for iron deficiency anemia?

Oral or infused iron Signup and view all the answers

What patient group is identified to potentially require iron supplements due to higher anemia risks?

Breastfeeding infants Signup and view all the answers

Which condition is associated with malabsorption leading to iron deficiency?

Celiac disease Signup and view all the answers

Which group is most at risk of decreased dietary iron intake due to specific physiological conditions?

Infants who breastfeed Signup and view all the answers

What is a characteristic feature of stage 2 iron deficiency anemia (IDA)?

Decline in serum iron and marrow iron Signup and view all the answers

How does total iron binding capacity (TIBC) relate to iron deficiency?

It increases due to free binding sites Signup and view all the answers

Which type of anemia occurs when there are sufficient iron stores, but the body cannot utilize the iron effectively?

Sideroblastic anemia Signup and view all the answers

What occurs to RBCs in the severe stage of iron deficiency anemia?

RBC production is nearly absent Signup and view all the answers

Which of the following is a common consequence of chronic inflammation on iron levels?

Utilization of stored iron is impaired Signup and view all the answers

Study Notes

Anemia Overview

Anemia is a condition where there is a deficiency of healthy red blood cells (RBCs) or hemoglobin, leading to insufficient oxygen delivery to tissues causing hypoxia.
Decreased production of RBCs can occur due to iron, vitamin B12, or folate deficiency, as well as hemopoietic cell defects like chronic inflammation, aplastic anemia, dysplastic or neoplastic anemias, and proliferative anemias.
Increased destruction of RBCs can occur due to acute or chronic blood loss, congenital or acquired trauma, and hemolytic anemias.

Anemia Morphologies

The morphology of RBCs changes based on the type of anemia.
Common findings in anemia include hypochromia and microcytosis.
Elliptocytes and target cells may be observed in severe anemia.
Polychromasia can be seen depending on the state of deficiency.

Bone Marrow in Anemia

Bone marrow iron stores are decreased or depleted in anemia.
Erythropoietin (EPO) levels increase due to increasing hypoxia.
The normal myeloid: erythroid (M:E) ratio of 2:1 to 5:1 shifts towards 1:1 in anemia.

Critical Hemoglobin Levels

Hemoglobin levels below 80 g/L are considered "alert" and require prompt intervention.
Hemoglobin levels below 60 g/L are considered "critical" and require immediate intervention due to potential complications from hypoxia.

Considerations When Discussing Anemia

Age of onset: helps distinguish between inherited and acquired anemia.
Duration of illness: differentiates between previous anemia or a sudden onset.
Prior treatment for anemia: establishes if it's a repeat occurrence or if the patient stopped therapy.
Suddenness of anemia: can point towards increased blood loss, destruction of RBCs, or underlying disease.
Chronic blood loss: often harder to determine the cause as patients may not feel the immediate effects of a slow decline in hemoglobin.
Hemolytic episodes: characterized by weakness, icterus in plasma or serum, and dark urine; can be life-threatening.
Toxic exposure: drugs, hobbies, and occupational exposures can cause sudden drops in hemoglobin levels.
Dietary history: alcohol use, unusual diet, dietary changes, and prolonged milk ingestion in infants and toddlers are important factors to consider.
Family history: provides insight into potential genetic predispositions for anemia.
Underlying disease: kidney disease, chronic liver disease, and hypothyroidism can contribute to anemia.

Physical Examination Findings

Pale and tired: pallor is often noticeable under the eyelids and inside the lips.
Smooth tongue: can indicate pernicious anemia or severe iron deficiency anemia.
Petechiae: small, pinpoint-sized red spots on the skin, can indicate thrombocytopenia, often observed in aplastic anemia.
Heart: may show cardiac dilation, tachycardia, and heart murmurs.
Abdomen: hepatosplenomegaly can be present in cases of liver disease, leukemia, or myelofibrosis.

Chemical Testing

Complete blood count (CBC) reveals important information about RBCs.
Red blood cell distribution width (RDW) is a good indicator of anisocytosis (variation in RBC size) and is helpful for differentiating anemia types.

Anemia Classification

Anemias can be classified according to RBC size (microcytic, normocytic, macrocytic) and RDW (normal or high).
Microcytic anemia is often associated with iron deficiency, thalassemia minor, chronic disease, and some hemoglobinopathies.
Normocytic anemia can be caused by chronic disease, hereditary spherocytosis, and some hemoglobinopathies.
Macrocytic anemia is frequently linked to vitamin B12 deficiency, folate deficiency, alcohol abuse, and thyroid disorders.

Microcytic Anemia

Microcytic anemia is characterized by small, pale RBCs on a blood smear.

Iron Deficiency Anemia (IDA)

Vitamin C promotes iron absorption.
Daily iron needs: males and infants (1mg/day), females (0.2-2.0mg/day), children (0.5mg/day).
Heme iron (Fe^2+) is more readily absorbed than non-heme iron (Fe^3+).
Transferrin transports iron in the blood.
Ferritin stores iron.
Breastfed infants are more prone to iron deficiency than formula-fed infants.
Platelet count is commonly increased in IDA.
Diagnosing IDA involves assessing both iron stores and iron levels in the blood.

Iron Deficiency Anemia (IDA) Treatment

First-line treatment: oral or intravenous iron supplementation (ferrous iron is preferred).
Transfusions are required in cases of severe symptoms or critical hemoglobin levels (below 60 g/L).
Synthetic erythropoietin (EPO) can be used to stimulate bone marrow production.
Monitor for increased polychromasia (immature RBCs) and reticulocytes (precursors to mature RBCs) to assess erythropoiesis.

Iron in the Body

Iron recycling is crucial, with adults recycling 95% and children recycling 70%.
Heme molecules break down into biliverdin and bilirubin, releasing iron which is recycled.
Iron is absorbed in the duodenum, transported to the bone marrow, liver, and spleen, and stored as ferritin.
Vitamin C facilitates the absorption of ferrous iron (Fe^2+).
Tannins (found in red wine, nuts, and seeds) inhibit iron absorption.

Mechanisms of IDA

Increased iron loss: GI bleeds, menstrual bleeding.
Malabsorption: duodenum surgeries, celiac disease.
Decreased dietary iron: common in infants, children, adolescents, pregnant and breastfeeding women, the elderly, individuals with eating disorders, and those with chronic inflammation.
Defective utilization of iron: sideroblastic anemia, sometimes anemia of chronic inflammation.

Testing for IDA

Normal: Normal iron stores and serum levels.
Stage 1: Iron stores are depleted to maintain serum levels; still within normal range.
Stage 2: Both serum levels and storage decline, leading to a decrease in RBC count.
Stage 3: Almost complete depletion of iron stores, resulting in severe iron deficiency.

Total Iron Binding Capacity (TIBC)

TIBC reflects the ability of transferrin to bind iron.
A higher TIBC suggests that there are more binding sites available due to low iron levels.

Histograms in IDA

Histograms show the distribution of RBC sizes.
A histogram in IDA would exhibit a shift towards smaller RBCs, reflecting the microcytic nature of the anemia.

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Description

Explore the condition of anemia, including its types, causes, and the impact on red blood cell morphology. Understand the role of bone marrow and erythropoietin in the development of anemia. This quiz covers essential concepts related to anemia and its pathological features.