Anemia Types and Characteristics

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Questions and Answers

Which of the following is a characteristic feature of microangiopathic hemolytic anemia (MAHA)?

  • Spherocytes
  • Prolonged severity
  • Presence of Heinz bodies
  • Schistocytes (correct)

What is a potential cause of MAHA?

  • Autoimmune hemolytic anemia (AIHA)
  • Neonatal jaundice
  • Disseminated intravascular coagulation (DIC) (correct)
  • Congenital Spherocytes

What is a potential cause of Heinz bodies?

  • Autoimmune hemolytic anemia (AIHA)
  • G6PD deficiency (correct)
  • Artificial heart valve
  • Thrombotic thrombocytopenic purpura (TTP)

Which of the following is a potential cause of acute hemolytic anemia?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of hemolytic anemia?

<p>Increased white blood cell count (B)</p> Signup and view all the answers

Which of the following is a potential cause of hemolytic anemia?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is associated with neonatal jaundice?

<p>All of the above (D)</p> Signup and view all the answers

What is a potential cause of prolonged severity of hemolytic anemia?

<p>All of the above (D)</p> Signup and view all the answers

What is the relationship between MAHA and TTP?

<p>TTP is a rare cause of MAHA (C)</p> Signup and view all the answers

What is the mechanism of hemolysis in MAHA?

<p>Red blood cells are ripped apart by small blood clots (C)</p> Signup and view all the answers

Which of the following is NOT a type of red blood cell that can be seen in MAHA?

<p>Spherocyte (D)</p> Signup and view all the answers

What is the most accurate description of the type of anemia observed in a patient presenting with hypochromic microcytic anemia?

<p>Anemia characterized by small, pale red blood cells (C)</p> Signup and view all the answers

Which of the following diagnostic tests is NOT typically used to assess for hypochromic microcytic anemia?

<p>Complete Blood Count (CBC) with a reticulocyte count (B)</p> Signup and view all the answers

A patient with hypochromic microcytic anemia presents with a low serum iron level and an elevated TIBC. What is the most likely explanation for these findings?

<p>Iron deficiency due to insufficient dietary intake (A)</p> Signup and view all the answers

What is a key feature of the red blood cells in hypochromic microcytic anemia, typically observed under a microscope?

<p>Presence of target cells (A)</p> Signup and view all the answers

Which of the following is NOT a common symptom of hypochromic microcytic anemia?

<p>Headache (A)</p> Signup and view all the answers

What is the most likely cause of hypochromic microcytic anemia in a patient presenting with chronic kidney disease?

<p>Iron deficiency due to impaired erythropoietin production (A)</p> Signup and view all the answers

A patient diagnosed with hypochromic microcytic anemia presents with elevated serum ferritin levels and a normal TIBC. What is the most plausible explanation for these findings?

<p>Iron overload due to genetic mutations (A)</p> Signup and view all the answers

What is a key difference between hypochromic microcytic anemia due to iron deficiency and that due to thalassemia?

<p>Thalassemia is primarily a genetic disorder (A)</p> Signup and view all the answers

In hypochromic microcytic anemia, what is the primary mechanism that leads to the reduced red blood cell size (microcytosis)?

<p>Decreased hemoglobin synthesis (B)</p> Signup and view all the answers

Which of the following is NOT a common laboratory finding observed in a patient with hypochromic microcytic anemia?

<p>Elevated reticulocyte count (B)</p> Signup and view all the answers

A patient presents with hypochromic microcytic anemia and elevated levels of HbF (fetal hemoglobin) and HbA2 (adult hemoglobin). What is the most likely diagnosis?

<p>Thalassemia minor (D)</p> Signup and view all the answers

A patient with hypochromic microcytic anemia undergoes a bone marrow aspiration. The examination reveals an increased number of sideroblasts (red blood cell precursors with iron granules). What is the most likely diagnosis?

<p>Sideroblastic anemia (A)</p> Signup and view all the answers

What is the most appropriate treatment for a patient diagnosed with hypochromic microcytic anemia due to iron deficiency?

<p>Iron supplementation (D)</p> Signup and view all the answers

A patient with hypochromic microcytic anemia is found to have a history of excessive alcohol consumption. What is the most likely cause of the anemia in this patient?

<p>Sideroblastic anemia due to alcohol-induced toxicity (C)</p> Signup and view all the answers

A patient with hypochromic microcytic anemia is diagnosed with a genetic mutation in the CAIAS2 gene. What is the most likely underlying cause of their anemia?

<p>Sideroblastic anemia due to a genetic defect (B)</p> Signup and view all the answers

In a patient with Warm AIHA, which of the following is NOT a likely laboratory finding?

<p>Increased serum iron (D)</p> Signup and view all the answers

Which of these is the MOST likely reason for spherocytes seen in Warm AIHA?

<p>Immune-mediated destruction by antibodies (A)</p> Signup and view all the answers

What is a distinguishing characteristic of Cold agglutinin disease (Cold AIHA) compared to Warm AIHA?

<p>Positive DAT with IgM antibodies (C)</p> Signup and view all the answers

In a patient with untreated Megaloblastic anemia, what is the primary cause of the macro-ovalocytes?

<p>Defective DNA synthesis in red blood cells (A)</p> Signup and view all the answers

What is the MOST likely reason for hypersegmented neutrophils seen in a patient with Megaloblastic anemia?

<p>Impaired DNA synthesis in neutrophils (B)</p> Signup and view all the answers

Which of these is a typical characteristic of Acute Leukemia that distinguishes it from Chronic Leukemia?

<p>Presence of blasts (D)</p> Signup and view all the answers

In a patient suspected of having Acute Lymphoblastic Leukemia, what are the MOST prominent characteristics of the lymphoblasts?

<p>Small, condensed nuclear chromatin (D)</p> Signup and view all the answers

What is the MOST accurate statement regarding the Peroxidase test in the differentiation of Leukemia?

<p>Positive in myeloblastic leukemia, negative in lymphoblastic leukemia (C)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to present with splenomegaly?

<p>Acute Lymphoblastic Leukemia (D)</p> Signup and view all the answers

Which of the following is a CORRECT association between the specific type of antibody and the corresponding type of AIHA?

<p>IgM antibodies - Cold AIHA (D)</p> Signup and view all the answers

Which of the following is a defining characteristic of Erythroid Maturation in both acute and chronic leukemia?

<p>Presence of blasts in the bone marrow (C)</p> Signup and view all the answers

What statement CORRECTLY describes the relationship between antibody type and DAT findings in Warm AIHA?

<p>IgG antibodies cause a positive DAT in Warm AIHA (B)</p> Signup and view all the answers

Which of these BEST describes the role of the spleen in Warm AIHA?

<p>The spleen destroys red blood cells that are coated with antibodies (A)</p> Signup and view all the answers

Which of these LABORATORY findings is MOST characteristic of a patient with severe Megaloblastic anemia?

<p>Decreased white blood cell count (WBC) (B)</p> Signup and view all the answers

Which of these is NOT a common clinical feature of Warm AIHA?

<p>Elevated liver enzymes (B)</p> Signup and view all the answers

What is the MOST likely reason for the presence of basophilic stippling in red blood cells in Megaloblastic anemia?

<p>Impaired DNA synthesis (A)</p> Signup and view all the answers

Flashcards

Hemolytic Anemia

A condition where red blood cells are destroyed faster than they can be made.

Heinz Bodies

Aggregates of denatured hemoglobin found in red blood cells during hemolytic anemia.

Microangiopathic Hemolytic Anemia

A type of hemolytic anemia caused by small blood vessel damage.

Thrombotic Thrombocytopenic Purpura (TTP)

A rare blood disorder leading to the formation of small clots in blood vessels.

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Disseminated Intravascular Coagulation (DIC)

A serious disorder in which blood clots form throughout the body's small blood vessels.

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Spherocytes

Abnormally shaped red blood cells that are spherical instead of biconcave, often seen in hemolytic anemia.

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Acute Hemolytic Anemia

Rapid destruction of red blood cells leading to anemia, often following transfusion reactions.

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Artificial Heart Valve

A medical device used to replace a damaged heart valve which can cause red blood cell destruction.

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Schistocyte

A fragmented red blood cell, often seen in conditions like hemolytic anemia and DIC.

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Congenital Hemolytic Anemia

Inherited conditions that cause the premature destruction of red blood cells.

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Warm AIHA

Autoimmune hemolytic anemia occurring at body temperature.

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Positive DAT

Direct Antiglobulin Test, indicating antibodies attached to RBCs.

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Cold AIHA

Autoimmune hemolytic anemia that occurs at lower temperatures.

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Megaloblastic Anemia

Macrocytic anemia due to Vitamin B12 or folic acid deficiency.

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Macrocytic Anemia

Anemia characterized by larger than normal red blood cells.

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Intrinsic Factor

A protein necessary for Vitamin B12 absorption in the intestine.

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Reticulocytes

Immature red blood cells often elevated in anemia.

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Hypersegmented Neutrophils

Neutrophils with more than five nuclear lobes, seen in megaloblastic anemia.

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IDA

Iron Deficiency Anemia, a common type of microcytic anemia.

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Acute Myeloid Leukemia (AML)

A type of cancer that affects the blood and bone marrow, characterized by the rapid growth of myeloid cells.

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Lymphoblastic Leukemia

Cancer of the blood and bone marrow characterized by lymphoblasts.

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Bone Marrow Hypercellularity

An increase in cell numbers in the bone marrow, often seen in hematologic disorders.

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Anisocytosis

Presence of red blood cells of unequal size, often a sign of anemia.

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Hypochromic Microcytic Anemia

Anemia characterized by low MCH and MCV, often due to iron deficiency.

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MCH

Mean corpuscular hemoglobin; measures the average amount of hemoglobin per RBC.

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MCV

Mean corpuscular volume; indicates average size of red blood cells.

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Serum Iron

Measures the amount of circulating iron in the blood.

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Ferritin

A protein that stores iron; low levels indicate depleted iron stores.

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TIBC

Total iron-binding capacity; high levels indicate iron deficiency.

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Anemia of Chronic Disease

Anemia associated with chronic infections or inflammation.

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Sideroblastic Anemia

Anemia due to impaired heme synthesis, leading to iron overload.

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Intrinsic Hemolytic Anemia

Anemia due to defects within the red blood cells.

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Sickle Cell Anemia

Genetic disorder causing misshaped red blood cells, leading to blockage and pain.

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Reticulocyte Count

A measure of immature red blood cells; reflects bone marrow activity.

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GGPD Deficiency

An inherited condition where red blood cells break down prematurely due to enzyme lack.

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Jaundice

Yellowing of skin and eyes caused by high bilirubin due to hemolysis.

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Splenomegaly

Enlargement of the spleen; often due to increased RBC destruction.

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Study Notes

Hypochromic Microcytic Anemia

  • Key features:
    • Mean corpuscular hemoglobin (MCH) is low (<32 g/dL)
    • Mean corpuscular volume (MCV) is low (<80 fL)

Iron Deficiency Anemia

  • Most common type of hypochromic microcytic anemia
  • Symptoms: Fatigue, pallor, brittle nails, pica (craving non-food items like ice)
  • Serum iron, ferritin, and transferrin receptor are affected
  • Bone marrow iron stores are decreased
  • Erythroblast iron is decreased

Anemia of Chronic Disorder

  • Serum iron, ferritin and transferrin receptor are affected
  • Bone Marrow iron stores are reduced/normal.
  • Cause: chronic infection, inflammation, rheumatoid arthritis

Sideroblastic Anemia

  • Serum iron and ferritin are elevated (iron overload)
  • Transferrin is reduced
  • % Transferrin saturation is elevated (body has too much iron)
  • TIBC is normal
  • Cause: genetic or acquired (alcoholism, pyridoxine deficiency, lead poisoning, isoniazid, chloramphenicol)

Thalassemia, Abnormal Hemoglobin

  • Often have normal or slightly elevated serum iron and ferritin
  • Low MCH, MCV
  • Haemoglobin studies (HbF/HbA2) are abnormal

Thalassemia Minor

  • Ferritin, Serum iron and transferrin are normal or elevated.
  • TIBC normal
  • Transferrin saturation slightly abnormal

Hemolytic Anemia

  • Increased reticulocytes
  • Intrinsic causes: defects in red blood cell membranes, enzymes
  • Extrinsic causes: immune mechanisms, mechanical damage, infections

Non-Hemolytic Normochromic Normocytic Anemia

  • Normal MCV (80-100 fL)
  • Non-hemoglobinopathy anemias
  • Causes: Iron deficiency, chronic disease, chronic kidney disease, aplastic anemia

Intrinsic Haemolytic Anemia

  • Clinical Features: fluctuating jaundice, splenomegaly, pigment gallstones
  • Cause: hereditary spherocytosis, hereditary elliptocytosis, G6PD deficiency

Microangiopathic Haemolytic Anemia (MAHA)

  • Fragmented red blood cells (schistocytes, helmet cells)
  • Cause: Disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), artificial heart valve

Autoimmune Haemolytic Anemia (AIHA)

  • Warm AIHA: Splenomegaly, spherocytes increase MCHC.
  • Cold AIHA: Skin manifestations, acrocyanosis

Megaloblastic Anemia

  • MCV > 100 fL
  • Insufficient nuclear DNA Synthesis (lack of vitamin B12/folate)
  • Large RBC due to continued hemoglobin production.
  • Oval morphology (macro-ovalocytes)
  • Symptoms: Fatigue, headache, palpitations, dyspnea, gray hair
  • Lab findings: increased LDH, indirect bilirubin, haptoglobin
  • Causes: Lack of intrinsic factor, destruction of gastric parietal cells, anti-gastric parietal cell auto antibodies

Blast Cells

  • Erythroid maturation: Proerythroblast, Basophilic erythroblast, polychromatophilic erythroblast, orthochromatic erythroblast, reticulocytes, erythrocyte
  • Granulocytic maturation: Myeloblast, promyelocyte, myelocyte, metamyelocyte, neutrophil, band neutrophil
  • Lymphocytic Leukemia/Lymphoma: Lymphoblasts, (small, condensed nuclear chromatin, small nucleoli, scant agranular cytoplasm)
  • Acute myeloid leukaemia (AML): Myeloblasts, (delicate nuclear chromatin, prominent nucleoli, fine azurophilic cytoplasmic granules)

Leukemia

  • Acute vs chronic: differing onset and dominance of cell types
  • Myeloid vs lymphoid: affecting different hematopoietic cell lineages
    • Acute myeloid leukemia (AML): immature myeloid blasts
    • Chronic myeloid leukemia (CML): mature myeloid cells
    • Acute lymphoblastic leukemia (ALL): immature lymphoid blasts
    • Chronic lymphocytic leukemia (CLL): mature lymphoid cells
  • Diagnostics include blood smears, bone marrow biopsies and immunologic tests

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