Diseases of Red Cells and Anemias
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Questions and Answers

What is the definition of anemia?

  • A decrease in the oxygen-carrying capacity of white blood cells
  • An increase in the total circulating red cell mass above normal limits
  • A change in the color of red cells from hypochromic to normochromic
  • A reduction of the total circulating red cell mass below normal limits (correct)
  • How is anemia usually diagnosed?

  • By a reduction in the hematocrit and hemoglobin concentration below normal range (correct)
  • By changes in plasma volume due to dehydration
  • By measuring the red cell mass directly
  • Based on the total white blood cell count
  • What does the degree of hemoglobinization reflected in the color of red cells indicate?

  • The shape of red cells
  • The level of oxygen saturation in the blood
  • The color of red blood cells: normochromic or hypochromic (correct)
  • The volume of plasma in the blood
  • How are anemias classified based on underlying mechanisms?

    <p>Based on alterations in red cell morphology</p> Signup and view all the answers

    What does microcytic anemia refer to?

    <p>Anemia with abnormally small red blood cells</p> Signup and view all the answers

    Which characteristic provides clues to the etiology of anemia?

    <p>Red cell size, reflected in normocytic, microcytic, or macrocytic types</p> Signup and view all the answers

    Why is measurement of red cell mass challenging in practice?

    <p>Because the volume of plasma in blood fluctuates frequently</p> Signup and view all the answers

    What is the average volume of a red cell expressed in femtoliters?

    <p>Femtoliters</p> Signup and view all the answers

    Which type of anemias are often caused by disorders of hemoglobin synthesis?

    <p>Microcytic hypochromic anemias</p> Signup and view all the answers

    What does Mean cell hemoglobin represent?

    <p>Average content of hemoglobin per red cell</p> Signup and view all the answers

    How is red cell shape assessed?

    <p>By visual inspection of peripheral smears</p> Signup and view all the answers

    Which index expresses the average concentration of hemoglobin in a given volume of packed red cells?

    <p>Mean cell hemoglobin concentration</p> Signup and view all the answers

    What abnormalities often impair the maturation of erythroid precursors in the bone marrow leading to macrocytic anemias?

    <p>Abnormalities in erythropoiesis</p> Signup and view all the answers

    Which anemias have diverse etiologies and may feature characteristic abnormalities of red cell shape?

    <p>Normochromic, normocytic anemias</p> Signup and view all the answers

    What is the unit used to express the average mass of hemoglobin per red cell?

    <p>Picograms</p> Signup and view all the answers

    What is the primary consequence of anemia on the blood?

    <p>Decreased red cell mass</p> Signup and view all the answers

    How is anemia typically diagnosed?

    <p>By observing a reduction in hematocrit and hemoglobin levels</p> Signup and view all the answers

    What characteristic provides clues to the etiology of anemia?

    <p>Red cell size</p> Signup and view all the answers

    In anemia classification, what does normochromic red cell color indicate?

    <p>Normocytic anemia</p> Signup and view all the answers

    What does the shape of red cells indicate in the context of anemia classification?

    <p>Possible causes</p> Signup and view all the answers

    What leads to diverse etiologies in some types of anemias?

    <p>Characteristic abnormalities in red cell shape</p> Signup and view all the answers

    How does anemia reduce the oxygen-carrying capacity of the blood?

    <p>By decreasing hematocrit levels</p> Signup and view all the answers

    Which index indicates the average content of hemoglobin per red cell, expressed in picograms?

    <p>Mean cell hemoglobin</p> Signup and view all the answers

    What is the most likely cause of microcytic hypochromic anemias?

    <p>Disorders of hemoglobin synthesis</p> Signup and view all the answers

    How is red cell shape primarily assessed?

    <p>Visual inspection of peripheral smears</p> Signup and view all the answers

    Which type of anemia tends to show characteristic abnormalitites of red cell shape providing clues to its cause?

    <p>Normochromic, normocytic anemias</p> Signup and view all the answers

    Which index expresses the average volume of a red cell in femtoliters?

    <p>Mean cell volume</p> Signup and view all the answers

    What is the primary abnormality that leads to macrocytic anemias?

    <p>Bone marrow abnormalities</p> Signup and view all the answers

    What is the average concentration of hemoglobin in a given volume of packed red cells expressed in?

    <p>(g/dL) grams per deciliter</p> Signup and view all the answers

    How are the red cell indices like mean cell volume, mean cell hemoglobin, and mean cell hemoglobin concentration typically determined?

    <p>Specialized instrumentation in clinical laboratories</p> Signup and view all the answers

    Which mechanism of anemia classification includes deficiencies affecting DNA synthesis?

    <p>Decreased Red Cell Production</p> Signup and view all the answers

    What is a common cause of anemia related to defects leading to stem cell depletion?

    <p>Primary hematopoietic neoplasms</p> Signup and view all the answers

    Which type of anemia would be associated with immune-mediated injury of progenitors?

    <p>Immune-mediated injury of progenitors</p> Signup and view all the answers

    What type of anemia is typically caused by a deficiency of phosphatidylinositol-linked glycoproteins?

    <p>Infections of red cells</p> Signup and view all the answers

    In which mechanism of anemia classification might cardiac traumatic hemolysis be observed?

    <p>Increased Red Cell Destruction</p> Signup and view all the answers

    Which category of anemia classification involves deficiencies affecting hemoglobin synthesis?

    <p>Decreased Red Cell Production</p> Signup and view all the answers

    What might be the result of infections of red cell progenitors according to the text?

    <p>Space-occupying marrow lesions</p> Signup and view all the answers

    Which condition is NOT associated with hemolytic anemia?

    <p>Defective cardiac valves</p> Signup and view all the answers

    Which activity is least likely to contribute to hemolytic anemia?

    <p>Snake venom</p> Signup and view all the answers

    Which phenomena are commonly linked to anemia of chronic inflammation?

    <p>Metastatic neoplasms, granulomatous disease</p> Signup and view all the answers

    Which disorder is NOT typically associated with abnormal red cell shape?

    <p>Renal failure</p> Signup and view all the answers

    Which condition does NOT result in anemia related to iron deficiency?

    <p>Babesiosis</p> Signup and view all the answers

    Which disorder is NOT directly associated with defects in hemoglobin synthesis?

    <p>Clostridial sepsis, snake venom, lead poisoning</p> Signup and view all the answers

    What manifestations are related to severe anemia according to the text?

    <p>Pallor and easy fatigability</p> Signup and view all the answers

    What organ can undergo fatty changes due to hypoxia caused by anemia?

    <p>Liver</p> Signup and view all the answers

    Which symptom may indicate myocardial hypoxia in a patient with severe anemia?

    <p>Angina pectoris</p> Signup and view all the answers

    What renal condition can develop due to renal hypoperfusion from acute blood loss?

    <p>Oliguria</p> Signup and view all the answers

    Which symptom may indicate central nervous system hypoxia in a patient with severe anemia?

    <p>Dimness of vision</p> Signup and view all the answers

    What are the effects of acute blood loss mainly attributed to?

    <p>Loss of intravascular volume</p> Signup and view all the answers

    In what scenario can acute blood loss lead to cardiovascular collapse, shock, and death?

    <p>When there's massive blood loss</p> Signup and view all the answers

    Which organ may suffer hypoxia-related damage in the presence of severe anemia?

    <p>Brain</p> Signup and view all the answers

    What is the striking increase seen in the reticulocyte count after 7 days of significant bleeding?

    <p>Reticulocytosis</p> Signup and view all the answers

    What results from an increase in platelet production during early recovery from blood loss?

    <p>Thrombocytosis</p> Signup and view all the answers

    What happens when the rate of chronic blood loss exceeds the regenerative capacity of the marrow?

    <p>Anemia is induced</p> Signup and view all the answers

    Which feature is common among hemolytic anemias?

    <p>Reticulocytosis</p> Signup and view all the answers

    What process takes place within macrophages in the spleen, liver, and bone marrow related to red cell destruction?

    <p>Phagocytosis</p> Signup and view all the answers

    What condition may appear when iron reserves are depleted due to chronic blood loss?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What occurs initially with red cells during blood loss before marrow production increases?

    <p>Normocytosis and normochromasia</p> Signup and view all the answers

    What is the primary feature of reticulocytes that allows for their identification in the clinical laboratory?

    <p>'Blue-red' polychromatophilic cytoplasm</p> Signup and view all the answers

    'Compensatory release of adrenergic hormones mobilizes granulocytes' in response to what condition?

    <p>'Decreased blood pressure'</p> Signup and view all the answers

    What is the primary mechanism that triggers increased erythropoietin secretion leading to the proliferation of committed erythroid progenitors?

    <p>Tissue oxygenation reduction</p> Signup and view all the answers

    Which factor can lead to iron deficiency and hamper the restoration of normal red cell counts?

    <p>External bleeding</p> Signup and view all the answers

    What is the approximate range for the hematocrit (%) in men?

    <p>39-49</p> Signup and view all the answers

    What is the typical range for the reticulocyte count (%) in women?

    <p>0.5-1.5</p> Signup and view all the answers

    Which lab measurement reflects the average content of hemoglobin per red cell in picograms?

    <p>Mean cell hemoglobin concentration</p> Signup and view all the answers

    What phenomenon leads to hemodilution and subsequently reduces hematocrit levels?

    <p>Fluid shift from interstitial fluid to intravascular compartment</p> Signup and view all the answers

    What happens to iron if red cells extravasate into tissues?

    <p>Recaptured</p> Signup and view all the answers

    What is the primary consequence of intravascular hemolysis on red cells?

    <p>Anemia</p> Signup and view all the answers

    How is free hemoglobin released from lysed red cells cleared?

    <p>Bound by haptoglobin</p> Signup and view all the answers

    What color does methemoglobin, formed from oxidized free hemoglobin, appear as?

    <p>Brown</p> Signup and view all the answers

    Which renal condition can develop due to iron released from hemoglobin accumulation within tubular cells?

    <p>Renal hemosiderosis</p> Signup and view all the answers

    What happens to heme groups derived from hemoglobin-haptoglobin complexes within mononuclear phagocytes?

    <p>Metabolized to bilirubin</p> Signup and view all the answers

    What contributes to the red-brown color imparted to urine in cases of intravascular hemolysis?

    <p>Filtered hemoglobin and methemoglobin</p> Signup and view all the answers

    Intravascular hemolysis can lead to the depletion of which substance that results in oxidized hemoglobin?

    <p>Haptoglobin</p> Signup and view all the answers

    'Cardiac traumatic hemolysis' mentioned in the text is an example of mechanical injury caused by what?

    <p>'Raindrop' cells</p> Signup and view all the answers

    What is the event referred to as when premature destruction of red cells occurs within phagocytes?

    <p>Extravascular hemolysis</p> Signup and view all the answers

    Which of the following is a principal clinical feature of extravascular hemolysis?

    <p>Jaundice</p> Signup and view all the answers

    What happens when red cell shape alterations make red cells less deformable in extravascular hemolysis?

    <p>Red cell sequestration</p> Signup and view all the answers

    What is the function of plasma haptoglobin in the context of extravascular hemolysis?

    <p>Binds free hemoglobin</p> Signup and view all the answers

    What is the primary consequence for individuals with extravascular hemolysis who undergo splenectomy?

    <p>Prolonged red cell life span</p> Signup and view all the answers

    In extravascular hemolysis, what leads to red cells being less able to navigate the splenic sinusoids?

    <p>Reduced deformability</p> Signup and view all the answers

    What results from much of the premature destruction of red cells occurring in the spleen during extravascular hemolysis?

    <p>Decreased plasma haptoglobin</p> Signup and view all the answers

    What feature is typically manifested by varying degrees in individuals with extravascular hemolysis?

    <p>Splenomegaly</p> Signup and view all the answers

    What is the primary role of phagocytes in extravascular hemolysis?

    <p>Sequester and remove red cells</p> Signup and view all the answers

    What triggers the production of erythropoietin in hemolytic anemia?

    <p>Decreased tissue oxygen tension</p> Signup and view all the answers

    What is the primary consequence of compensatory increases in erythropoiesis in hemolytic anemia?

    <p>Prominent reticulocytosis</p> Signup and view all the answers

    What can chronic hemolysis lead to in terms of hematopoiesis?

    <p>Increased extramedullary hematopoiesis</p> Signup and view all the answers

    What contributes to the formation of pigment gallstones (cholelithiasis) in individuals with chronic hemolytic anemia?

    <p>Elevated biliary excretion of bilirubin</p> Signup and view all the answers

    What is the term for iron accumulation due to phagocytosis of red cells seen particularly in the spleen, liver, and bone marrow in hemolytic anemia?

    <p>Hemosiderosis</p> Signup and view all the answers

    What can Hereditary Spherocytosis cause in red cells that makes them less deformable and more prone to destruction?

    <p>Spheroid shape</p> Signup and view all the answers

    In Hereditary Spherocytosis, what renders red cells vulnerable to splenic sequestration and destruction?

    <p>Spheroid shape</p> Signup and view all the answers

    What is the major cause of Hereditary Spherocytosis?

    <p>Defects in red cell membrane skeleton</p> Signup and view all the answers

    What is the chief protein component responsible for the deformability and durability of a normal red cell?

    <p>Spectrin</p> Signup and view all the answers

    What causes a more severe form of the disease in the remaining patients with hemolytic anemia?

    <p>Compound heterozygosity</p> Signup and view all the answers

    Which interaction binds spectrin to the transmembrane ion transporter, band 3?

    <p>Band 3 and ankyrin</p> Signup and view all the answers

    In what region is the prevalence of HS highest?

    <p>Northern Europe</p> Signup and view all the answers

    How many polypeptide chains does spectrin consist of in a normal red cell?

    <p>Two</p> Signup and view all the answers

    What is responsible for connecting the two-dimensional spectrin-actin skeleton to the cell membrane?

    <p>Ankyrin</p> Signup and view all the answers

    What is the main consequence of the pathogenic mutations associated with hereditary spherocytosis?

    <p>Decreased red cell life span</p> Signup and view all the answers

    Which protein interaction is primarily altered by mutations causing hereditary spherocytosis?

    <p>Ankyrin and band 3</p> Signup and view all the answers

    What structural changes characterize red cells affected by hereditary spherocytosis?

    <p>Transition to a spherical shape</p> Signup and view all the answers

    Which protein is NOT commonly affected by pathogenic mutations in hereditary spherocytosis?

    <p>Actin</p> Signup and view all the answers

    What is the average life span of red cells affected by hereditary spherocytosis?

    <p>10 to 20 days</p> Signup and view all the answers

    Which protein interaction is crucial for tethering spectrin to another transmembrane protein in red cells?

    <p>Protein 4.1 and glycophorin A</p> Signup and view all the answers

    What cellular feature makes spherocytic red cells less deformable than normal cells?

    <p>Loss of membrane fragments</p> Signup and view all the answers

    Which factor contributes significantly to the entrapment of spherocytic red cells in splenic cords?

    <p>Loss of membrane fragments</p> Signup and view all the answers

    What is the primary consequence of intravascular hemolysis?

    <p>Depletion of haptoglobin</p> Signup and view all the answers

    What is the term for iron accumulation due to phagocytosis of red cells seen particularly in the spleen, liver, and bone marrow?

    <p>Hemosiderosis</p> Signup and view all the answers

    What leads to the appearance of increased numbers of erythroid precursors in the bone marrow in response to anemia and lowered tissue oxygen tension?

    <p>Production of erythropoietin</p> Signup and view all the answers

    What condition can extramedullary hematopoiesis appear in if the anemia is severe?

    <p>Liver</p> Signup and view all the answers

    Which inherited disorder is caused by intrinsic defects in the red cell membrane skeleton?

    <p>Hereditary spherocytosis</p> Signup and view all the answers

    Which organ can suffer hypoxia-related damage in the presence of severe anemia?

    <p>Brain</p> Signup and view all the answers

    What is the primary cause of pigment gallstones in patients with chronic hemolysis?

    <p>Increased biliary excretion of bilirubin</p> Signup and view all the answers

    What makes red cells vulnerable to splenic sequestration and destruction in hereditary spherocytosis?

    <p>Abnormal red cell shape</p> Signup and view all the answers

    What is the percentage of cases where hereditary spherocytosis displays an autosomal dominant inheritance pattern?

    <p>75%</p> Signup and view all the answers

    What is the term used to describe the state in hereditary spherocytosis where patients inherit two different defects?

    <p>Compound heterozygosity</p> Signup and view all the answers

    Which protein component forms intertwined flexible heterodimers in the red cell membrane skeleton?

    <p>Spectrin</p> Signup and view all the answers

    In hereditary spherocytosis, what do the 'head' regions of spectrin dimers self-associate to form?

    <p>Tetramers</p> Signup and view all the answers

    Which interaction binds spectrin to the transmembrane ion transporter band 3 in the red cell membrane?

    <p>Ankyrin and Band 4.2</p> Signup and view all the answers

    What is the term used for the state when patients with hereditary spherocytosis inherit two different defects?

    <p>Compound heterozygosity</p> Signup and view all the answers

    Which component connects the two-dimensional spectrin-actin skeleton to the red cell membrane in hereditary spherocytosis?

    <p>Ankyrin</p> Signup and view all the answers

    What is the primary protein component responsible for the deformability and durability of a normal red cell?

    <p>Spectrin</p> Signup and view all the answers

    What is the primary consequence of the alterations caused by the diverse mutations in hereditary spherocytosis?

    <p>Decreased red cell deformability</p> Signup and view all the answers

    Which proteins are most commonly affected by pathogenic mutations in hereditary spherocytosis, leading to insufficiency of membrane skeletal components?

    <p>Ankyrin, band 3, spectrin, band 4.2</p> Signup and view all the answers

    In hereditary spherocytosis, what is the typical effect of mutations on the lifespan of affected red cells compared to normal red cells?

    <p>Decreased lifespan from 120 days to 10-20 days</p> Signup and view all the answers

    What happens to red cells with weakened interactions between major membrane skeletal proteins in hereditary spherocytosis?

    <p>They lose membrane fragments as they age</p> Signup and view all the answers

    Which transmembrane protein is bound to the 'tail' of spectrin by protein 4.1 in red cells?

    <p>Glycophorin A</p> Signup and view all the answers

    What is the main characteristic that causes spherocytic red cells to become trapped in splenic cords?

    <p>Decreased surface area to volume ratio</p> Signup and view all the answers

    Which type of mutations are most commonly caused by pathogenic mutations in hereditary spherocytosis?

    <p>'Frameshift' mutations</p> Signup and view all the answers

    What is the typical shape alteration seen in red cells affected by hereditary spherocytosis?

    <p>'Spherical' shape</p> Signup and view all the answers

    What occurs to red cells affected by hereditary spherocytosis due to changes in the ratio of surface area to volume?

    <p>'Phagocytosis' process</p> Signup and view all the answers

    What is the consequence of red cells with weakened interactions between skeletal proteins being phagocytosed by macrophages?

    <p>They are cleared from circulation</p> Signup and view all the answers

    What role does the spleen play in the life of a spherocyte?

    <p>Causes the premature demise of spherocytes</p> Signup and view all the answers

    How does compound heterozygosity for two defective alleles affect membrane skeleton deficiency?

    <p>Leads to more profound membrane skeleton deficiency</p> Signup and view all the answers

    What happens to red cells as they age in circulation due to destabilized lipid bilayer?

    <p>They shed membrane fragments</p> Signup and view all the answers

    What is the primary consequence of destabilizing the overlying plasma membrane in red cells?

    <p>Reduces assembly of the skeleton</p> Signup and view all the answers

    In hereditary spherocytosis, what do red cells assume to minimize their volume?

    <p>Sphere shape</p> Signup and view all the answers

    What consequence does anisocytosis have on red cells?

    <p>Causes abnormal shapes</p> Signup and view all the answers

    What feature can be observed in red cells of an asplenic patient with hereditary spherocytosis?

    <p><strong>Howell-Jolly bodies</strong></p> Signup and view all the answers

    What contributes to the trapping of spherocytes in the splenic cords?

    <p>Loss of membrane along with K+ ions and H₂O</p> Signup and view all the answers

    What is the distinctive morphologic finding seen on smears in patients with spherocytosis?

    <p>Small, dark-staining red cells lacking central zone of pallor</p> Signup and view all the answers

    What is a common feature seen in all hemolytic anemias?

    <p>Hemosiderosis</p> Signup and view all the answers

    Which organ typically shows moderate splenomegaly in individuals with hemolytic anemias?

    <p>Spleen</p> Signup and view all the answers

    What condition occurs in 40% to 50% of adults with hemolytic anemias?

    <p>Cholelithiasis (pigment stones)</p> Signup and view all the answers

    What is the primary consequence of splenectomy in individuals with spherocytosis?

    <p>Anemia correction</p> Signup and view all the answers

    What primarily causes iron accumulation in the spleen, liver, and bone marrow in individuals with hemolytic anemias?

    <p>Hemosiderosis</p> Signup and view all the answers

    What is the primary cause of red cells in hereditary spherocytosis having an increased mean cell hemoglobin concentration?

    <p>Increased K+ and H₂O loss</p> Signup and view all the answers

    What is the characteristic that sets apart a small minority of hereditary spherocytosis patients, mainly compound heterozygotes?

    <p>Marked jaundice at birth</p> Signup and view all the answers

    What event may trigger aplastic crises in individuals with hereditary spherocytosis?

    <p>Viral infection</p> Signup and view all the answers

    Which feature is most indicative of the chronic clinical course seen in most patients with hereditary spherocytosis?

    <p>Increased erythropoiesis</p> Signup and view all the answers

    What contributes to the stable clinical course of hereditary spherocytosis despite occasional aplastic crises?

    <p>Increased red cell survival</p> Signup and view all the answers

    What is the primary mechanism behind the red cell shape alteration in hereditary spherocytosis?

    <p>Defects in cytoskeletal proteins</p> Signup and view all the answers

    What is the characteristic often seen in asymptomatic cases of hereditary spherocytosis?

    <p>Virtually asymptomatic</p> Signup and view all the answers

    What triggers aplastic crises in individuals with hereditary spherocytosis?

    <p>Viral infection</p> Signup and view all the answers

    What is the most cited food trigger for hemolysis in G6PD-deficient individuals?

    <p>Fava beans</p> Signup and view all the answers

    Which type of anemia presents as neonatal jaundice or chronic low-grade hemolytic anemia without known triggers?

    <p>G6PD-deficiency anemia</p> Signup and view all the answers

    What is the primary consequence of exposing G6PD-deficient red cells to high levels of oxidants?

    <p>Cross-linking of reactive sulfhydryl groups</p> Signup and view all the answers

    Which geographic regions show a higher prevalence of 'favism' due to fava bean consumption?

    <p>Mediterranean, Middle East, and parts of Africa</p> Signup and view all the answers

    Which type of infections are most likely to trigger hemolysis in G6PD-deficient individuals?

    <p>Viral hepatitis and pneumonia</p> Signup and view all the answers

    What causes the episodic hemolysis characteristic of G6PD deficiency?

    <p>Exposures generating oxidant stress</p> Signup and view all the answers

    Which category of drugs has been implicated in causing hemolysis in individuals with G6PD deficiency?

    <p>Antimalarials</p> Signup and view all the answers

    In G6PD deficiency, what leads to the formation of membrane-bound precipitates known as Heinz bodies?

    <p>Cross-linking of reactive sulfhydryl groups on globin chains</p> Signup and view all the answers

    How does 'favism' differ from other triggers for hemolysis in G6PD-deficient individuals?

    <p>Ingestion and metabolism of a specific food item</p> Signup and view all the answers

    What is the primary source of reduced glutathione (GSH) required for detoxification of H2O2 in red blood cells?

    <p>Glutathione reductase</p> Signup and view all the answers

    Which enzyme's activity is essential for the synthesis of reduced nicotinamide adenine dinucleotide (NADPH) in red blood cells?

    <p>Glucose-6-phosphate dehydrogenase (G6PD)</p> Signup and view all the answers

    What is the oxidized form of glutathione that needs to be reduced for effective detoxification in red blood cells?

    <p>GSSG</p> Signup and view all the answers

    Which variant of Glucose-6-phosphate dehydrogenase (G6PD) is prevalent in the Middle East?

    <p>G6PD Mediterranean</p> Signup and view all the answers

    What is believed to be the reason for the high frequency of G6PD variants in each population?

    <p>Protective effect against Plasmodium falciparum malaria</p> Signup and view all the answers

    What may be a clinical consequence of splenectomy in treating anemia and its complications?

    <p>Increased risk of sepsis</p> Signup and view all the answers

    What intercurrent event can lead to increased splenic destruction of red cells in patients with hemolytic anemia?

    <p>Infectious mononucleosis</p> Signup and view all the answers

    What can lead to sudden worsening of anemia even for short periods?

    <p>Infectious mononucleosis</p> Signup and view all the answers

    What condition may be found in many patients with hereditary spherocytosis and can cause symptoms?

    <p>Hemolytic crises</p> Signup and view all the answers

    What is a clinical complication associated with aplastic crises?

    <p>Sudden worsening of the anemia</p> Signup and view all the answers

    What is the primary reason why older red cells are more prone to hemolysis than younger ones?

    <p>Decreased enzyme protection from oxidative stress</p> Signup and view all the answers

    What is the likely fate of red cells with Heinz bodies as they pass through the splenic cords?

    <p>They are removed by phagocytes</p> Signup and view all the answers

    Which enzyme deficiency is most critical in reducing the ability of red cells to protect against oxidative injuries and leads to hemolysis?

    <p>Glucose-6-phosphate dehydrogenase (G6PD)</p> Signup and view all the answers

    Which cells are trapped in splenic cords and removed by phagocytes in G6PD-deficient individuals?

    <p>Bite cells</p> Signup and view all the answers

    What role does NADPH play in protecting red cells against oxidant injury?

    <p>Provides reducing equivalents for glutathione reduction</p> Signup and view all the answers

    What is the hallmark sign of acute intravascular hemolysis in G6PD-deficient individuals?

    <p>Hemoglobinuria</p> Signup and view all the answers

    What triggers the recovery phase marked by reticulocytosis in G6PD-deficient individuals?

    <p>Lysis of older red cells</p> Signup and view all the answers

    What type of trait is glucose-6-phosphate dehydrogenase (G6PD) deficiency?

    <p>X-linked recessive</p> Signup and view all the answers

    Why are males at a higher risk for symptomatic disease related to glucose-6-phosphate dehydrogenase (G6PD) deficiency?

    <p>Recessive X-linked trait inheritance</p> Signup and view all the answers

    What feature is notably absent in G6PD-deficient individuals due to the intermittent nature of hemolytic episodes?

    <p>Splenomegaly</p> Signup and view all the answers

    What symptom typically begins 2 to 3 days following exposure of G6PD-deficient individuals to environmental triggers?

    <p>Anemia</p> Signup and view all the answers

    How does G6PD deficiency impact the ability of red cells to protect themselves against oxidative injuries?

    <p>Impairs NADPH production</p> Signup and view all the answers

    What crucial function does NADPH serve in the cellular defense system against oxidant injury?

    <p>Supplies reducing equivalents for glutathione reduction</p> Signup and view all the answers

    What abnormal shape may red cells affected by membrane damage retain as a result of partial consumption by macrophages?

    <p>'Bite' shape</p> Signup and view all the answers

    Why do red cells deficient in glucose-6-phosphate dehydrogenase (G6PD) become more susceptible to hemolysis?

    <p>Reduced protection from oxidative stress</p> Signup and view all the answers

    What condition is NOT typically associated with acute intravascular hemolysis in G6PD-deficient individuals?

    <p>'Droplet' spherocytes</p> Signup and view all the answers

    What cells are mainly responsible for removing Heinz bodies from inclusion-bearing red cells in G6PD-deficient individuals?

    <p>'Bite' cells</p> Signup and view all the answers

    What is the mutation responsible for symptomatic sickle cell disease?

    <p>HbSS</p> Signup and view all the answers

    Why do AS children have lower parasite loads in malaria infection?

    <p>Enhanced clearance by phagocytes</p> Signup and view all the answers

    What promotes the sickling of AS red cells during falciparum malaria infection?

    <p>Low oxygen levels and decreased pH</p> Signup and view all the answers

    What is the primary consequence of sickling on the formation of membrane knobs?

    <p>Impaired knob formation</p> Signup and view all the answers

    What protective effect does sickle cell trait offer against in certain African populations?

    <p>Malaria</p> Signup and view all the answers

    What leads to the high prevalence of sickle cell trait in specific African populations?

    <p>Selective pressure from malaria</p> Signup and view all the answers

    What characteristic differentiates AS children from AA children in terms of disease severity during malaria infection?

    <p>% of HbS in red cells</p> Signup and view all the answers

    Why do infected AS children have a lower likelihood of developing severe malaria?

    <p>Rapid clearance by phagocytes</p> Signup and view all the answers

    What is the primary pathogenic role of membrane knobs in cerebral malaria?

    <p>Promoting adhesion of red cells to endothelium</p> Signup and view all the answers

    How do G6PD deficiency and thalassemia protect against malaria?

    <p>By raising levels of oxidant stress</p> Signup and view all the answers

    What causes the red cell cytosol to convert into a viscous gel in sickle cell disease?

    <p>Deoxygenation leading to polymerization</p> Signup and view all the answers

    What prevents red cells in heterozygous individuals with sickle cell trait from sickling under hypoxia?

    <p>Enhanced HbA interference</p> Signup and view all the answers

    In sickle cell trait heterozygotes, what percentage of hemoglobin is typically composed of HbS?

    <p>40%</p> Signup and view all the answers

    Which variable affects the rate and degree of sickling in sickle cell disease?

    <p>Deoxygenation duration</p> Signup and view all the answers

    What is the consequence of HbS molecules assembling into long needlelike fibers within red cells?

    <p>Distorted sickle or holly-leaf shape</p> Signup and view all the answers

    What interferes with polymerization of HbS molecules in heterozygotes with sickle cell trait?

    <p>Presence of HbA</p> Signup and view all the answers

    What condition is characterized by hereditary persistence of fetal hemoglobin?

    <p>HbC disease</p> Signup and view all the answers

    In individuals with HbSC disease, what is the percentage of HbS in red cells compared to HbAS cells?

    <p>50%</p> Signup and view all the answers

    What effect does intracellular dehydration have on sickling in red blood cells?

    <p>Increases the MCHC</p> Signup and view all the answers

    Which variant hemoglobin disorder results in a symptomatic sickling disorder termed HbSC disease?

    <p>HbC/HbS heterozygotes</p> Signup and view all the answers

    What factor contributes to the severity of HbSC disease compared to sickle cell disease?

    <p>Lower mean cell hemoglobin concentration</p> Signup and view all the answers

    What happens to the probability of aggregation and polymerization of HbS with higher concentrations of HbS?

    <p>Increases</p> Signup and view all the answers

    'Hereditary persistence of fetal hemoglobin' results in a milder form of what disease?

    <p>'Sickle cell disease'</p> Signup and view all the answers

    'HbSC disease' arises from individuals who are compound heterozygotes for which hemoglobins?

    <p>'HbS' and 'HbC'</p> Signup and view all the answers

    What is the primary physiochemical property of the sickle hemoglobin (HbS) responsible for sickle cell disease?

    <p>Replacement of a charged glutamate residue with a hydrophobic valine residue</p> Signup and view all the answers

    What is the defining characteristic of red cells in sickle cell disease when exposed to deoxygenated conditions?

    <p>Polymerization of deoxygenated hemoglobin</p> Signup and view all the answers

    Which type of mutation specifically causes sickle cell disease?

    <p>Missense mutation</p> Signup and view all the answers

    What is the main consequence of the point mutation in the ẞ-globin gene that causes sickle cell disease?

    <p>Polymerization of deoxygenated hemoglobin</p> Signup and view all the answers

    Which type of anemia results from the polymerization of deoxygenated hemoglobin in sickle cell disease?

    <p>Sickle cell anemia</p> Signup and view all the answers

    In normal adult red cells, which type of hemoglobin is present as the main component?

    <p>HbA (alpha2beta2)</p> Signup and view all the answers

    Which term best describes the genetic basis of sickle cell disease among various hemoglobinopathies?

    <p>'Autosomal recessive'</p> Signup and view all the answers

    What is the primary effect of the point mutation in the ẞ-globin gene that causes sickle cell disease on red cells?

    <p>Increased membrane rigidity</p> Signup and view all the answers

    Why does a decrease in pH increase the tendency for sickling in individuals with HbS?

    <p>Augments the fraction of deoxygenated HbS</p> Signup and view all the answers

    What leads to vascular occlusion in sickle cell disease within microvascular beds?

    <p>Slow transit times</p> Signup and view all the answers

    What mechanism causes cumulative damage to red cells in sickle cell disease?

    <p>Growth of HbS polymers</p> Signup and view all the answers

    Why are inflamed vascular beds prone to sickling and occlusion in sickle cell disease?

    <p>Presence of leukocytes</p> Signup and view all the answers

    What contributes to the milder disease in individuals homozygous for HbS who also have coexistent α-thalassemia?

    <p>Reduced Hb synthesis</p> Signup and view all the answers

    What is the primary cause of the pathology of sickle cell disease within microvascular beds?

    <p>Sickling due to slow transit times</p> Signup and view all the answers

    What feature distinguishes individuals with coexistent α-thalassemia from those with only HbS?

    <p>Reduced Hb synthesis</p> Signup and view all the answers

    What causes cummulative damage to red cells in sickle cell disease?

    <p>Growth of HbS polymers</p> Signup and view all the answers

    What is the primary consequence of prolonged exposure to low oxygen tension in the context of sickle cell disease?

    <p>Enhanced red cell stasis</p> Signup and view all the answers

    How does the release of free hemoglobin from lysed sickle red cells impact vascular function?

    <p>Inactivates nitric oxide</p> Signup and view all the answers

    What role does the depletion of nitric oxide (NO) play in vascular occlusions in sickle cell disease?

    <p>Promotes vasodilation</p> Signup and view all the answers

    What is the main consequence of the binding of free hemoglobin to nitric oxide (NO) in sickle cell disease?

    <p>Enhanced platelet activation</p> Signup and view all the answers

    How does the up-regulation of adhesion molecules on endothelial cells affect sickle red cells during inflammatory reactions?

    <p>Enhances red cell arrest tendency</p> Signup and view all the answers

    What contributes significantly to the vicious cycle described in sickle cell disease involving sickling, obstruction, and hypoxia?

    <p>Stagnation of red cells within inflamed vascular beds</p> Signup and view all the answers

    What potential outcome is associated with the increased vascular tone resulting from the binding of free hemoglobin to nitric oxide?

    <p>Enhanced platelet aggregation</p> Signup and view all the answers

    How does the presence of mediators from granulocytes impact the interaction between sickle red cells and endothelial cells?

    <p>Up-regulates adhesion molecule expression</p> Signup and view all the answers

    What is the primary cause of target cell formation in sickle cell anemia?

    <p>Red cell dehydration</p> Signup and view all the answers

    Which process leads to the formation of Howell-Jolly bodies in red cells in sickle cell anemia?

    <p>Asplenia</p> Signup and view all the answers

    What is the process that leads to prominent cheekbones and 'crewcut' changes in the skull in sickle cell anemia?

    <p>Bone resorption</p> Signup and view all the answers

    What causes the formation of pigment gallstones in sickle cell anemia?

    <p>Hemoglobin breakdown</p> Signup and view all the answers

    Why do individuals with sickle cell anemia initially experience splenomegaly in early childhood?

    <p>Red pulp congestion</p> Signup and view all the answers

    What is the term for the process where chronic erythrostasis leads to shrinkage of the spleen in sickle cell anemia?

    <p>Autosplenectomy</p> Signup and view all the answers

    What can result from vascular occlusions caused by sickled red cells in sickle cell anemia?

    <p>'Crewcut' changes in the bones</p> Signup and view all the answers

    What complication can be rare in children but often occurs due to vascular stagnation in subcutaneous tissues in adult patients with sickle cell anemia?

    <p>'Crewcut' ulcers</p> Signup and view all the answers

    What is the primary cause of the microvascular occlusions responsible for the serious clinical features in sickle cell disease?

    <p>Red cell membrane damage and local factors</p> Signup and view all the answers

    What is the primary mechanism that leads to the appearance of nondeformable irreversibly sickled cells in sickle cell disease?

    <p>Cross-linking of membrane proteins</p> Signup and view all the answers

    What is the fate of most severely damaged red cells that are converted to nondeformable irreversibly sickled cells in sickle cell disease?

    <p>Rapidly sequestered and removed by phagocytes</p> Signup and view all the answers

    Which factor contributes significantly to the mechanical fragility of sickled red cells in sickle cell disease?

    <p>Cross-linking of membrane proteins</p> Signup and view all the answers

    What is the primary role of mononuclear phagocytes in the context of extravascular hemolysis in sickle cell disease?

    <p>Sequester and remove irreversibly sickled cells</p> Signup and view all the answers

    What is the likely consequence of local factors such as inflammation or vasoconstriction on red cells passing through microvascular beds?

    <p>Slowing or arrest in movement through microvascular beds</p> Signup and view all the answers

    What is the primary physiologic alteration that leads to the dense and rigid transformation of red cells during repeated sickling episodes?

    <p>Cross-linking of membrane proteins</p> Signup and view all the answers

    What contributes to the mechani- cal fragility and intravascular hemolysis observed in sickled red cells?

    <p>Red cells' stickiness due to higher adhesion molecule levels</p> Signup and view all the answers

    What is a common clinical presentation of sickle cell disease involving episodes of hypoxic injury and infarction?

    <p>Vaso-occlusive crises</p> Signup and view all the answers

    What is the main distinguishing feature of acute chest syndrome in sickle cell disease?

    <p>Pulmonary infiltrates</p> Signup and view all the answers

    In children with sickle cell disease, what common painful bone crisis frequently involves the hands and feet?

    <p>Dactylitis</p> Signup and view all the answers

    Which body part is particularly at risk during vaso-occlusive crises in sickle cell disease, leading to complications like dactylitis?

    <p>Penis</p> Signup and view all the answers

    What hematocrit range is typically associated with hemo-lytic anemia in sickle cell disease?

    <p>18% to 30%</p> Signup and view all the answers

    What condition is often a trigger for vaso-occlusive crises but is not always identified as a predisposing cause in sickle cell disease?

    <p>Dehydration</p> Signup and view all the answers

    Which type of crisis in sickle cell disease presents with fever, cough, and chest pain due to lung involvement?

    <p>Acute chest syndrome</p> Signup and view all the answers

    What does the term 'hand-foot syndrome' commonly refer to in children with sickle cell disease?

    <p>'Dactylitis'</p> Signup and view all the answers

    What is the potential consequence of pulmonary inflammation-induced sluggish blood flow in sickle cell disease?

    <p>Worsening pulmonary function</p> Signup and view all the answers

    What clinical issue may affect up to 45% of males with sickle cell disease after puberty?

    <p>Hypoxic damage</p> Signup and view all the answers

    What is one of the disorders related to vascular obstruction in sickle cell disease that can lead to visual impairment?

    <p>Retinopathy</p> Signup and view all the answers

    Which term best describes the state when individuals with sickle cell trait experience increased adhesion of sickle red cells?

    <p>Hypercoagulability</p> Signup and view all the answers

    What is the primary consequence of priapism in males with sickle cell disease?

    <p>Erectile dysfunction</p> Signup and view all the answers

    How does vaso-occlusion in sickle cell disease contribute to stroke development?

    <p>Promotes adhesion of sickle red cells</p> Signup and view all the answers

    What devastating consequence can result from the retinopathy associated with sickle cell disease?

    <p>'Tunnel vision'</p> Signup and view all the answers

    How does pulmonary vaso-occlusion contribute to the cycle of hypoxemia and sickling in sickle cell disease?

    <p>'Traps' red cells leading to localized ischemia</p> Signup and view all the answers

    What process is impaired in children by congestion and poor blood flow, and completely absent in adults due to splenic infarction?

    <p>Opsonization of bacteria</p> Signup and view all the answers

    Which complement pathway defects are mentioned as causing impairment in the opsonization of bacteria in sickle cell disease?

    <p>Alternative complement pathway</p> Signup and view all the answers

    What contributes to reducing the incidence of Pneumococcus pneumoniae and Haemophilus influenzae septicemia and meningitis in children with sickle cell disease?

    <p>Prophylactic antibiotics</p> Signup and view all the answers

    What is the primary method for confirming the diagnosis of sickle cell disease?

    <p>Tests for sickle hemoglobin</p> Signup and view all the answers

    How is prenatal diagnosis for sickle cell disease typically performed?

    <p>Fetal DNA analysis from amniocentesis</p> Signup and view all the answers

    What percentage of patients with sickle cell disease survive to 20 years of age?

    <p>~90%</p> Signup and view all the answers

    In what way has the outlook for patients with sickle cell disease improved over the past 10 to 20 years?

    <p>Improved survival rates</p> Signup and view all the answers

    What is the primary cause of a-thalassemia?

    <p>Diminished synthesis of a chains</p> Signup and view all the answers

    Which region is NOT mentioned as an area where thalassemia is endemic?

    <p>Europe</p> Signup and view all the answers

    What is the clinical consequence of mutations that diminish the synthesis of B-globin chains in B-thalassemia?

    <p>Variability in clinical severity</p> Signup and view all the answers

    What does the relative excess of one globin chain contribute to in ẞ-thalassemia?

    <p>Hematologic consequences</p> Signup and view all the answers

    Which chromosome encodes the ẞ-globin gene responsible for the synthesis of the two ẞ chains in HbA?

    <p>Chromosome 11</p> Signup and view all the answers

    What is among the most common inherited disorders of humans according to the text?

    <p>Sickle cell disease</p> Signup and view all the answers

    In what way do the defects in globin synthesis cause anemia in red cell disorders?

    <p>By decreasing red cell production and lifespan</p> Signup and view all the answers

    What condition leads to a transient cessation of erythropoiesis due to the infection of red cell progenitors by parvovirus B19?

    <p>Aplastic crises</p> Signup and view all the answers

    Which complication of sickle cell disease involves rapid splenic enlargement due to massive entrapment of sickled red cells?

    <p>Sequestration crises</p> Signup and view all the answers

    What is the primary cause of chronic tissue damage affecting organs like the spleen, heart, kidneys, and lungs in sickle cell disease?

    <p>Chronic hypoxia</p> Signup and view all the answers

    What is the main effect of hypertonicity in the renal medulla on red blood cells in sickle cell disease?

    <p>Hyposthenuria</p> Signup and view all the answers

    Which complication of sickle cell disease may necessitate prompt treatment with exchange transfusions?

    <p>Sequestration crises</p> Signup and view all the answers

    What feature is primarily responsible for the impairment of growth and development in individuals with sickle cell disease?

    <p>Chronic hypoxia</p> Signup and view all the answers

    Why does chronic hypoxia in sickle cell disease lead to organ damage in the heart, kidneys, and lungs?

    <p>Reduced erythropoiesis</p> Signup and view all the answers

    What is a potential consequence of sequestration crises in children with intact spleens?

    <p>Hypovolemia and shock</p> Signup and view all the answers

    What is the primary mechanism of action of L-glutamine in decreasing pain crises when added to hydroxyurea treatment?

    <p>Promoting oxidant stress in red cells</p> Signup and view all the answers

    Which of the following is NOT a beneficial effect of hydroxyurea in the treatment of sickle cell disease?

    <p>Stimulation of hemoglobin switching</p> Signup and view all the answers

    In sickle cell disease treatment, what effect does hematopoietic stem cell transplantation offer?

    <p>Chance at cure</p> Signup and view all the answers

    Which approach involves using gene editing technology to reverse hemoglobin switching in sickle cell disease?

    <p>CRISPR technology</p> Signup and view all the answers

    What is the main consequence of germline mutations that decrease α-globin or ẞ-globin synthesis in thalassemia?

    <p>Tissue hypoxia</p> Signup and view all the answers

    Regarding thalassemia, what distinguishes it as a genetically heterogeneous disorder?

    <p>Multiple mutations affecting globin chain synthesis</p> Signup and view all the answers

    What role does CRISPR technology play in the treatment of sickle cell disease?

    <p>Reversing hemoglobin switching</p> Signup and view all the answers

    How does hydroxyurea contribute to decreasing crises related to vascular occlusions in sickle cell disease?

    <p>'Raising red cell HbF levels</p> Signup and view all the answers

    What do ẞ° mutations in ẞ-thalassemia result in?

    <p>Absence of ẞ-globin synthesis</p> Signup and view all the answers

    Which type of mutations in ẞ-thalassemia are characterized by reduced (but detectable) ẞ-globin synthesis?

    <p>ẞ+ mutations</p> Signup and view all the answers

    What is the most common cause of B+-thalassemia?

    <p>Splicing mutations</p> Signup and view all the answers

    How do promoter region mutations in ẞ-thalassemia affect transcription?

    <p>Reduce by 75% to 80%</p> Signup and view all the answers

    What is the consequence of some splicing mutations in ẞ-thalassemia creating an 'ectopic' splice site within an intron?

    <p>Both normal and abnormal splicing occur</p> Signup and view all the answers

    Which class of causative mutations in ẞ-thalassemia is associated with Bº-thalassemia?

    <p>'Absence of ẞ-globin synthesis' mutations</p> Signup and view all the answers

    In what class of causative mutations do some splicing mutations result in both normal and abnormal splicing?

    <p>'Ectopic' splice site mutations</p> Signup and view all the answers

    What is the primary consequence of promoter region mutations in terms of normal ẞ-globin synthesis?

    <p>Reduced but detectable synthesis</p> Signup and view all the answers

    'Chain termination' cause of mutation insertion leads to what type of damage to red cells?

    <p>'Impair mechanis' within red cells</p> Signup and view all the answers

    'Splicing mutations' are most commonly associated with which type of thalassemia?

    <p>'B+-thalassemia'</p> Signup and view all the answers

    What is the primary consequence of impaired B-globin synthesis in individuals with severe ß-thalassemia?

    <p>Decreased hemoglobin content in red cells</p> Signup and view all the answers

    What is the most common cause of ineffective erythropoiesis in severe ß-thalassemia?

    <p>Imbalance in a- and ß-globin synthesis</p> Signup and view all the answers

    What is the proximal cause of most red cell pathology in severe ß-thalassemia?

    <p>Membrane damage from unpaired o-chains precipitation</p> Signup and view all the answers

    What characteristic differentiates red cells released from the marrow in severe ß-thalassemia?

    <p>Proneness to splenic sequestration</p> Signup and view all the answers

    Which mechanism leads to the diminished survival of red cell precursors in severe ß-thalassemia?

    <p>Imbalance in a- and ß-globin synthesis</p> Signup and view all the answers

    What contributes to the formation of insoluble inclusions affecting red cell precursors in severe ß-thalassemia?

    <p>Unpaired a-chains precipitation</p> Signup and view all the answers

    Why do red cell precursors undergo apoptosis in severe ß-thalassemia?

    <p>Membrane damage from unpaired o-chains precipitation</p> Signup and view all the answers

    What happens to most red cell precursors affected by severe ß-thalassemia?

    <p>'Ineffective erythropoiesis'</p> Signup and view all the answers

    What is the primary consequence of untreated patients with severe uncompensated anemia according to the text?

    <p>Skeletal abnormalities</p> Signup and view all the answers

    Which condition is a direct result of metabolically active erythroid progenitors stealing nutrients from already oxygen-starved tissues?

    <p>Cachexia</p> Signup and view all the answers

    What is the characteristic feature of B-thalassemia major that leads to most erythroblasts dying in the bone marrow?

    <p>Insoluble β-globin aggregate</p> Signup and view all the answers

    What is the main problem caused by extraosseous masses in extreme cases of extra-medullary hematopoiesis?

    <p>Impaired bone growth</p> Signup and view all the answers

    What is the primary effect of unpaired β-globin chains, seen in B-thalassemia major, on red cell production?

    <p>Reduced red cell production</p> Signup and view all the answers

    In patients with severe anemia, what does the increase in erythropoietin secretion primarily trigger?

    <p>Proliferation of erythroid progenitors</p> Signup and view all the answers

    What is the notable outcome of aggregate-containing red cells being destroyed in the spleen in B-thalassemia major?

    <p>Extravascular hemolysis</p> Signup and view all the answers

    What does the suppression of hepcidin in B-thalassemia major mainly contribute to?

    <p>Iron overload</p> Signup and view all the answers

    What is the direct cause of the production of skeletal abnormalities in untreated patients with severe uncompensated anemia?

    <p>Erosion of bony cortex by red cell precursors</p> Signup and view all the answers

    What is the primary consequence of increased release of erythroferrone in those with severe thalassemia?

    <p>Suppressed hepcidin production</p> Signup and view all the answers

    In β-thalassemia major, what is the main feature that distinguishes it from β-thalassemia intermedia?

    <p>Requirement for regular blood transfusions</p> Signup and view all the answers

    Which clinical syndrome is characterized by asymptomatic presentation and mild or absent anemia with red cell abnormalities?

    <p>α-Thalassemia trait</p> Signup and view all the answers

    What is the molecular genetic basis of α-Thalassemia trait?

    <p>Gene deletions affecting α-globin synthesis</p> Signup and view all the answers

    Which condition is lethal in utero without transfusions and is characterized by severe anemia and resembles β-thalassemia intermedia?

    <p>Hydrops fetalis</p> Signup and view all the answers

    "Compound heterozygous" individuals for hemoglobinopathies typically have which genetic characteristic?

    <p>Two defective alleles affecting α-globin synthesis</p> Signup and view all the answers

    "Silent carrier" individuals of α-thalassemia typically present with which key feature?

    <p>Asymptomatic state with no red cell abnormality</p> Signup and view all the answers

    "Homozygous β-thalassemia" individuals mainly have what type of genetic defects?

    <p>&quot;B°/ẞ°, ẞ*/ẞ*, B°/ẞ*&quot; point mutations in ẞ-globin mRNA</p> Signup and view all the answers

    What genetic characteristic distinguishes "β-thalassemia intermedia" from "β-thalassemia minor"?

    <p>Mainly gene deletions affecting beta globin synthesis</p> Signup and view all the answers

    What role does an α-thalassemia gene defect play in some patients with B-thalassemia intermedia?

    <p>Worsens the imbalance in α- and ß-chain synthesis</p> Signup and view all the answers

    In rare cases of B-thalassemia intermedia, what worsens the chain imbalance?

    <p>Extra copies of abnormal ß-globin genes</p> Signup and view all the answers

    What is the cardinal role emphasized in unusual forms of ß-thalassemia?

    <p>Role of unpaired α-globin chains</p> Signup and view all the answers

    What can be surmised about ß-thalassemia intermedia based on the text?

    <p>It is not specifically described separately</p> Signup and view all the answers

    What is the consequence of two defective ß-globin genes and an α-thalassemia gene defect in some patients with B-thalassemia intermedia?

    <p>Lessened imbalance in chain synthesis</p> Signup and view all the answers

    What is the primary emphasis of the unusual forms of ß-thalassemia discussed in the text?

    <p>Role of extra copies of normal α-globin genes</p> Signup and view all the answers

    Which aspect do unusual forms of ß-thalassemia highlight according to the text?

    <p>Importance of unpaired α-globin chains</p> Signup and view all the answers

    What is a distinguishing feature of ß-thalassemia intermedia according to the text?

    <p>Its distinct clinical presentation</p> Signup and view all the answers

    What is the primary negative consequence of ineffective erythropoiesis in thalassemia?

    <p>Excessive iron accumulation in the body</p> Signup and view all the answers

    Which hormone secreted by erythroid precursors inhibits production of hepcidin in thalassemia?

    <p>Erythroferrone</p> Signup and view all the answers

    Individuals with two B-thalassemia alleles are classified as having which severe form of anemia?

    <p>Beta-thalassemia major</p> Signup and view all the answers

    What type of anemia is characterized by one normal gene and one Beta-thalassemia gene?

    <p>Beta-thalassemia minor</p> Signup and view all the answers

    What underlying genotype determines the severity of anemia in Beta-thalassemia?

    <p>Beta* or Beta°</p> Signup and view all the answers

    What is the classification of individuals with one Beta-thalassemia gene and one normal gene?

    <p>Alpha/Beta</p> Signup and view all the answers

    What condition is referred to as Beta-thalassemia intermedia?

    <p>Mild asymptomatic anemia</p> Signup and view all the answers

    Individuals with heterozygous Beta-thalassemia trait typically present with which type of anemia?

    <p>'Microcytic'</p> Signup and view all the answers

    What is the primary reason for the recognition of ß-thalassemia trait?

    <p>To exclude iron deficiency anemia</p> Signup and view all the answers

    Which laboratory measurements are used to exclude iron deficiency anemia?

    <p>Serum iron, total iron-binding capacity, and serum ferritin</p> Signup and view all the answers

    What is the diagnostic significance of the increase in HbA₂?

    <p>Useful in diagnosing iron deficiency anemia</p> Signup and view all the answers

    What forms hemoglobin Barts in newborns with alpha-thalassemia?

    <p>Gamma-globin chains</p> Signup and view all the answers

    In older children and adults with alpha-thalassemia, what forms HbH?

    <p>Beta-globin chains</p> Signup and view all the answers

    Why is hemolysis less severe in alpha-thalassemia compared to beta-thalassemia?

    <p>Due to the differences in hemoglobin types produced</p> Signup and view all the answers

    What differentiates a-thalassemia from ß-thalassemia in terms of globin chains?

    <p>Lower synthesis of beta-globin chains</p> Signup and view all the answers

    What is the typical percentage of HbA₂ in patients with B-Thalassemia minor?

    <p>5% to 10%</p> Signup and view all the answers

    Which hematological feature is typically NOT seen in patients with B-Thalassemia minor?

    <p>Anisocytosis</p> Signup and view all the answers

    What is a common consequence of iron overload in patients with B-Thalassemia?

    <p>Secondary hemochromatosis</p> Signup and view all the answers

    What radiographic appearance is typically seen in patients with B-Thalassemia major?

    <p>&quot;Crewcut&quot; appearance due to eroded cortical bone</p> Signup and view all the answers

    What is the primary cause of enlargement of the spleen in patients with untransfused B-Thalassemia?

    <p>Extramedullary hematopoiesis</p> Signup and view all the answers

    Which organ may be enlarged by extramedullary hematopoiesis in patients with B-Thalassemia?

    <p>Liver</p> Signup and view all the answers

    What is a common manifestation of iron overload in patients with B-Thalassemia if chelation therapy is not given?

    <p>&quot;Bronze diabetes&quot;</p> Signup and view all the answers

    What is a common radiographic finding in the bones of the face and skull in patients with B-Thalassemia major?

    <p>&quot;Crewcut&quot; appearance</p> Signup and view all the answers

    What is the primary red cell hemoglobin in patients with B-Thalassemia major?

    <p>HbF</p> Signup and view all the answers

    Which of the following is a common morphological feature seen in the blood smears of patients with B-Thalassemia major?

    <p>Target cells</p> Signup and view all the answers

    In B-Thalassemia major, what triggers the elevated reticulocyte count despite ineffective erythropoiesis?

    <p>Abnormal release of red cell precursors from extramedullary sites</p> Signup and view all the answers

    What is a characteristic feature of red cells in patients with B-Thalassemia major that contributes to their vulnerability to splenic sequestration?

    <p>Reduced surface area to volume ratio</p> Signup and view all the answers

    What is the reason for the lower-than-expected reticulocyte count in untransfused patients with B-Thalassemia major?

    <p>Ineffective erythropoiesis</p> Signup and view all the answers

    Which of the following abnormalities is NOT commonly seen in the blood smears of patients with B-Thalassemia major?

    <p>Spherocytes</p> Signup and view all the answers

    What is the characteristic pattern of hemoglobin synthesis in infants affected by B-Thalassemia major?

    <p>$HbF \rightarrow HbA_2 \rightarrow HbA$</p> Signup and view all the answers

    Which of the following is a common feature of red cells in B-Thalassemia major that contributes to their decreased lifespan?

    <p>$\beta$-globin chains excess</p> Signup and view all the answers

    What is the most common molecular lesion resulting in α-thalassemia?

    <p>Gene deletion</p> Signup and view all the answers

    In untreated children with β-thalassemia major, what is a characteristic effect of the anemia?

    <p>Growth retardation</p> Signup and view all the answers

    What is a common consequence of prolonged iron overload in heavily transfused patients?

    <p>Cardiac disease</p> Signup and view all the answers

    What is the primary purpose of iron chelators in treating heavily transfused patients?

    <p>Prevent cardiac disease</p> Signup and view all the answers

    Which therapy offers a cure for β-thalassemia major and is increasingly being used?

    <p>Hematopoietic stem cell transplantation</p> Signup and view all the answers

    What technique allows prenatal diagnosis of β-thalassemia?

    <p>Molecular analysis of DNA</p> Signup and view all the answers

    In heavily transfused patients with β-thalassemia major, why is survival into the third decade possible?

    <p>Through blood transfusions and iron chelation</p> Signup and view all the answers

    What is a typical radiographic feature seen in patients with β-thalassemia major?

    <p>'Crewcut' appearance on skull X-ray</p> Signup and view all the answers

    What is the defining factor in determining the classification of a-thalassemia syndromes?

    <p>Number of a-globin genes deleted</p> Signup and view all the answers

    Which condition is associated with the deletion of a single a-globin gene and causes a barely detectable reduction in a-globin chain synthesis?

    <p>Silent carrier state</p> Signup and view all the answers

    In what population is the genotype involving the deletion of two α-globin genes from a single chromosome more common?

    <p>Asian populations</p> Signup and view all the answers

    Which genotype produces similar deficiencies of α-globin, but has different implications for the children of affected individuals based on parental haplotypes?

    <p>(a/- a/-) genotype</p> Signup and view all the answers

    What clinical condition are children of individuals with the -/- haplotype at risk of developing?

    <p>Hydrops fetalis</p> Signup and view all the answers

    What type of anemia does a-Thalassemia trait result from?

    <p>Microcytic anemia</p> Signup and view all the answers

    Which combination of α-globin gene deletions results in completely asymptomatic individuals with slight clinical features?

    <p>(a/a-/-)</p> Signup and view all the answers

    In what regions are the deletion genotypes differing in implications between children of affected individuals more commonly found?

    <p>Africa</p> Signup and view all the answers

    In PNH, the deficiency of GPI-linked proteins is caused by mutations in which gene?

    <p>PIGA</p> Signup and view all the answers

    What is the primary cause of Hydrops Fetalis?

    <p>Deletion of all alpha-globin genes</p> Signup and view all the answers

    Which process results in the inactivation of one X chromosome in females with PIGA mutations?

    <p>Lyonization</p> Signup and view all the answers

    How does a single acquired mutation in an active PIGA gene result in a deficiency state in PNH?

    <p>By decreasing GPI-linked proteins</p> Signup and view all the answers

    What differentiates the mutant clone from normal stem cell progeny in PNH?

    <p>Deficiency in GPI-linked proteins</p> Signup and view all the answers

    Which type of anemia is characterized by somatic mutations in the PIGA gene?

    <p>Paroxysmal nocturnal hemoglobinuria (PNH)</p> Signup and view all the answers

    What happens to all clonal progeny (red cells, white cells, and platelets) of a hematopoietic stem cell with a PIGA mutation?

    <p>They are deficient in GPI-linked proteins</p> Signup and view all the answers

    'Hydrops fetalis' occurs due to the deletion of which genes?

    <p>$\alpha$-globin genes</p> Signup and view all the answers

    What is the main difference in the clinical picture between symptomatic α-thalassemia and HbH disease?

    <p>Presence of small red cells in HbH disease</p> Signup and view all the answers

    What distinguishes Hemoglobin H (HbH) from other hemoglobin types in terms of oxygen affinity?

    <p>High oxygen affinity</p> Signup and view all the answers

    What is the primary consequence of HbH's high affinity for oxygen?

    <p>Tissue hypoxia</p> Signup and view all the answers

    What is the cause of intracellular inclu- sions and red cell sequestration in HbH disease?

    <p>Hemoglobin H precipitation</p> Signup and view all the answers

    What feature distinguishes Paroxysmal Nocturnal Hemoglobinuria (PNH) from HbH disease?

    <p>Mutations in the PIGA gene</p> Signup and view all the answers

    What is the primary issue that necessitates blood transfusions in individuals with HbH disease?

    <p>Moderately severe anemia</p> Signup and view all the answers

    How does Hematopoietic stem cell transplantation contribute to the treatment of HbH disease?

    <p>Curative effect</p> Signup and view all the answers

    What role does the phosphati- dylinositol glycan complementation group A gene (PIGA) play in the pathogenesis of Paroxysmal Nocturnal Hemoglobinuria (PNH)?

    <p>Essential enzyme for certain membrane proteins synthesis</p> Signup and view all the answers

    What is the primary function of CD59 in PNH blood cells?

    <p>Prevent the spontaneous activation of the alternative complement pathway</p> Signup and view all the answers

    In what trimester of pregnancy do signs of fetal distress usually become evident?

    <p>Third trimester</p> Signup and view all the answers

    What is the role of y chains in early development survival?

    <p>Form a functional Hb tetramer</p> Signup and view all the answers

    What is the main consequence of PIGA mutations in normal individuals?

    <p>Increase in bone marrow cell numbers</p> Signup and view all the answers

    What is the primary hypothesis regarding the selective advantage leading to clinically evident PNH?

    <p>Autoimmune reactions against GPI-linked antigens</p> Signup and view all the answers

    Which proteins are deficient in PNH blood cells, leading to complement activity dysregulation?

    <p>CD55, CD59, and C8-binding protein</p> Signup and view all the answers

    What is the most important function of CD59 in PNH blood cells?

    <p>Inhibit C3 convertase to prevent complement pathway activation</p> Signup and view all the answers

    What is the primary reason for the paroxysmal and nocturnal manifestation of hemolysis in PNH?

    <p>Slight decrease in blood pH during sleep</p> Signup and view all the answers

    What is the leading cause of disease-related death in individuals with PNH?

    <p>Thrombosis</p> Signup and view all the answers

    What eventually leads to iron deficiency in individuals with PNH?

    <p>Heme iron excretion at night</p> Signup and view all the answers

    What explains the paroxysmal and nocturnal nature of hemolysis in only 25% of PNH cases?

    <p>Increased blood pH during sleep</p> Signup and view all the answers

    What factor may contribute to thrombosis in patients with PNH?

    <p>Absorption of free hemoglobin by NO</p> Signup and view all the answers

    How is the mechanism of thrombosis in PNH suspected to involve endothelial damage?

    <p>By inhibiting C5-9 membrane attack complex</p> Signup and view all the answers

    What is a suspected contributing factor to the development of acute myeloid leukemia or myelodysplastic syndrome in PNH patients?

    <p>Genetic damage to hematopoietic stem cells</p> Signup and view all the answers

    What type of antibody testing is typically used to characterize the antigen target and temperature dependence in PNH?

    <p>Coomb's test</p> Signup and view all the answers

    In PNH, what does the presence of a second population of CD55+/CD59+ red cells indicate?

    <p>Residual normal hematopoietic stem cells</p> Signup and view all the answers

    How is the ability of a patient's serum to agglutinate commercially available red cells used in PNH diagnosis?

    <p>Determine antigen target and temperature dependence</p> Signup and view all the answers

    What is a suspected role that endothelial damage plays in thrombosis development in PNH?

    <p>Contributes to NO depletion by free hemoglobin</p> Signup and view all the answers

    What might be a contributing factor to the development of acute myeloid leukemia or myelodysplastic syndrome in some PNH patients?

    <p>'Normal' hematopoietic stem cells present</p> Signup and view all the answers

    What is the cardinal role of complement activation in paroxysmal nocturnal hemoglobinuria (PNH) pathogenesis?

    <p>Enhances red cell hemolysis</p> Signup and view all the answers

    What is the main drawback to using a monoclonal antibody called Eculizumab for treating PNH?

    <p>High cost of therapy</p> Signup and view all the answers

    Which type of antibody is most commonly the cause of warm antibody immunohemolytic anemia?

    <p>IgG</p> Signup and view all the answers

    What is the primary method for diagnosing paroxysmal nocturnal hemoglobinuria (PNH)?

    <p>Flow cytometry</p> Signup and view all the answers

    How does IgG-coated red cell removal differ in hereditary spherocytosis (HS) compared to warm antibody immunohemolytic anemia?

    <p>Is primarily intravascular in HS</p> Signup and view all the answers

    Why is there an increased risk of serious meningococcal infection in individuals receiving C5 inhibitor therapy for PNH?

    <p>Inhibition of terminal complement activation</p> Signup and view all the answers

    What class of antibodies are less commonly implicated as culprits in warm antibody immunohemolytic anemia?

    <p>IgA</p> Signup and view all the answers

    Which method provides a sensitive means for detecting red cells deficient in GPI-linked proteins in the diagnosis of PNH?

    <p>Flow cytometry</p> Signup and view all the answers

    What is the preferred designation for disorders commonly referred to as autoimmune hemolytic anemias?

    <p>Immuno-hemolytic anemia</p> Signup and view all the answers

    In drug-induced immuno-hemolytic anemia, how do antigenic drugs lead to hemolysis?

    <p>By creating new antigenic determinants on red cell membranes</p> Signup and view all the answers

    What is the characteristic mechanism of action of antibodies in drug-induced immuno-hemolytic anemia?

    <p>Fixing complement leading to intravascular hemolysis</p> Signup and view all the answers

    What is the primary cause of primary immunohemolytic anemia according to the text?

    <p>Unknown</p> Signup and view all the answers

    Which proteins are involved in tolerance-breaking during immuno-hemolytic anemia?

    <p>Rh blood group complex proteins</p> Signup and view all the answers

    What is the primary method used to diagnose immunohemolytic anemia?

    <p>Direct Coombs test</p> Signup and view all the answers

    Which type of antibodies are active at below 37°C in cold agglutinin type immunohemolytic anemia?

    <p>IgM antibodies</p> Signup and view all the answers

    What is the primary role of the direct Coombs antiglobulin test in diagnosing immunohemolytic anemia?

    <p>Detecting antibodies and/or complement on red cells</p> Signup and view all the answers

    Which viral infections are commonly associated with the development of acute cold hemolysin type immunohemolytic anemia?

    <p>Measles</p> Signup and view all the answers

    In which type of immunohemolytic anemia do IgG antibodies become active at 37°C?

    <p>Warm antibody type</p> Signup and view all the answers

    What is the characteristic action of specific antibodies in the direct Coombs antiglobulin test?

    <p>Agglutination</p> Signup and view all the answers

    What distinguishes primary warm antibody type immunohemolytic anemia from secondary warm antibody type?

    <p>'Idiopathic' classification</p> Signup and view all the answers

    In which scenario would the antibodies in the direct Coombs antiglobulin test NOT cause agglutination of red cells?

    <p>'Cold' antibody activity above 37°C</p> Signup and view all the answers

    'Rare; occurs mainly in children following viral infections' describes which type of immunohemolytic anemia?

    <p>'Cold hemolysin' type</p> Signup and view all the answers

    'Acute (mycoplasmal infection, infectious mononucleosis)' is associated with which category of immunohemolytic anemia?

    <p>'Cold agglutinin' type</p> Signup and view all the answers

    What type of autoantibodies are responsible for paroxysmal cold hemoglobinuria?

    <p>IgG</p> Signup and view all the answers

    In which body regions do the autoantibodies bind to the red cell surface in paroxysmal cold hemoglobinuria?

    <p>Peripheral regions</p> Signup and view all the answers

    What type of hemolysis occurs when the red cells recirculate to the warm core in paroxysmal cold hemoglobinuria?

    <p>Intravascular hemolysis</p> Signup and view all the answers

    What is the primary feature that distinguishes chronic cold agglutinin immunohemolytic anemia from paroxysmal cold hemoglobinuria?

    <p>Antibody type involved</p> Signup and view all the answers

    Which antibody type leads to the removal of red cells by phagocytes in chronic cold agglutinin immunohemolytic anemia?

    <p>IgM</p> Signup and view all the answers

    What feature may cause pallor, cyanosis, and Raynaud phenomenon in individuals with agglutinated red cells?

    <p>Hypoxia</p> Signup and view all the answers

    Which region of the body is most commonly exposed to cold temperatures leading to manifestations of chronic cold agglutinin immunohemolytic anemia?

    <p>Hands and feet</p> Signup and view all the answers

    What is the primary mechanism by which phagocytes remove red cells in chronic cold agglutinin immunohemolytic anemia?

    <p>'Opsonization' mediated by C3b deposition from IgM antibodies</p> Signup and view all the answers

    What is the primary cause of chronic cold agglutinin immunohemolytic anemia according to the text?

    <p>IgM antibodies binding to red cells at low temperatures</p> Signup and view all the answers

    Which condition is commonly associated with microangiopathic hemolytic anemia and microvascular lesions?

    <p>Disseminated intravascular coagulation (DIC)</p> Signup and view all the answers

    What is the most common cause of transient cold agglutinin antibodies according to the text?

    <p>Mycoplasma pneumoniae infection</p> Signup and view all the answers

    What is the common pathogenic feature among disorders leading to intravascular hemolysis and the appearance of red cell fragments?

    <p>Thrombi deposition</p> Signup and view all the answers

    In hereditary spherocytosis, which genetic characteristic leads to the eventual conversion of red cells to spherocytes?

    <p>Mutations affecting red cell membrane skeleton</p> Signup and view all the answers

    What is the cardinal role of IgM binding in cold agglutinin immunohemolytic anemia?

    <p>Fixing complement rapidly</p> Signup and view all the answers

    What is the main consequence of mutations in a- or ẞ-globin causing thalassemias?

    <p>Microcytic, hypochromic anemia</p> Signup and view all the answers

    What is the characteristic feature of chronic cold agglutinin immunohemolytic anemia that distinguishes it from other types?

    <p>Symptomatic manifestation in vascular beds with low temperatures</p> Signup and view all the answers

    Which term best describes the red cell fragments seen in blood smears in cases of traumatic damage?

    <p>&quot;Burr cells&quot;</p> Signup and view all the answers

    What is the self-limited nature of transient cold agglutinin antibodies primarily attributed to?

    <p>Release of IgM before hemolysis can occur</p> Signup and view all the answers

    Which factor contributes to the rarity of clinically important hemolysis in some cold agglutinin immunohemolytic anemia cases?

    <p>Rapid clearance of IgM from circulation</p> Signup and view all the answers

    What is the primary issue leading to microangiopathic hemolytic anemia in malignant hypertension?

    <p>Shear forces from turbulent blood flow</p> Signup and view all the answers

    What differentiates chronic cold agglutinin immunohemolytic anemia from other disorders involving IgM antibodies?

    <p>Red cell agglutination in colder regions</p> Signup and view all the answers

    Which disorder manifests with anemia and splenomegaly due to mutations affecting the red cell membrane skeleton?

    <p>&quot;Hereditary Spherocytosis&quot;</p> Signup and view all the answers

    'Fixing complement rapidly' as mentioned in the text refers to what aspect of cold agglutinin immunohemolytic anemia?

    <p>'Complement-mediated intravascular hemolysis'</p> Signup and view all the answers

    What is the primary cause of hemolysis in thrombotic thrombocytopenic purpura (TTP) and malignant hypertension?

    <p>&quot;Schistocytes&quot;</p> Signup and view all the answers

    What is the primary consequence of unpaired alpha-globin chains in Beta-thalassemia?

    <p>Impaired erythropoiesis</p> Signup and view all the answers

    Which condition is primarily characterized by episodic blockage of vessels by sickle red cells?

    <p>Sickle Cell Anemia</p> Signup and view all the answers

    In Glucose-6-Phosphate Dehydrogenase Deficiency, red cells are susceptible to damage due to mutations that destabilize which enzyme?

    <p>G6PD</p> Signup and view all the answers

    Immunohemolytic Anemias can be caused by antibodies against red cell constituents or antigens modified by haptens. What is the consequence of antibody binding in these anemias?

    <p>Red cell extravascular hemolysis</p> Signup and view all the answers

    What is a key characteristic of Microangiopathic Hemolytic Anemia based on the provided information?

    <p>Fragmentation of red cells</p> Signup and view all the answers

    What distinguishes Sickle Cell Anemia from other types of anemias due to hemoglobinopathies?

    <p>Deoxygenated hemoglobin self-association</p> Signup and view all the answers

    What is the consequence of red cell membrane damage caused by repeated bouts of sickling in Sickle Cell Anemia?

    <p>Moderate to severe hemolytic anemia</p> Signup and view all the answers

    In Glucose-6-Phosphate Dehydrogenase Deficiency, why are red cells susceptible to oxidant damage?

    <p>Mutations destabilizing G6PD</p> Signup and view all the answers

    What is a key feature of Hemolytic Uremic Syndrome based on the provided information?

    <p>Fragmented red cells in blood smear</p> Signup and view all the answers

    What is the primary cause of damage to red cell precursors in ß-thalassemia?

    <p>Unpaired a-globin chains</p> Signup and view all the answers

    What is the primary consequence of a deficiency of vitamin B12 and folic acid in red cell production?

    <p>Inadequate nuclear maturation</p> Signup and view all the answers

    Which category of anemias is most commonly associated with red cell underproduction due to nutritional deficiencies?

    <p>Anemias caused by stem cell depletion</p> Signup and view all the answers

    What is a major extrinsic cause of diminished erythropoiesis that is clinically significant?

    <p>Nutritional deficiencies of vitamin B12 and folic acid</p> Signup and view all the answers

    Inadequate DNA synthesis due to vitamin B12 or folic acid deficiency primarily affects which aspect of red blood cell development?

    <p>Nuclear maturation</p> Signup and view all the answers

    What is the most common cause of anemia associated with red cell underproduction?

    <p>Nutritional deficiencies</p> Signup and view all the answers

    Which type of disorders can lead to generalized bone marrow failure, resulting in anemia?

    <p>Primary hematopoietic neoplasms</p> Signup and view all the answers

    Which intrinsic cause can result in diminished erythropoiesis?

    <p>Genetic mutations affecting hemoglobin synthesis</p> Signup and view all the answers

    'Pernicious anemia' is the major form of anemia associated with the deficiency of which vitamin?

    <p>Vitamin B12</p> Signup and view all the answers

    'Folate deficiency anemia' is primarily characterized by the deficiency of which essential nutrient?

    <p>Folic acid</p> Signup and view all the answers

    What is a common theme among the various causes of megaloblastic anemia?

    <p>Impairment of DNA synthesis</p> Signup and view all the answers

    Which condition can lead to decreased intake resulting in megaloblastic anemia?

    <p>Vegetarianism</p> Signup and view all the answers

    What is a potential cause of impaired absorption leading to megaloblastic anemia?

    <p>Intrinsic factor deficiency</p> Signup and view all the answers

    Which factor could contribute to increased loss of folic acid and result in megaloblastic anemia?

    <p>Hemodialysis</p> Signup and view all the answers

    What might lead to an increased requirement for folic acid in the body and contribute to megaloblastic anemia?

    <p>Pregnancy</p> Signup and view all the answers

    Which of the following is NOT a potential cause of megaloblastic anemia due to decreased intake?

    <p>'Carnivorous' diet</p> Signup and view all the answers

    Competitive parasitic uptake leading to megaloblastic anemia can be seen in cases of:

    <p>'Fish tapeworm' infestation</p> Signup and view all the answers

    'Unresponsive to Vitamin B12 or Folic Acid Therapy' in megaloblastic anemia may be due to the use of:

    <p>'Folic acid' antagonists</p> Signup and view all the answers

    'Pernicious anemia' is usually associated with which impairment that contributes to megaloblastic anemia?

    <p>'Intrinsic factor' deficiency</p> Signup and view all the answers

    What is a highly characteristic feature of red cells in megaloblastic anemia?

    <p>Large size and oval shape</p> Signup and view all the answers

    What is the primary reason that most macrocytes in megaloblastic anemia lack the central pallor?

    <p>Elevated mean cell hemoglobin content</p> Signup and view all the answers

    What is the term used to describe the variation in red cell size observed in megaloblastic anemia?

    <p>Anisocytosis</p> Signup and view all the answers

    What is a significant difference between neutrophils in megaloblastic anemia and normal neutrophils?

    <p>Nuclear hypersegmentation</p> Signup and view all the answers

    What is a distinctive feature of the most primitive red cell progenitors in megaloblastic anemia?

    <p>Fine nuclear chromatin pattern</p> Signup and view all the answers

    What is the primary reason for nuclear-to-cytoplasmic asynchrony in megaloblastic anemia?

    <p>Delayed nuclear maturation</p> Signup and view all the answers

    Which type of cells occasionally appear in the circulating blood of severe anemia cases?

    <p>'Promegaloblasts'</p> Signup and view all the answers

    What is the primary site for the association of vitamin B12 with transcobalamin II before secretion into the plasma?

    <p>Ileum</p> Signup and view all the answers

    Which cells express a receptor for intrinsic factor called cubilin on their surfaces during the absorption of vitamin B12 in the ileum?

    <p>Ileal enterocytes</p> Signup and view all the answers

    What is the salivary protein that vitamin B12 binds to, eventually released in the duodenum, during its absorption process?

    <p>Haptocorrin</p> Signup and view all the answers

    Which organ stores sufficient intrahepatic reserves of vitamin B12 from animal product-rich diets?

    <p>Liver</p> Signup and view all the answers

    In a macrobiotic diet, what essential nutrient is often inadequately provided due to its low content in plants and vegetables?

    <p>Vitamin B12</p> Signup and view all the answers

    Which enzyme, found in the pancreas, plays a role in releasing bound vitamin B12 from haptocorrin in the duodenum?

    <p>Proteases</p> Signup and view all the answers

    What is the essential factor secreted by parietal cells of the fundic mucosa required for absorption of vitamin B12?

    <p>Intrinsic factor</p> Signup and view all the answers

    Abundant amounts of vitamin B12 are typically found in diets that include which type of food products?

    <p>Animal products</p> Signup and view all the answers

    Which process occurs in the stomach to release vitamin B12 from binding proteins in food?

    <p>Action of pepsin</p> Signup and view all the answers

    What is the primary consequence of impaired intrinsic factor production in pernicious anemia?

    <p>Decreased vitamin B12 uptake</p> Signup and view all the answers

    What is the characteristic feature of orthochromatic megaloblasts in vitamin B12 deficiency anemia?

    <p>Cytoplasmic coloration</p> Signup and view all the answers

    What is the consequence of ineffective hematopoiesis in megaloblastic anemia?

    <p>Apoptosis of precursors in the marrow</p> Signup and view all the answers

    Which nutritional source can provide vitamin B12 essential for normal metabolism?

    <p>Dairy products</p> Signup and view all the answers

    What is the role of erythropoietin in the context of vitamin B12 deficiency anemia?

    <p>Compensates for ineffective hematopoiesis</p> Signup and view all the answers

    What is the primary mechanism through which pernicious anemia leads to megaloblastic anemia?

    <p>Impaired DNA replication</p> Signup and view all the answers

    How does the immune response in pernicious anemia contribute to the disease process?

    <p>Damages gastric mucosal cells</p> Signup and view all the answers

    What distinguishes orthochromatic megaloblasts from normal orthochromatic normoblasts?

    <p>Immature chromatin</p> Signup and view all the answers

    What is the role of intrinsic factor in vitamin B12 metabolism?

    <p>Necessary for vitamin B12 uptake from the gut</p> Signup and view all the answers

    What is the mechanism behind impaired DNA synthesis in vitamin B12 deficiency?

    <p>Exacerbated folate polyglutamates</p> Signup and view all the answers

    Why is folate considered the proximate cause of anemia in vitamin B12 deficiency?

    <p>Leads to anemia improvement post-folic acid administration</p> Signup and view all the answers

    Which enzyme's deficiency is associated with elevated plasma levels of methylmalonic acid?

    <p>Methylmalonyl-Coenzyme A Mutase</p> Signup and view all the answers

    Which vitamin is required for the synthesis of methionine, contributing to folate polyglutamates?

    <p>Vitamin B12</p> Signup and view all the answers

    What leads to the formation and incorporation of abnormal fatty acids into neuronal lipids in vitamin B12 deficiency?

    <p>Increased plasma methylmalonic acid</p> Signup and view all the answers

    Why do neurologic complications in vitamin B12 deficiency not improve with folate administration?

    <p>Folate traps N-methyl FH4</p> Signup and view all the answers

    What does the enzyme methylmalonyl-coenzyme A mutase require for its functioning?

    <p>Adenosylcobalamin</p> Signup and view all the answers

    What is the consequence of a deficiency in metabolically active polyglutamylated forms of FH4?

    <p>-Cbl reaction inhibition</p> Signup and view all the answers

    Which molecule serves as an essential cofactor in the conversion of homocysteine to methionine by methionine synthase?

    <p>Tetrahydrofolic acid (FH)</p> Signup and view all the answers

    What is the principal form of folic acid in plasma that recovers a methyl group in the conversion of homocysteine to methionine?

    <p>N-methyltetrahydrofolic acid (N-methyl FH4)</p> Signup and view all the answers

    What is crucial for the conversion of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP)?

    <p>Tetrahydrofolic acid (FH)</p> Signup and view all the answers

    What is converted to tetrahydrofolic acid (FH) in the process of recovering a methyl group from N-methyltetrahydrofolic acid?

    <p>N-methyltetrahydrofolic acid (N-methyl FH4)</p> Signup and view all the answers

    What is a building block for DNA synthesis that is produced from one-carbon fragments derived from serine?

    <p>Deoxythymidine monophosphate (dTMP)</p> Signup and view all the answers

    Which molecule is required for the conversion of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP)?

    <p>Tetrahydrofolic acid (FH)</p> Signup and view all the answers

    What is recovered from N-methyltetrahydrofolic acid in the process of converting homocysteine to methionine?

    <p>Methyl group</p> Signup and view all the answers

    Which molecule is necessary for the transfer of one-carbon fragments in the synthesis of biologic macromolecules?

    <p>(FH4) tetrahydrofolic acid</p> Signup and view all the answers

    What is a plausible explanation for the lack of myelin breakdown in rare individuals with hereditary deficiencies of methylmalonyl-coenzyme A mutase?

    <p>Absence of folate sequestration as N-methyl FH4</p> Signup and view all the answers

    In which racial groups does pernicious anemia occur, according to the text?

    <p>Scandinavian, Caucasian, and African descent populations</p> Signup and view all the answers

    What is the median age at diagnosis for pernicious anemia?

    <p>60 years</p> Signup and view all the answers

    What is believed to be the cause of pernicious anemia, according to the text?

    <p>Autoimmune attack on the gastric mucosa</p> Signup and view all the answers

    What is the primary consequence of cobalamin (Cbl) deficiency in terms of DNA synthesis?

    <p>Deprivation of folate coenzyme for thymidylate synthetase</p> Signup and view all the answers

    What is the relationship between N'-methyl FH4, methionine synthase, and thymidylate synthetase in the context of pernicious anemia?

    <p>Folate deprivation impairs thymidylate synthetase function</p> Signup and view all the answers

    Why do rare individuals with hereditary deficiencies of methylmalonyl-coenzyme A mutase not experience abnormalities like myelin breakdown?

    <p>No folate coenzyme deprivation for thymidylate synthetase</p> Signup and view all the answers

    What is suspected to be a genetic predisposition in individuals with pernicious anemia?

    <p>Formation of antibodies against multiple self antigens</p> Signup and view all the answers

    What is the primary role of type II antibodies present in patients with chronic atrophic gastritis?

    <p>To prevent binding of intrinsic factor-vitamin B12 complex</p> Signup and view all the answers

    What do type III antibodies in patients with chronic atrophic gastritis recognize?

    <p>The a and ß subunits of the gastric proton pump</p> Signup and view all the answers

    What is the percentage of patients with chronic atrophic gastritis who have type III antibodies?

    <p>80%</p> Signup and view all the answers

    Which antibody is NOT specific as it is found in older adults with idiopathic chronic gastritis?

    <p>Type III antibody</p> Signup and view all the answers

    What is the characteristic feature of the histological appearance of chronic atrophic gastritis in patients?

    <p>Loss of parietal cells</p> Signup and view all the answers

    What do type I antibodies do in patients with chronic atrophic gastritis?

    <p>Block the binding of vitamin B12 to intrinsic factor</p> Signup and view all the answers

    'Megaloblastic changes in mucosal cells similar to those found in erythroid precursors' are characteristic changes seen in patients with chronic atrophic gastritis due to a deficiency in which vitamin?

    <p>$B12$</p> Signup and view all the answers

    'Loss of parietal cells' observed in chronic atrophic gastritis leads to a decrease in the production of which crucial substance?

    <p>$HCl$</p> Signup and view all the answers

    'Prominent infiltrate of lymphocytes and plasma cells' seen histologically in chronic atrophic gastritis indicates what type of immune response?

    <p>$Cell-mediated$ response</p> Signup and view all the answers

    What clinical manifestations can occur due to demyelination of the dorsal and lateral spinal tracts?

    <p>Spastic paraparesis and sensory ataxia</p> Signup and view all the answers

    What is a characteristic feature of individuals with pernicious anemia by the time it comes to medical attention?

    <p>Moderate to severe megaloblastic anemia</p> Signup and view all the answers

    Which laboratory finding is specific for pernicious anemia?

    <p>Low serum vitamin B12 levels</p> Signup and view all the answers

    What is a confirmatory test for the diagnosis of pernicious anemia?

    <p>Outpouring of reticulocytes after parenteral administration of vitamin B12</p> Signup and view all the answers

    Which condition are individuals with atrophy and metaplasia of the gastric mucosa due to pernicious anemia at an increased risk for?

    <p>Gastric carcinoma</p> Signup and view all the answers

    How does treatment with parenteral or high-dose oral vitamin B12 affect the progression of peripheral neurologic disease in pernicious anemia?

    <p>Halts or reverses the progression of peripheral neurologic disease</p> Signup and view all the answers

    What is the primary role of serum antibodies to intrinsic factor in diagnosing pernicious anemia?

    <p>Highly specific for pernicious anemia</p> Signup and view all the answers

    What risk factor is unaffected by treatment with vitamin B12 in pernicious anemia?

    <p>Risk for gastric carcinoma</p> Signup and view all the answers

    What is thought to be the primary cause of the gastric pathology discussed in the text?

    <p>Autoreactive T-cell response</p> Signup and view all the answers

    In pernicious anemia, which autoimmune disorders are particularly associated with the condition?

    <p>Autoimmune thyroiditis and adrenalitis</p> Signup and view all the answers

    What happens when intrinsic factor-secreting cells fall below a certain threshold in the context of vitamin B12 deficiency?

    <p>Anemia develops</p> Signup and view all the answers

    Which of the following conditions can lead to vitamin B12 deficiency in ways outlined in Table 14.5 of the text?

    <p>Gastrectomy and intrinsic factor loss</p> Signup and view all the answers

    Why can't vitamin B12 be released from haptocorrin-vitamin B12 complexes in cases of exocrine pancreatic insufficiency?

    <p>Loss of intrinsic factor</p> Signup and view all the answers

    How can tapeworms potentially contribute to inducing a deficiency state in vitamin B12?

    <p>By competing for vitamin B12</p> Signup and view all the answers

    What occurs if red cells with Heinz bodies pass through the splenic cords according to the text?

    <p>&quot;They are physiologically processed by the spleen&quot;</p> Signup and view all the answers

    "Why does chronic hypoxia in sickle cell disease lead to organ damage in the heart, kidneys, and lungs?"

    <p>&quot;As a result of microvascular occlusion&quot;</p> Signup and view all the answers

    What is the most characteristic alteration seen in the stomach of patients with pernicious anemia?

    <p>Intestinal metaplasia</p> Signup and view all the answers

    What term is used to describe the shiny, glazed appearance of the tongue in patients with pernicious anemia?

    <p>Atrophic glossitis</p> Signup and view all the answers

    Which of the following is a characteristic central nervous system manifestation seen in cases of florid pernicious anemia?

    <p>Ataxia</p> Signup and view all the answers

    What is the primary reason why the 'megaloblastic' changes in the bone marrow and gut are reversible in pernicious anemia?

    <p>Parenteral administration of vitamin B12</p> Signup and view all the answers

    Which statement regarding the persistence of gastric atrophy and metaplastic changes after parenteral vitamin B12 administration is true?

    <p>'Megaloblastic' changes are responsible for this phenomenon</p> Signup and view all the answers

    What may a shiny, glazed appearance of the tongue indicate in a patient with pernicious anemia?

    <p>Atrophic glossitis</p> Signup and view all the answers

    'Fundic gland atrophy' in pernicious anemia affects which type of cells in the stomach?

    <p>'Parietal' cells</p> Signup and view all the answers

    What distinguishes the 'megaloblastic' change seen in the marrow and gut from the gastric atrophy and metaplastic changes in pernicious anemia?

    <p>'Megaloblastic' changes are irreversible</p> Signup and view all the answers

    What serves as the biologic 'middleman' in a series of swaps involving one-carbon moieties?

    <p>Folic acid derivatives</p> Signup and view all the answers

    Which enzyme is susceptible to inhibition by various drugs in the process of folate metabolism?

    <p>Dihydrofolate reductase</p> Signup and view all the answers

    Which metabolic process is NOT mentioned as depending on one-carbon transfers involving folic acid derivatives?

    <p>Heme synthesis</p> Signup and view all the answers

    What is the role of dihydrofolate reductase in folate metabolism?

    <p>Reduction of dihydrofolic acid to FH4</p> Signup and view all the answers

    In which reaction is dihydrofolate produced that requires dihydrofolate reductase for recycling back into the folate pool?

    <p>dTMP synthesis</p> Signup and view all the answers

    Which process in folate metabolism requires FH2 to be reduced by dihydrofolate reductase?

    <p>dTMP synthesis</p> Signup and view all the answers

    What is the common denominator of folic acid and vitamin B12 deficiency?

    <p>Suppressed synthesis of DNA</p> Signup and view all the answers

    Which process destroys up to 95% of the folate content in foods?

    <p>Boiling, steaming, or frying food</p> Signup and view all the answers

    What form is the folic acid primarily found in animal sources?

    <p>Folylpolyglutamates</p> Signup and view all the answers

    Where are monoglutamates absorbed during intestinal absorption?

    <p>Proximal jejunum</p> Signup and view all the answers

    What modification happens to monoglutamates during intestinal absorption?

    <p>Conversion to 5-methyltetrahydrofolate</p> Signup and view all the answers

    Which of the following cooking methods is most detrimental to folate content?

    <p>Deep-frying food in oil</p> Signup and view all the answers

    What are the three major causes of folic acid deficiency mentioned in the text?

    <p>Decreased intake, increased requirements, impaired utilization</p> Signup and view all the answers

    Which part of the intestine absorbs monoglutamates?

    <p>'J' shaped jejunum</p> Signup and view all the answers

    What is a consequence of a folate deficiency in the body?

    <p>Excessive urinary loss of folate</p> Signup and view all the answers

    Why might individuals with alcoholism and cirrhosis experience folate deficiency?

    <p>Trapping of folate within the liver</p> Signup and view all the answers

    Which group is most likely to have inadequate dietary intake of folate?

    <p>Chronic alcoholics</p> Signup and view all the answers

    What impact does sprue have on folate absorption in the body?

    <p>Reduces folate absorption</p> Signup and view all the answers

    How do certain drugs like phenytoin affect folate absorption?

    <p>Interfere with absorption</p> Signup and view all the answers

    What characteristic of folic acid antagonists like methotrexate leads to a deficiency of FH4?

    <p>Inhibition of dihydrofolate reductase</p> Signup and view all the answers

    In what way do chemotherapeutic drugs used in cancer treatment affect rapidly proliferating tissues?

    <p>Cause megaloblastic changes</p> Signup and view all the answers

    What makes the diagnosis of folate deficiency similar to that of vitamin B12 deficiency?

    <p>Increased serum homocysteine levels</p> Signup and view all the answers

    Which factor does NOT occur as a consequence of folic acid deficiency compared to iron deficiency?

    <p>Increased serum folate levels</p> Signup and view all the answers

    How do serum homocysteine levels typically differ between folate deficiency and normal conditions?

    <p>Markedly elevated</p> Signup and view all the answers

    What is the primary distinguishing factor between folic acid deficiency and vitamin B12 deficiency in terms of red cell morphology?

    <p>Nucleus-to-cytoplasm ratio</p> Signup and view all the answers

    Why is the diagnosis of folate deficiency dependent on demonstrating decreased serum or red cell folate levels?

    <p>To distinguish it from vitamin B12 deficiency</p> Signup and view all the answers

    What is the approximate percentage of absorbable heme iron in the normal daily Western diet?

    <p>20%</p> Signup and view all the answers

    Where is about 80% of the functional iron found in the body?

    <p>Hemoglobin</p> Signup and view all the answers

    What percentage of the total body iron is stored in the hemosiderin and ferritin pool?

    <p>15% to 20%</p> Signup and view all the answers

    Why do healthy young females typically have smaller iron stores than males?

    <p>Blood loss during menstruation</p> Signup and view all the answers

    Which group of enzymes contains some of the functional iron in the body apart from hemoglobin and myoglobin?

    <p>Catalase and cytochromes</p> Signup and view all the answers

    What causes iron deficiency in many females during menstruation and pregnancy?

    <p>Blood loss</p> Signup and view all the answers

    Which type of iron is predominantly found in animal products in the Western diet?

    <p>Heme iron</p> Signup and view all the answers

    What is a common storage site for storage iron in the body apart from the liver?

    <p>Spleen</p> Signup and view all the answers

    What is the primary function of plasma transferrin in the body?

    <p>Transporting iron to cells for hemoglobin synthesis</p> Signup and view all the answers

    What is the major role of ferritin in the body?

    <p>Sequestering storage iron and preventing toxicity</p> Signup and view all the answers

    Which protein-iron complex is found at highest levels in the liver, spleen, bone marrow, and skeletal muscles?

    <p>Ferritin</p> Signup and view all the answers

    What is the primary role of erythroid precursors in the context of iron metabolism?

    <p>Requiring iron for hemoglobin synthesis</p> Signup and view all the answers

    Which population in the United States is particularly common to have iron deficiency anemia?

    <p>Adolescent girls</p> Signup and view all the answers

    What is the average serum iron level in men?

    <p>$120$ µg/dL</p> Signup and view all the answers

    How is iron primarily transported in plasma in the body?

    <p>By transferrin</p> Signup and view all the answers

    What happens when transferrin is about one-third saturated with iron?

    <p>$120$ µg/dL serum iron level is reached</p> Signup and view all the answers

    What mechanism mediates iron import into cells from plasma?

    <p>$eta$-receptor-mediated endocytosis</p> Signup and view all the answers

    What is the primary role of hephaestin and ceruloplasmin in iron transport in duodenal cells?

    <p>Convert Fe2+ iron to Fe iron</p> Signup and view all the answers

    What is the primary function of ferroportin in duodenal cells?

    <p>Transport Fe²+ iron across the enterocyte membrane</p> Signup and view all the answers

    What is the effect of high levels of hepcidin on iron absorption in duodenal cells?

    <p>Traps iron within duodenal cells</p> Signup and view all the answers

    Which molecule facilitates the delivery of iron to red cell progenitors in the bone marrow?

    <p>Transferrin</p> Signup and view all the answers

    In which process is iron oxidized from Fe2+ to Fe iron?

    <p>Carried out by hephaestin and ceruloplasmin</p> Signup and view all the answers

    What happens when hepcidin binds to ferroportin in duodenal cells?

    <p>Causes ferroportin degradation</p> Signup and view all the answers

    What is the primary role of DMT1 in the context of iron transport?

    <p>Mediates uptake of functional iron into red cell precursors</p> Signup and view all the answers

    What role does transferrin play in iron transport from duodenal cells?

    <p>Delivers absorbed iron to red cell progenitors</p> Signup and view all the answers

    How is luminal nonheme iron mainly found?

    <p>In the Fe3+ state</p> Signup and view all the answers

    What is the primary pathway for the absorption of nonheme iron?

    <p>Transport by DMT1</p> Signup and view all the answers

    What percentage of dietary nonheme iron is typically absorbed?

    <p>Less than 5%</p> Signup and view all the answers

    Which type of iron is absorbed more efficiently from animal proteins like hemoglobin and myoglobin?

    <p>Heme iron</p> Signup and view all the answers

    What happens to absorption of iron as body stores increase?

    <p>Absorption decreases</p> Signup and view all the answers

    How does the absorption of nonheme iron get affected by substances in the diet that stabilize Fe3+ iron?

    <p>Inhibited</p> Signup and view all the answers

    Which transporter is responsible for moving heme iron across the apical membrane?

    <p>Heme transporters</p> Signup and view all the answers

    What must happen to luminal nonheme iron before it can be transported across the apical membrane?

    <p>It must be reduced to Fe2+ iron</p> Signup and view all the answers

    What is the primary storage site for iron in the body apart from the liver?

    <p>Spleen</p> Signup and view all the answers

    Which cells are primarily responsible for extracting iron from hemoglobin of ingested red cells?

    <p>Macrophages</p> Signup and view all the answers

    At equilibrium, what balances the iron absorbed from the gut?

    <p>Blood loss through shedding</p> Signup and view all the answers

    What is the primary function of plasma transferrin in iron metabolism?

    <p>Transport of iron to red cell precursors</p> Signup and view all the answers

    What is the consequence of iron overload within cells?

    <p>Storage of most iron in ferritin</p> Signup and view all the answers

    In iron deficiency, what is the typical level of serum ferritin?

    <p>&lt; 12 µg/L</p> Signup and view all the answers

    What triggers the mobilization of the storage iron pool when iron requirements increase?

    <p>Loss of blood</p> Signup and view all the answers

    Where are trace amounts of hemosiderin mainly found in the body?

    <p>Macrophages in bone marrow and spleen</p> Signup and view all the answers

    What is the primary role of hepcidin in iron metabolism?

    <p>Suppressing iron uptake from enterocytes</p> Signup and view all the answers

    How do mutations that disable TMPRSS6 affect hepcidin production?

    <p>Increase hepcidin levels</p> Signup and view all the answers

    In which condition is hepcidin activity inappropriately low?

    <p>Secondary hemochromatosis</p> Signup and view all the answers

    Which type of anemia is caused by mutations in hepcidin or its regulatory genes?

    <p>Primary hemochromatosis</p> Signup and view all the answers

    What is the primary effect of high hepcidin levels in patients with TMPRSS6 mutations?

    <p>Failure to respond to iron therapy</p> Signup and view all the answers

    How do inflammatory mediators contribute to the anemia of chronic inflammation?

    <p>Increase hepcidin production</p> Signup and view all the answers

    What is the consequence of disabling TMPRSS6 in relation to iron absorption?

    <p>Decreased iron absorption</p> Signup and view all the answers

    How do mutations in hepcidin contribute to primary hemochromatosis?

    <p>Increase hepcidin production</p> Signup and view all the answers

    What is the effect of high hepcidin levels on iron absorption?

    <p>Suppressed iron release from macrophages.</p> Signup and view all the answers

    What does hepcidin inhibit in the context of iron metabolism?

    <p>Iron absorption and iron release from macrophages.</p> Signup and view all the answers

    What is the primary cause of iron deficiency according to the text?

    <p>Dietary lack</p> Signup and view all the answers

    Which dietary component enhances the absorption of inorganic iron?

    <p>Ascorbic acid</p> Signup and view all the answers

    What percentage of ingested iron is typically absorbed according to the text?

    <p>15-20%</p> Signup and view all the answers

    In which form is most dietary iron found in high-income countries?

    <p>Heme in meat</p> Signup and view all the answers

    Which dietary component inhibits the absorption of inorganic iron?

    <p>Tannates</p> Signup and view all the answers

    What is the daily iron requirement for adult women according to the text?

    <p>$7-20$ mg</p> Signup and view all the answers

    What is the main influence on the absorption of dietary iron according to the text?

    <p>$2/3$ heme content</p> Signup and view all the answers

    What is the primary role of plasma hepcidin when liver iron levels are high?

    <p>Decreasing iron uptake and increasing iron loss</p> Signup and view all the answers

    In which scenario would hepcidin levels typically fall according to the text?

    <p>Low plasma iron</p> Signup and view all the answers

    What happens to hepcidin levels in the context of systemic inflammation?

    <p>Rise</p> Signup and view all the answers

    Which protein is primarily responsible for moving heme iron across the apical membrane in duodenal epithelial cells?

    <p>Hephaestin</p> Signup and view all the answers

    When liver iron levels are high, what is the outcome on iron uptake and loss according to the text?

    <p>Decreased iron uptake and increased iron loss</p> Signup and view all the answers

    What is the main role of Divalent Metal Transporter 1 (DMT1) in the process of iron transport?

    <p>Facilitating transport of nonheme iron into cells</p> Signup and view all the answers

    What is the most common cause of iron deficiency in high income societies?

    <p>Chronic blood loss</p> Signup and view all the answers

    Who is at exceptionally high risk for iron deficiency due to multiple, closely spaced pregnancies?

    <p>Economically deprived women</p> Signup and view all the answers

    What is a potential consequence of prematurely ascribing iron deficiency in adults to a non-gastrointestinal cause?

    <p>Missing a gastrointestinal cancer</p> Signup and view all the answers

    Why must iron deficiency in adult men and postmenopausal women be attributed to gastrointestinal blood loss?

    <p>Gastrointestinal bleeding risk</p> Signup and view all the answers

    What does iron deficiency primarily lead to?

    <p>Inadequate hemoglobin production</p> Signup and view all the answers

    What is the most significant consequence of missing a gastrointestinal cancer due to falsely attributing iron deficiency in adults?

    <p>Delayed diagnosis of cancer</p> Signup and view all the answers

    Which group is particularly at risk for iron deficiency during pregnancy according to the text?

    <p>Pregnant women</p> Signup and view all the answers

    What is a potential manifestation of severe, long-standing iron deficiency beyond anemia?

    <p>Alopecia</p> Signup and view all the answers

    Which symptom is associated with the depletion of iron from the central nervous system due to iron deficiency?

    <p>Pica</p> Signup and view all the answers

    In the context of iron deficiency anemia, what triad of findings characterizes Plummer-Vinson syndrome?

    <p>Esophageal webs, microcytic hypochromic anemia, and atrophic glossitis</p> Signup and view all the answers

    What is one of the rare manifestations linked to the depletion of iron-containing enzymes throughout the body due to iron deficiency?

    <p>Koilonychia</p> Signup and view all the answers

    What is a common symptom associated with the appearance of pica in individuals affected by severe iron deficiency?

    <p>Craving for non-food items</p> Signup and view all the answers

    Which group of symptoms could indicate a diagnosis of Plummer-Vinson syndrome in a patient with microcytic hypochromic anemia?

    <p>Esophageal webs, atrophic glossitis, intestinal malabsorption</p> Signup and view all the answers

    What clinical feature is associated with the presence of fully hemoglobinized cells on a peripheral blood smear due to recent blood transfusion?

    <p>Reticulocytosis</p> Signup and view all the answers

    What is the primary morphological characteristic seen in the red cells of individuals with established iron deficiency anemia?

    <p>Small and hypochromic</p> Signup and view all the answers

    What is the diagnostically significant finding in the bone marrow associated with iron deficiency anemia?

    <p>Absence of stainable iron in macrophages</p> Signup and view all the answers

    What is the early hematological manifestation seen in individuals experiencing progressive depletion of iron reserves?

    <p>Lowered serum iron and transferrin saturation</p> Signup and view all the answers

    What is a common feature found in peripheral blood smears of individuals with anemia due to iron deficiency?

    <p>Small and pale red cells</p> Signup and view all the answers

    What is the primary consequence of complete depletion of iron stores before the onset of anemia in patients?

    <p>Lowered serum iron without producing anemia</p> Signup and view all the answers

    Which staining technique is best used to assess the presence or absence of stainable iron in macrophages in the bone marrow of individuals with iron deficiency anemia?

    <p>Prussian blue staining</p> Signup and view all the answers

    What morphological appearance is commonly seen in red cells on peripheral blood smears of individuals with early iron deficiency before the onset of anemia?

    <p>Small and polychromic</p> Signup and view all the answers

    'Pencil cells' are a characteristic feature seen in the peripheral blood smears of individuals with what type of anemia?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What is a characteristic of the serum iron and ferritin levels in patients with anemia of chronic inflammation?

    <p>Low serum iron and low ferritin</p> Signup and view all the answers

    What is the primary consequence of reduced iron stores inhibiting hepcidin synthesis in patients with anemia?

    <p>Falling serum hepcidin levels</p> Signup and view all the answers

    Which category of chronic illnesses can lead to anemia of chronic inflammation?

    <p>Autoimmune disorders</p> Signup and view all the answers

    In anemia of chronic inflammation, what is the typical relationship between serum iron and total iron-binding capacity?

    <p>Serum iron is low, total iron-binding capacity is high</p> Signup and view all the answers

    How does oral iron supplementation typically affect reticulocyte counts in patients with anemia?

    <p>Initial increase followed by steady rise</p> Signup and view all the answers

    What happens to transferrin saturation in patients with reduced iron stores inhibiting hepcidin synthesis?

    <p>Decreases below 15%</p> Signup and view all the answers

    What is the primary impact of impaired iron utilization in patients with anemia of chronic inflammation?

    <p>Reduced red cell production</p> Signup and view all the answers

    What is the primary role of interleukin-6 (IL-6) in the context of iron metabolism?

    <p>Increasing the production of hepcidin</p> Signup and view all the answers

    What effect does hepcidin have on ferroportin function in macrophages?

    <p>Deactivates ferroportin reducing iron transfer</p> Signup and view all the answers

    Why are erythroid precursors starved for iron during inflammation?

    <p>Hepcidin inhibits iron transfer to developing erythroid precursors</p> Signup and view all the answers

    What contributes to inadequate proliferation of erythroid precursors during inflammation?

    <p>Low levels of erythropoietin production</p> Signup and view all the answers

    What might explain the connection between iron sequestration and fighting off bacterial infections?

    <p>Iron is required for pathogenicity in certain bacteria</p> Signup and view all the answers

    What indicates a possible relationship between inflammation, innate immunity, and iron metabolism?

    <p>Structural similarity between hepcidin and defensins</p> Signup and view all the answers

    What leads to the mild anemia observed during chronic inflammation?

    <p>'Inflammatory cytokine-driven' iron sequestration</p> Signup and view all the answers

    How does the reduction in erythropoietin production contribute to anemia during inflammation?

    <p>'Hepcidin-like' suppression of erythropoiesis</p> Signup and view all the answers

    What typically rules out iron deficiency as the cause of anemia in patients with red cells that are hypochromic and microcytic?

    <p>Increased serum ferritin level</p> Signup and view all the answers

    In aplastic anemia, what is the most common consequence of chronic primary hematopoietic failure?

    <p>Pancytopenia</p> Signup and view all the answers

    What is a significant circumstance often associated with aplastic anemia following exposure to certain drugs and chemicals?

    <p>Dose-related bone marrow suppression</p> Signup and view all the answers

    Which conditions benefit from the administration of erythropoietin, despite the requirement for treatment of the underlying cause for reliable correction of anemia?

    <p>Cancer-related anemia</p> Signup and view all the answers

    What type of hematopoietic failure primarily characterizes aplastic anemia?

    <p>Immune-mediated</p> Signup and view all the answers

    In aplastic anemia, what contributes to pancytopenia in the majority of patients?

    <p>Autoimmune mechanisms</p> Signup and view all the answers

    What is a distinguishing feature between chemically-induced and idiosyncratic aplastic anemia following exposure to certain agents?

    <p>'Unpredictable and idiosyncratic' onset</p> Signup and view all the answers

    'Chronic primary hematopoietic failure' primarily describes which syndrome associated with pancytopenia?

    <p>'Aplastic anemia'</p> Signup and view all the answers

    Which drug has been implicated in causing idiosyncratic reactions leading to aplastic anemia?

    <p>Benzene</p> Signup and view all the answers

    What is a common viral infection associated with approximately 5% of cases of persistent marrow aplasia?

    <p>Hepatitis (unknown virus)</p> Signup and view all the answers

    Which autosomal recessive disorder is characterized by hypofunction of the bone marrow and multiple congenital anomalies?

    <p>Fanconi anemia</p> Signup and view all the answers

    What specific abnormalities are associated with Fanconi anemia?

    <p>Both a and b</p> Signup and view all the answers

    Which infection is NOT typically associated with persistent marrow aplasia?

    <p>Herpes zoster (varicella zoster)</p> Signup and view all the answers

    What can destroy hematopoietic stem cells in a dose-dependent fashion?

    <p>Whole-body irradiation</p> Signup and view all the answers

    What is the percentage range of adult-onset aplastic anemia cases that have inherited defects in telomerase?

    <p>5% to 10%</p> Signup and view all the answers

    What is more common than telomerase mutations in individuals affected by aplastic anemia?

    <p>Abnormally short telomeres</p> Signup and view all the answers

    What is the predominant category that aplastic anemia cases fall into, where no initiating factor can be identified?

    <p>Idiopathic category</p> Signup and view all the answers

    What is the primary function of telomerase in cellular replication?

    <p>Promote cellular immortality</p> Signup and view all the answers

    What is the most likely consequence of excessive stem cell replication in individuals with deficits in telomerase activity?

    <p>Aplastic anemia</p> Signup and view all the answers

    What is the pathogenesis of aplastic anemia characterized by, according to the text?

    <p>Dual major etiologies</p> Signup and view all the answers

    What is the effect of abnormally short telomeres on bone marrow cells in aplastic anemia?

    <p><strong>Decreased</strong> replication potential</p> Signup and view all the answers

    What is the primary mechanism proposed in the text for the development of aplastic anemia?

    <p>Immune-mediated suppression of marrow progenitors</p> Signup and view all the answers

    Which cytokines are mentioned as being produced by activated Th1 cells in the context of aplastic anemia?

    <p>Interferon-gamma (IFN-γ) and Tumor Necrosis Factor (TNF)</p> Signup and view all the answers

    What is the proposed effect of activated T cell-mediated suppression on hematopoietic stem cells?

    <p>Inhibition of stem cell proliferation</p> Signup and view all the answers

    Which type of environmental insults are mentioned as potentially causing antigenic alteration of stem cells in aplastic anemia?

    <p>Exposure to drugs or infectious agents</p> Signup and view all the answers

    Which type of genes are found to be up-regulated in both aplastic anemia and normal stem cells exposed to interferon-gamma?

    <p>Genes associated with apoptosis and death pathways</p> Signup and view all the answers

    What is the proposed role of Th1 cells in the context of aplastic anemia?

    <p>Creating a hostile microenvironment for stem cells</p> Signup and view all the answers

    Which condition is suggested as a potential result of systemic hemosiderosis appearing due to multiple transfusions for anemia?

    <p>Liver failure</p> Signup and view all the answers

    How do antithymocyte globulin and cyclosporine work in treating patients, as per the text?

    <p>By suppressing or killing autoreactive T-cell clones</p> Signup and view all the answers

    What antigens are suggested to be targeted by autoreactive T cells in some instances, based on the text?

    <p>GPI-linked proteins</p> Signup and view all the answers

    How is aplastic anemia proposed to result, according to the text?

    <p>By stem cell abnormalities</p> Signup and view all the answers

    What does the presence of karyotypic aberrations and acquired mutations suggest about aplastic anemia?

    <p>It results from stem cell abnormalities</p> Signup and view all the answers

    What is the main characteristic of marrow in aplastic anemia, based on the image description provided in the text?

    <p>Mainly fat cells</p> Signup and view all the answers

    What is the proposed association between aplastic anemia and PNH, as per the text?

    <p>Targeting GPI-linked proteins</p> Signup and view all the answers

    Which factor is not well defined in relation to the antigens recognized by autoreactive T cells, according to the text?

    <p>'Pure Pure onl red' tests</p> Signup and view all the answers

    What is the result of damaged stem cells producing progeny expressing neoantigens in aplastic anemia?

    <p>Autoimmune reaction</p> Signup and view all the answers

    In aplastic anemia, what is the primary cause of marrow aplasia?

    <p>Genetically altered stem cells</p> Signup and view all the answers

    What characterizes the morphology of bone marrow in aplastic anemia?

    <p>Markedly hypocellular with fibrous stroma and scattered lymphocytes</p> Signup and view all the answers

    How is aplasia best appreciated in individuals with aplastic anemia?

    <p>Via bone marrow biopsies</p> Signup and view all the answers

    What contributes to the diminished survival of red cell precursors in severe ß-thalassemia?

    <p>Shortened telomeres</p> Signup and view all the answers

    What leads to the appearance of increased numbers of erythroid precursors in response to anemia?

    <p>Lowered tissue oxygen tension</p> Signup and view all the answers

    What color does methemoglobin, formed from oxidized free hemoglobin, typically appear as?

    <p>Greenish-blue</p> Signup and view all the answers

    What is the consequence of HbS molecules assembling into long needlelike fibers within red cells?

    <p>Sickling of red cells</p> Signup and view all the answers

    What is the primary method used to diagnose aplastic anemia?

    <p>Bone marrow biopsy</p> Signup and view all the answers

    Which of the following manifestations is characteristic of thrombocytopenia in aplastic anemia?

    <p>Petechiae</p> Signup and view all the answers

    What differentiates aplastic anemia from myeloid neoplasms based on bone marrow examination?

    <p>Presence of hypercellular marrow</p> Signup and view all the answers

    Which of the following features distinguishes anemias due to neoplastic infiltration from aplastic anemia?

    <p>Splenomegaly</p> Signup and view all the answers

    What is a key aspect to consider when suspecting aplastic anemia if splenomegaly is noted?

    <p>Think of concurrent myelodysplastic syndrome</p> Signup and view all the answers

    Which cell line predominately affected in aplastic anemia leads to infections like chills, fever, and prostration?

    <p>Neutrophils</p> Signup and view all the answers

    What could be a serious concern if reticulocytopenia is observed in a patient?

    <p>&quot;Aleukemic&quot; leukemia</p> Signup and view all the answers

    Which clinical finding should raise doubts about the diagnosis of aplastic anemia?

    <p>&quot;Petechiae and ecchymoses&quot;</p> Signup and view all the answers

    What is the primary treatment of choice for patients with stem cell transplantation as an option?

    <p>Stem cell transplantation</p> Signup and view all the answers

    In Pure Red Cell Aplasia, what type of progenitors are primarily suppressed?

    <p>Red cell progenitors</p> Signup and view all the answers

    What is the likely basis for many cases of Pure Red Cell Aplasia according to the text?

    <p>Autoimmune disorders</p> Signup and view all the answers

    In patients with thymoma who have Pure Red Cell Aplasia, what intervention leads to hematologic improvement in around one-half of patients?

    <p>Immunosuppressive therapy</p> Signup and view all the answers

    What is the characteristic feature of red cell precursors in severe Pure Red Cell Aplasia cases?

    <p>Complete absence from the marrow</p> Signup and view all the answers

    In patients without thymoma who have Pure Red Cell Aplasia, what treatment is often beneficial?

    <p>Immunosuppressive therapy</p> Signup and view all the answers

    What is the primary cause of anemia in chronic renal failure?

    <p>Diminished synthesis of erythropoietin by the kidneys</p> Signup and view all the answers

    Which mechanism contributes to anemia in renal failure through extra-vascular hemolysis and abnormal bleeding?

    <p>Shortened red cell lifespan due to uremia</p> Signup and view all the answers

    Which condition may result from individuals infected with parvovirus B19?

    <p>Aplastic crisis leading to increased erythropoiesis</p> Signup and view all the answers

    How does a special form of red cell aplasia occur in individuals infected with parvovirus B19?

    <p>Due to the preferential infection and destruction of red cell progenitors</p> Signup and view all the answers

    What is the primary consequence of a brief cessation of erythropoiesis in individuals with moderate to severe hemolytic anemias?

    <p>Worsening of anemia causing an aplastic crisis</p> Signup and view all the answers

    In which individuals is a transient aplasia clinically unimportant after parvovirus B19 infection?

    <p>Normal individuals who clear the infection within 1 to 2 weeks</p> Signup and view all the answers

    What is the main effect of a prolonged exposure to low oxygen tension in sickle cell disease?

    <p>Increased adhesion of sickle red cells</p> Signup and view all the answers

    Which factor triggers aplastic anemia development based on the text?

    <p>Severe hypoxia leading to erythropoietin secretion</p> Signup and view all the answers

    What type of anemia is characterized by space-occupying lesions replacing normal marrow elements?

    <p>Myelophthisic anemia</p> Signup and view all the answers

    Which condition is associated with anemia attributed to decreased marrow function, often seen as slightly macrocytic?

    <p>Hepatocellular disease</p> Signup and view all the answers

    In individuals with advanced HIV infection, what may permit infection to persist, leading to chronic red cell aplasia and moderate to severe anemia?

    <p>Ineffective immune response</p> Signup and view all the answers

    What is the most common cause of myelophthisic anemia?

    <p>Metastatic cancer</p> Signup and view all the answers

    Which type of progenitors are preferentially affected in cases of anemia associated with hepatocellular disease?

    <p>Erythroid progenitors</p> Signup and view all the answers

    What may cause red cell membranes to acquire phospholipid and cholesterol in liver failure, leading to a slightly macrocytic anemia?

    <p>Lipid abnormalities</p> Signup and view all the answers

    'Mild normochromic, normocytic anemia' is particularly associated with which endocrine disorder?

    <p>Hypothyroidism</p> Signup and view all the answers

    In patients with advanced HIV infection, what can sometimes lead to chronic red cell aplasia and moderate to severe anemia?

    <p>Ineffective immune response</p> Signup and view all the answers

    What are the lipid abnormalities frequently associated with liver failure that can result in a slightly macrocytic anemia?

    <p>Acquired phospholipid and cholesterol</p> Signup and view all the answers

    What aspect of the bleeding diathesis evaluation does the Prothrombin time (PT) test assess?

    <p>Extrinsic clotting pathway</p> Signup and view all the answers

    Which factor deficiency can lead to a prolonged Partial thromboplastin time (PTT) test result?

    <p>Factor IX</p> Signup and view all the answers

    What is a possible cause of excessive bleeding resulting from platelet deficiency?

    <p>Deficiency of factor X</p> Signup and view all the answers

    How does a prolonged Prothrombin time (PT) test result indicate a potential issue in hemostasis?

    <p>Deranged coagulation factors</p> Signup and view all the answers

    Which component is NOT directly assessed by the Partial thromboplastin time (PTT) test?

    <p>Fibrinogen levels</p> Signup and view all the answers

    What could lead to a prolonged Prothrombin time (PT) test in an individual?

    <p>Deficiency of factor VII</p> Signup and view all the answers

    Which condition can potentially cause both increased vessel fragility and platelet dysfunction?

    <p>Hypoxia</p> Signup and view all the answers

    What is the primary cause of Polycythemia vera?

    <p>Inherited erythropoietin receptor mutations</p> Signup and view all the answers

    What is the main association of chronic Pure Red Cell Aplasia?

    <p>Thymoma</p> Signup and view all the answers

    What is the main feature of Chuvash polycythemia?

    <p>Hypoxia-induced factor 1a mutations</p> Signup and view all the answers

    What is the primary mechanism of Aplastic Anemia?

    <p>Toxins and radiation exposure</p> Signup and view all the answers

    What is the characteristic cause of Secondary Polycythemia in cyanotic heart disease?

    <p>Circulatory hypoxia</p> Signup and view all the answers

    Which condition is a common cause of marrow replacement leading to underproduction anemias?

    <p>Granulomatous disease</p> Signup and view all the answers

    What is the main characteristic of inherited defects that stabilize HIF-1a?

    <p>Hypoxia-induced factor 1a mutations</p> Signup and view all the answers

    What is the primary cause of Anemia of Chronic Inflammation?

    <p>Suppressed hepcidin levels</p> Signup and view all the answers

    What is a potential cause of prolongation of the PTT mentioned in the text?

    <p>Deficiency of factor VII</p> Signup and view all the answers

    What is the reference range for platelet counts as per the text?

    <p>150 x 10³ to 350 x 10³ platelets/μL</p> Signup and view all the answers

    What condition may high platelet counts be indicative of according to the text?

    <p>Essential thrombocythemia</p> Signup and view all the answers

    In the context of platelet counts, what is essential in confirming abnormal counts?

    <p>Blood smear inspection</p> Signup and view all the answers

    Which factor deficiency can lead to abnormal prolongation of PTT?

    <p>Factor VIII</p> Signup and view all the answers

    What can cause spurious thrombocytopenia during automated platelet counting?

    <p>Clumping of platelets</p> Signup and view all the answers

    What is the likely diagnosis in a patient with high platelet counts and a myeloproliferative neoplasm?

    <p><strong>Essential thrombocythemia</strong></p> Signup and view all the answers

    What type of polycythemia occurs due to an increase in total red cell mass?

    <p>Primary polycythemia</p> Signup and view all the answers

    What is the most common cause of primary polycythemia?

    <p>Polycythemia vera</p> Signup and view all the answers

    Which mutation is associated with erythropoietin-independent growth of red cell progenitors in polycythemia vera?

    <p>Familial erythropoietin receptor mutations</p> Signup and view all the answers

    What is the cause of secondary polycythemia?

    <p>Compensatory or pathologic increases in erythropoietin secretion</p> Signup and view all the answers

    Which syndrome is associated with stress-induced polycythemia?

    <p>Gaisböck syndrome</p> Signup and view all the answers

    What is the underlying cause of absolute polycythemia?

    <p>Intrinsic abnormality of hematopoietic precursors</p> Signup and view all the answers

    Which test is time-consuming, difficult to standardize, and has been largely discarded due to these reasons?

    <p>Bleeding time</p> Signup and view all the answers

    Which specialized test measures the levels of specific clotting factors, fibrinogen, fibrin split products, and the presence of circulating anticoagulants?

    <p>Instrument-based assays providing quantitative measures of platelet function</p> Signup and view all the answers

    Which category of disorders are relatively common but do not usually cause serious bleeding problems according to the text?

    <p>Vessel wall abnormalities</p> Signup and view all the answers

    Which clinical setting might find tests of platelet aggregation most useful based on the information provided?

    <p>Patients with platelet function abnormalities</p> Signup and view all the answers

    What do specialized tests for platelet function mainly aim to assess according to the text?

    <p>Platelet adhesion ability</p> Signup and view all the answers

    What is a potential consequence of difficulties in simulating in vivo clotting in laboratory-based platelet function assays?

    <p>Decreased bleeding risk prediction accuracy</p> Signup and view all the answers

    Which test is used to measure the ability of platelets to adhere to one another in response to agonists like thrombin?

    <p>'Tests of platelet aggregation'</p> Signup and view all the answers

    'Instrument-based assays' for platelet function are imperfect at predicting bleeding risk mainly due to what reason mentioned in the text?

    <p>'Difficulties in simulating in vivo clotting'</p> Signup and view all the answers

    What platelet count range can aggravate posttraumatic bleeding?

    <p>20,000 to 50,000 platelets/μL</p> Signup and view all the answers

    In which vascular injury response stage do platelets adhere and aggregate to form the primary hemostatic plug?

    <p>Primary hemostasis</p> Signup and view all the answers

    What is the common consequence of thrombocytopenia when isolated?

    <p>Normal PT and PTT</p> Signup and view all the answers

    Which type of bleeding is most often associated with small vessel involvement in thrombocytopenia?

    <p>Nontraumatic bleeding</p> Signup and view all the answers

    At what platelet count may spontaneous (nontraumatic) bleeding be associated with thrombocytopenia?

    <p>Less than 20,000 platelets/μL</p> Signup and view all the answers

    Which condition may lead to hypersensitivity vasculitis due to the deposition of drug-induced immune complexes?

    <p>Thrombocytopenia</p> Signup and view all the answers

    Where are common sites for hemorrhages associated with spontaneous bleeding in thrombocytopenia?

    <p>Skin and gastrointestinal/genitourinary tracts</p> Signup and view all the answers

    What does a platelet count less than 150,000/μL generally signify?

    <p>Thrombocytopenia</p> Signup and view all the answers

    What is the primary consequence of vascular fragility in older adults with acquired vascular fragility?

    <p>Spontaneous purpura</p> Signup and view all the answers

    Which condition is associated with microvascular bleeding due to collagen defects weakening vessel walls?

    <p>Ehlers-Danlos syndrome</p> Signup and view all the answers

    What characterizes Henoch-Schönlein purpura as a systemic immune disorder?

    <p>Colicky abdominal pain</p> Signup and view all the answers

    What mechanism can suppress platelet production through uncertain means when taken in large amounts?

    <p>Certain drugs and alcohol</p> Signup and view all the answers

    What immune-related mechanism underlies the skin hemorrhages seen in individuals with Cushing syndrome?

    <p>Deposition of circulating immune complexes</p> Signup and view all the answers

    What is a major category of conditions leading to decreased platelet production as described in the text?

    <p>Conditions depressing marrow output</p> Signup and view all the answers

    What accounts for the threat of intracranial bleeding in patients with markedly depressed platelet count?

    <p>&quot;Decreased platelet survival&quot;</p> Signup and view all the answers

    What is a potential effect of certain drugs and alcohol on platelet production?

    <p>&quot;Decreased platelet production&quot;</p> Signup and view all the answers

    What factor contributes to the purpura seen in individuals with acquired vascular fragility?

    <p>&quot;Collagen defects&quot;</p> Signup and view all the answers

    What is the most common location for bleeding to occur in patients with hereditary hemorrhagic telangiectasia?

    <p>Under the mucous membranes of the nose</p> Signup and view all the answers

    What is a characteristic manifestation of hereditary hemorrhagic telangiectasia?

    <p>Intracranial hemorrhage</p> Signup and view all the answers

    Which condition is most likely to cause serious bleeding among the mentioned clinical conditions?

    <p>Hereditary hemorrhagic telangiectasia</p> Signup and view all the answers

    What is a key characteristic of hereditary hemorrhagic telangiectasia-related bleeding?

    <p>Petechial and purpuric hemorrhages under the skin</p> Signup and view all the answers

    What genetic pattern is associated with hereditary hemorrhagic telangiectasia?

    <p>Autosomal dominant</p> Signup and view all the answers

    Which blood vessels are primarily affected in hereditary hemorrhagic telangiectasia?

    <p>Capillaries</p> Signup and view all the answers

    What is a common clinical manifestation of hereditary hemorrhagic telangiectasia in terms of bleeding?

    <p>Non-stop nosebleeds (epistaxis)</p> Signup and view all the answers

    What is the main consequence of autoantibody-mediated destruction of platelets in chronic immune thrombocytopenic purpura?

    <p>Decreased platelet aggregation</p> Signup and view all the answers

    In chronic immune thrombocytopenic purpura, what is the significance of antiplatelet antibodies binding to phagocytes?

    <p>Accelerated platelet clearance</p> Signup and view all the answers

    What role do IgG Fc receptors play in the context of antiplatelet antibodies?

    <p>Accelerate platelet destruction</p> Signup and view all the answers

    What is the primary site of removal of opsonized platelets in chronic immune thrombocytopenic purpura?

    <p>Spleen</p> Signup and view all the answers

    How does splenectomy improve thrombocytopenia in chronic immune thrombocytopenic purpura?

    <p>Reduces megakaryocyte damage</p> Signup and view all the answers

    In chronic immune thrombocytopenic purpura, what may exacerbate thrombocytopenia by decreasing platelet production?

    <p>Autoantibody-mediated megakaryocyte damage</p> Signup and view all the answers

    What class of autoantibodies are predominant in chronic immune thrombocytopenic purpura?

    <p>IgG</p> Signup and view all the answers

    Which condition is characterized by autoantibody-mediated destruction of platelets?

    <p>Chronic Immune Thrombocytopenic Purpura (ITP)</p> Signup and view all the answers

    What is a common nonimmunologic cause of thrombocytopenia mentioned in the text?

    <p>Disseminated intravascular coagulation</p> Signup and view all the answers

    Which infection can cause transient and mild thrombocytopenia according to the text?

    <p>Dengue fever</p> Signup and view all the answers

    What can cause selective impairment of platelet production according to the text?

    <p>Nutritional deficiencies</p> Signup and view all the answers

    In what condition does systemic, often unbridled, platelet activation reduce platelet life span?

    <p>Thrombotic microangiopathies</p> Signup and view all the answers

    Which of the following is NOT a drug-associated cause of decreased platelet survival?

    <p>Thiazides</p> Signup and view all the answers

    What is a primary immunologic cause of decreased platelet survival?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    Which of the following is a form of ineffective hematopoiesis causing thrombocytopenia?

    <p>Myelodysplastic syndromes</p> Signup and view all the answers

    What can cause hypersplenism leading to thrombocytopenia?

    <p>Alcohol-induced platelet sequestration</p> Signup and view all the answers

    What is the principal change found in thrombocytopenic purpura?

    <p>Mild form of extramedullary hematopoiesis</p> Signup and view all the answers

    What is typically found in the spleen of individuals with chronic ITP?

    <p>Enlarged splenic follicles</p> Signup and view all the answers

    What is the key diagnostic criterion for primary chronic ITP?

    <p>Exclusion of secondary causes</p> Signup and view all the answers

    Which condition is associated with accelerated thrombopoiesis found in various forms of thrombocytopenia?

    <p>Elevated levels of thrombopoietin</p> Signup and view all the answers

    In primary chronic ITP, autoantibodies are most often directed against which platelet components?

    <p>Platelet membrane glycoproteins IIb-IIIa or Ib-IX</p> Signup and view all the answers

    Where are the principal changes of thrombocytopenic purpura primarily found?

    <p>In the spleen, bone marrow, and blood</p> Signup and view all the answers

    What is the typical size of the spleen in individuals with chronic ITP?

    <p>Normal</p> Signup and view all the answers

    What does the modestly increased number of megakaryocytes in the marrow reflect?

    <p>Accelerated thrombopoiesis</p> Signup and view all the answers

    What is the primary hematological manifestation in chronic ITP?

    <p>Abnormally large platelets</p> Signup and view all the answers

    What is the most common gender affected by chronic ITP in adults younger than 40 years of age?

    <p>Female</p> Signup and view all the answers

    Which complication, although rare, can be fatal in treated patients with chronic ITP?

    <p>Subarachnoid hemorrhage</p> Signup and view all the answers

    What should the presence of splenomegaly and lymphadenopathy in a patient with suspected ITP lead the healthcare provider to consider?

    <p>Secondary causes of ITP</p> Signup and view all the answers

    What distinguishing feature is NOT typically seen in primary chronic ITP?

    <p>Subarachnoid hemorrhage</p> Signup and view all the answers

    Where do petechiae often prominently appear in patients with chronic ITP?

    <p>Dependent areas</p> Signup and view all the answers

    What might be the first presenting symptom of chronic ITP in some patients?

    <p>Hematuria</p> Signup and view all the answers

    What is the typical duration for acute ITP to resolve spontaneously?

    <p>6 months</p> Signup and view all the answers

    Which drugs are mentioned as commonly implicated in drug-induced thrombocytopenia due to drug-dependent antibody binding to platelet glycoproteins?

    <p>Quinine and quinidine</p> Signup and view all the answers

    In what percentage of children does thrombocytopenia persist, leading to a childhood form of chronic ITP?

    <p>20%</p> Signup and view all the answers

    What is the hypothesized mechanism by which platelet inhibitory drugs that bind glycoprotein IIb/IIIa induce severe thrombocytopenia?

    <p>Induction of immunogenic epitopes</p> Signup and view all the answers

    What is the primary cause of thrombocytopenia in drug-induced thrombocytopenia mediated by antibodies recognizing heparin-platelet factor 4 complexes?

    <p>Platelet activation</p> Signup and view all the answers

    Which condition is characterized by antibodies recognizing heparin-platelet factor 4 complexes that activate platelets and promote thrombosis?

    <p><strong>Heparin-induced thrombocytopenia</strong></p> Signup and view all the answers

    Bleeding disorders are caused by antibodies recognizing complexes of heparin and platelet factor 4. What primarily promotes thrombosis in this condition?

    <p><strong>Platelet activation</strong></p> Signup and view all the answers

    Glucocorticoids are administered in acute ITP only if the condition is severe. What is the primary purpose of administering glucocorticoids in this context?

    <p><strong>Inhibit immune response</strong></p> Signup and view all the answers

    Platelet inhibitory drugs can induce severe thrombocytopenia through conformational changes. What hypothesis explains the immunogenic epitope generation in this scenario?

    <p><strong>Conformational changes in glycoproteins</strong></p> Signup and view all the answers

    What is the primary treatment for patients with severe thrombocytopenia in immune thrombocytopenic purpura (ITP)?

    <p>Splenectomy</p> Signup and view all the answers

    What is the main mechanism of action of glucocorticoids in treating immune thrombocytopenic purpura (ITP)?

    <p>Suppressing phagocyte function</p> Signup and view all the answers

    What is the distinctive feature of acute immune thrombocytopenic purpura compared to chronic ITP?

    <p>Has a distinct clinical course</p> Signup and view all the answers

    In patients with moderately severe thrombocytopenia in ITP, what is the recommended management strategy?

    <p>Close monitoring</p> Signup and view all the answers

    Which treatment option may be effective in patients who relapse after splenectomy or for whom splenectomy is contraindicated in ITP?

    <p>Immunomodulatory agents</p> Signup and view all the answers

    What is the diagnostic approach for immune thrombocytopenic purpura (ITP) when platelet autoantibody tests are not clinically useful?

    <p>Exclusion diagnosis</p> Signup and view all the answers

    'Almost all patients respond to glucocorticoids' in the context of ITP suggests that glucocorticoids are effective due to their ability to enhance:

    <p>Phagocyte function</p> Signup and view all the answers

    'In individuals with severe thrombocytopenia, splenectomy normalizes the platelet count in about two-thirds of patients' implies that splenectomy has a success rate of approximately:

    <p>~70%</p> Signup and view all the answers

    'Those with moderately severe thrombocytopenia (platelet counts >30,000/mL) can be followed carefully' suggests that individuals falling within this range may not require immediate:

    <p>Emergency splenectomy</p> Signup and view all the answers

    What is the most serious consequence of failing to stop heparin and switch to an alternative anticoagulant in patients with type II HIT?

    <p>Clot formation and limb loss</p> Signup and view all the answers

    What is a characteristic of low-molecular-weight heparins in relation to type II HIT?

    <p>They worsen thrombotic tendencies in type II HIT</p> Signup and view all the answers

    How does HIV infection affect platelet destruction in infected individuals?

    <p>Promotes platelet opsonization</p> Signup and view all the answers

    What effect does HIV infection have on megakaryocytes in terms of platelet production?

    <p>Causes increased apoptosis of megakaryocytes</p> Signup and view all the answers

    Which cells are found to be infected in HIV due to the presence of CD4 and CXCR4 receptors?

    <p>Megakaryocytes</p> Signup and view all the answers

    In HIV infection, what predisposes individuals to the development of autoantibodies affecting platelets?

    <p>T-cell dysregulation</p> Signup and view all the answers

    What is the mechanism by which autoantibodies affect platelets in HIV-infected individuals?

    <p>Opsonize platelets for destruction</p> Signup and view all the answers

    What contributes to thrombocytopenia in some HIV-infected patients apart from autoantibodies?

    <p>Immune complex deposition on platelets</p> Signup and view all the answers

    What is a direct consequence of HIV-induced B-cell hyperplasia and dysregulation in relation to thrombocytopenia?

    <p>Development of autoantibodies against hemoglobin</p> Signup and view all the answers

    Which type of heparin-induced thrombocytopenia occurs rapidly after the onset of therapy and is of little clinical importance?

    <p>Type I HIT</p> Signup and view all the answers

    What is the distinguishing factor between Thrombotic Thrombocytopenic Purpura (TTP) and Hemolytic Uremic Syndrome (HUS)?

    <p>Presence of neurologic symptoms</p> Signup and view all the answers

    What is the primary mechanism that leads to the development of Type II Heparin-Induced Thrombocytopenia (HIT)?

    <p>Activation of platelets</p> Signup and view all the answers

    What is considered the hallmark of Thrombotic Thrombocytopenic Purpura (TTP) according to the original description?

    <p>Neurologic deficits</p> Signup and view all the answers

    Which condition presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure but lacks neurologic symptoms?

    <p>HUS</p> Signup and view all the answers

    In Thrombotic Microangiopathies, what causes excessive activation of platelets leading to thrombi formation in small blood vessels?

    <p>Insults to the body</p> Signup and view all the answers

    What distinguishes Hemolytic Uremic Syndrome (HUS) from Thrombotic Thrombocytopenic Purpura (TTP)?

    <p>Neurologic deficits</p> Signup and view all the answers

    Which disorder is defined by a pentad that includes fever, thrombocytopenia, microangiopathic hemolytic anemia, transient neurologic deficits, and renal failure?

    <p>TTP</p> Signup and view all the answers

    What is the distinguishing factor in the onset time of Type II Heparin-Induced Thrombocytopenia (HIT) compared to Type I HIT?

    <p>5 to 14 days after therapy begins</p> Signup and view all the answers

    What is a critical factor, in addition to ADAMTS13 deficiency, that is suggested to trigger full-blown TTP?

    <p>Vascular injury</p> Signup and view all the answers

    In what condition should TTP be an important consideration due to the potential fatal outcomes of delayed diagnosis?

    <p>Thrombocytopenia with microangiopathic hemolytic anemia</p> Signup and view all the answers

    With plasma exchange, what aspect of TTP treatment has led to improved outcomes in patients with the condition?

    <p>Removal of autoantibodies and provision of functional ADAMTS13</p> Signup and view all the answers

    What distinguishes HUS from TTP in terms of ADAMTS13 levels?

    <p>HUS has normal levels of ADAMTS13</p> Signup and view all the answers

    Which infectious agent is strongly linked to causing 'typical' HUS?

    <p>Escherichia coli O157:H7</p> Signup and view all the answers

    What is the role of Shiga-like toxin elaborated by Escherichia coli O157:H7 in the context of HUS?

    <p>Endothelial injury induction</p> Signup and view all the answers

    Which treatment intervention has significantly improved the prognosis of TTP patients from its once uniformly fatal outcome?

    <p>Plasma exchange</p> Signup and view all the answers

    What is a potential treatment approach for patients with atypical HUS?

    <p>Immunosuppression</p> Signup and view all the answers

    How is typical HUS usually managed?

    <p>Supportive treatment</p> Signup and view all the answers

    What is a common long-term consequence of typical HUS for some patients?

    <p>Permanent renal damage</p> Signup and view all the answers

    Which factor plays a central role in the pathogenesis of atypical HUS?

    <p>Excessive complement activation</p> Signup and view all the answers

    What may be seen in patients following exposure to agents that damage endothelial cells?

    <p>Thrombotic microangiopathies resembling HUS</p> Signup and view all the answers

    What type of disorders are characterized by abnormal platelet function and normal platelet counts?

    <p>Inherited disorders</p> Signup and view all the answers

    What does the effectiveness of therapeutic antibodies targeting complement factor C5 in atypical HUS patients suggest about the disease?

    <p>Immune dysregulation plays a role</p> Signup and view all the answers

    What is the primary mechanism behind the red cell shape alteration in hereditary spherocytosis?

    <p>Defective spectrin or ankyrin</p> Signup and view all the answers

    Which of the following contributes significantly to the vicious cycle described in sickle cell disease involving sickling, obstruction, and hypoxia?

    <p>Adhesion of sickle cells to endothelium</p> Signup and view all the answers

    What is the distinctive feature of acute immune thrombocytopenic purpura compared to chronic ITP?

    <p>Rapid onset of symptoms</p> Signup and view all the answers

    What is suspected to be a genetic predisposition in individuals with pernicious anemia?

    <p>Autoantibodies against intrinsic factor</p> Signup and view all the answers

    How does the up-regulation of adhesion molecules on endothelial cells affect sickle red cells during inflammatory reactions?

    <p>Accelerates red cell sickling</p> Signup and view all the answers

    'Instrument-based assays' for platelet function are imperfect at predicting bleeding risk mainly due to what reason mentioned in the text?

    <p>Platelet dysfunction in vitro</p> Signup and view all the answers

    'Rare; occurs mainly in children following viral infections' describes which type of immunohemolytic anemia?

    <p><strong>Paroxysmal cold hemoglobinuria</strong> immunohemolytic anemia</p> Signup and view all the answers

    What is the pathogenic mechanism behind Thrombotic Thrombocytopenic Purpura (TTP)?

    <p>Deficiency in ADAMTS13 causing spontaneous platelet activation</p> Signup and view all the answers

    What distinguishes the triggers for platelet activation in Thrombotic Thrombocytopenic Purpura (TTP) from other thrombotic microangiopathies?

    <p>Distinctive pathogenic triggers</p> Signup and view all the answers

    What can further promote the formation of Thrombotic Thrombocytopenic Purpura (TTP) in addition to ADAMTS13 deficiency?

    <p>Endothelial cell injury</p> Signup and view all the answers

    What distinguishes acquired ADAMTS13 deficiency in Thrombotic Thrombocytopenic Purpura (TTP) from the hereditary form?

    <p>Delayed onset and episodic symptoms</p> Signup and view all the answers

    In Thrombotic Thrombocytopenic Purpura (TTP), what happens when large multimers of von Willebrand factor accumulate due to ADAMTS13 deficiency?

    <p>Spontaneous platelet activation occurs</p> Signup and view all the answers

    What is a distinguishing feature between Thrombotic Thrombocytopenic Purpura (TTP) and Hemolytic Uremic Syndrome (HUS)?

    <p>Presence of pathogenic platelet aggregation</p> Signup and view all the answers

    How can endothelial cell injury contribute to the pathogenesis of Thrombotic Thrombocytopenic Purpura (TTP)?

    <p>Further formation of platelet aggregates</p> Signup and view all the answers

    Which of the following exemplifies bleeding due to defective platelet aggregation?

    <p>Glanzmann thrombasthenia</p> Signup and view all the answers

    What is the primary integrin involved in bridge formation between platelets binding fibrinogen?

    <p>Glycoprotein IIb-IIIa</p> Signup and view all the answers

    Which autosomal recessive disorder is caused by a deficiency of the platelet membrane glycoprotein complex Ib-IX?

    <p>Bernard-Soulier syndrome</p> Signup and view all the answers

    What is the essential receptor for von Willebrand factor for normal platelet adhesion to the subendothelial extracellular matrix?

    <p>Glycoprotein Ib-IX</p> Signup and view all the answers

    In Glanzmann thrombasthenia, platelets fail to aggregate in response to which of the following substances?

    <p>ADP</p> Signup and view all the answers

    Which receptor is deficient or dysfunctional in Thrombasthenic platelets, leading to their failure to aggregate?

    <p>Glycoprotein IIb-IIIa</p> Signup and view all the answers

    What is the underlying cause of Bernard-Soulier syndrome?

    <p>Inherited deficiency of the platelet membrane glycoprotein complex Ib-IX</p> Signup and view all the answers

    'Bridge formation' between platelets binding fibrinogen involves which integrin?

    <p>Glycoprotein IIb-IIIa</p> Signup and view all the answers

    'Variable, often severe, bleeding tendency' is a characteristic of which inherited disorder?

    <p>'Defects of adhesion'</p> Signup and view all the answers

    'Failure to aggregate in response to adenosine diphosphate (ADP)' is associated with which condition?

    <p>'Defects of aggregation'</p> Signup and view all the answers

    What is the primary consequence of inherited or acquired deficiencies of virtually every coagulation factor?

    <p>Bleeding diatheses</p> Signup and view all the answers

    In patients with acquired deficiencies of single coagulation factors, what is a rare cause of such deficiencies?

    <p>Inhibitory autoantibodies</p> Signup and view all the answers

    What distinguishes bleeding due to coagulation factor deficiencies from bleeding due to thrombocytopenia?

    <p>Bleeding into the gastrointestinal and urinary tracts</p> Signup and view all the answers

    What is the mechanism behind acquired deficiencies usually involving multiple coagulation factors?

    <p>Shortened protein half-life</p> Signup and view all the answers

    Which factors are impaired due to Vitamin K deficiency?

    <p>Factors II, VII, IX, X</p> Signup and view all the answers

    What is the primary cause of large posttraumatic ecchymoses or hematomas seen in bleeding diatheses?

    <p>Coagulation factor deficiencies</p> Signup and view all the answers

    What is the primary mechanism of action of aspirin in causing platelet dysfunction?

    <p>Inhibition of cyclooxygenase</p> Signup and view all the answers

    Which enzyme is affected by aspirin leading to a significant impact on platelet aggregation?

    <p>Cyclooxygenase</p> Signup and view all the answers

    Which clotting factor deficiency is common in hemophilia B?

    <p>Factor IX</p> Signup and view all the answers

    What characterizes von Willebrand disease in terms of its impact on coagulation and platelet function?

    <p>Decreased platelet adhesion</p> Signup and view all the answers

    Which condition leads to acquired defects in platelet function primarily by affecting granule secretion and aggregation?

    <p>Uremia</p> Signup and view all the answers

    What enzyme is irreversibly inhibited by aspirin, disrupting platelet aggregation and release reactions?

    <p>Cyclooxygenase</p> Signup and view all the answers

    "Hereditary deficiencies typically affect a single clotting factor" refers to which common clotting factor deficiency in hemophilia A?

    <p>Factor VIII</p> Signup and view all the answers

    "Deficiencies of vWF also are discussed here, as this factor influences both coagulation and platelet function". Which aspect of platelet function is most directly influenced by vWF?

    <p>Platelet adhesion</p> Signup and view all the answers

    What is the main function of factor VIII in the clotting cascade?

    <p>Converts factor IX to factor X</p> Signup and view all the answers

    Which cells are responsible for producing von Willebrand factor (vWF)?

    <p>Endothelial cells</p> Signup and view all the answers

    What effect does the interaction between factor VIII and vWF have on the half-life of factor VIII in circulation?

    <p>Increases half-life</p> Signup and view all the answers

    What is the primary source of vWF present in platelet alpha granules?

    <p>Megakaryocytes</p> Signup and view all the answers

    Where is von Willebrand factor (vWF) synthesized in the body?

    <p>Endothelial cells only</p> Signup and view all the answers

    What is the molecular mass range of vWF multimers secreted into circulation?

    <p>Exceeds 20 x 10 daltons</p> Signup and view all the answers

    What is the primary function of vWF in hemostasis?

    <p>Promote the adhesion of platelets to the subendothelial matrix</p> Signup and view all the answers

    How are factor VIII and vWF protein levels usually measured?

    <p>Through immunologic techniques</p> Signup and view all the answers

    In hemostasis, what occurs through bridging interactions between platelet glycoprotein Ib-IX, vWF, and matrix components like collagen?

    <p>Adhesion of platelets to the subendothelial matrix</p> Signup and view all the answers

    How is vWF's function assessed in laboratory tests?

    <p>Using the ristocetin agglutination test</p> Signup and view all the answers

    What is the method for measuring factor VIII function?

    <p>Through coagulation assays with factor VIII-deficient plasma</p> Signup and view all the answers

    Which activity may vWF promote under high shear stress conditions like those in small vessels?

    <p>Enhanced platelet aggregation</p> Signup and view all the answers

    What is the mechanism by which vWF promotes platelet adhesion to the subendothelial matrix?

    <p>Binding to von Willebrand factor receptors on platelets</p> Signup and view all the answers

    How does ristocetin assist in assessing vWF function?

    <p>By binding and 'activating' vWF in plasma samples</p> Signup and view all the answers

    What is the primary mechanism by which Ristocetin induces platelet clumping in the context of von Willebrand Disease?

    <p>Inducing multivalent vWF multimers to bind to platelet glycoprotein Ib-IX</p> Signup and view all the answers

    What is the most common presenting symptom of von Willebrand Disease?

    <p>Spontaneous bleeding from mucous membranes</p> Signup and view all the answers

    Which type of von Willebrand Disease is characterized by incomplete penetrance and mild to moderate vWF deficiency?

    <p>Type 1</p> Signup and view all the answers

    What is the percentage of adults in the United States affected by von Willebrand Disease?

    <p>Approximately 1%</p> Signup and view all the answers

    Which type of von Willebrand Disease is associated with quantitative defects in vWF?

    <p>Type 3</p> Signup and view all the answers

    What inheritance pattern is typically associated with von Willebrand Disease?

    <p>Autosomal dominant</p> Signup and view all the answers

    What major event may reveal the presence of von Willebrand Disease in affected individuals?

    <p>Hemostatic stress like surgery or dental procedures</p> Signup and view all the answers

    Which of the following symptoms is NOT a common presenting symptom of von Willebrand Disease?

    <p>Hematuria</p> Signup and view all the answers

    Which type of von Willebrand disease is characterized by missense mutations leading to defective multimer assembly of vWF?

    <p>Type 2A</p> Signup and view all the answers

    What is the inheritance pattern of type 3 von Willebrand disease?

    <p>Autosomal recessive</p> Signup and view all the answers

    What is a common feature of type 2 von Willebrand disease?

    <p>Qualitative defects in vWF</p> Signup and view all the answers

    What factor is reduced in type 3 von Willebrand disease, leading to a severe bleeding disorder?

    <p>Factor VIII levels</p> Signup and view all the answers

    Which genetic alteration is usually associated with type 3 von Willebrand disease?

    <p>Deletions</p> Signup and view all the answers

    What is the most common subtype of type 2 von Willebrand disease?

    <p>Type 2A</p> Signup and view all the answers

    'vWF stabilizes which factor in the circulation, contributing to the severity of bleeding disorders?'

    <p>Factor VIII</p> Signup and view all the answers

    What is the primary treatment for rare patients with type 3 von Willebrand disease?

    <p>Plasma concentrates and factor VIII infusions</p> Signup and view all the answers

    In what way does the inheritance of hemophilia A differ from von Willebrand disease?

    <p>Hemophilia A is X-linked recessive, while von Willebrand disease is autosomal dominant.</p> Signup and view all the answers

    What is the reason some heterozygous females with hemophilia A may experience excessive bleeding?

    <p>Unfavorable lyonization</p> Signup and view all the answers

    Which method can be used to treat persons with types 1 or 2 von Willebrand disease facing hemostatic challenges?

    <p>Desmopressin</p> Signup and view all the answers

    What influences the wide variability in clinical expression of von Willebrand disease within families?

    <p>Modifying genes that influence circulating levels of vWF</p> Signup and view all the answers

    What is the most common hereditary disease associated with life-threatening bleeding?

    <p>Hemophilia A</p> Signup and view all the answers

    "Hemophilia-like" bleeding can be observed in rare patients with which type of von Willebrand disease?

    <p>Type 3</p> Signup and view all the answers

    "Unfavorable lyonization" results in excessive bleeding in some heterozygous females with which condition?

    <p><strong>Hemophilia A</strong></p> Signup and view all the answers

    What factor level is typically associated with severe hemophilia A?

    <p>Less than 1% of normal levels</p> Signup and view all the answers

    What type of mutation in factor VIII results in severe hemophilia A with normal protein levels?

    <p>Point mutation</p> Signup and view all the answers

    Which factor level range corresponds to moderately severe hemophilia A?

    <p>2-5% of normal levels</p> Signup and view all the answers

    What is the main cause of varying degrees of factor VIII deficiency in hemophilia A?

    <p>Heterogeneity in causative mutations</p> Signup and view all the answers

    What type of deficiency leads to mild to moderate hemophilia A?

    <p>Active deficiency</p> Signup and view all the answers

    In which cases of hemophilia A may factor VIII protein levels appear normal by immunoassay?

    <p>Mild cases with point mutations</p> Signup and view all the answers

    What is the pre-eminent role of the factor VIIIa/factor IXa complex?

    <p>Activation of factor X</p> Signup and view all the answers

    What is the main consequence of thrombin binding to thrombomodulin?

    <p>Conversion to an anticoagulant</p> Signup and view all the answers

    How does thrombin contribute to the formation of a stable clot?

    <p>Inhibits fibrinolysis</p> Signup and view all the answers

    What is the primary role of the tissue factor/factor VII complex?

    <p>Activation of factor IX</p> Signup and view all the answers

    Which protein is activated by the thrombin-thrombomodulin complex?

    <p>Protein C</p> Signup and view all the answers

    What converts fibrinogen to fibrin at sites where the endothelium is disrupted?

    <p>Thrombin</p> Signup and view all the answers

    Why must the process of clot formation be limited to the site of tissue injury?

    <p>To prevent runaway clotting</p> Signup and view all the answers

    What happens to thrombin when it encounters uninjured vessels?

    <p>Is converted to an anticoagulant</p> Signup and view all the answers

    What is the primary method for diagnosing Christmas disease?

    <p>Assay of factor levels</p> Signup and view all the answers

    How is hemophilia B inherited?

    <p>X-linked recessive</p> Signup and view all the answers

    What is a characteristic feature of DIC in terms of coagulation factors?

    <p>Depletion</p> Signup and view all the answers

    In what percentage of hemophilia B patients is the factor IX protein nonfunctional?

    <p>15%</p> Signup and view all the answers

    What is the main treatment approach for Christmas disease?

    <p>Infusions of recombinant factor IX</p> Signup and view all the answers

    What is the effect on platelet count in DIC?

    <p>Decreased platelets</p> Signup and view all the answers

    What differentiates the PT and PTT results in hemophilia B?

    <p>PT normal, PTT prolonged</p> Signup and view all the answers

    What is the key distinguishing factor between DIC and localized coagulopathies?

    <p>Site of thrombi formation</p> Signup and view all the answers

    What is a potential consequence of severe factor IX deficiency?

    <p>Similar clinical disorder to factor VIII deficiency</p> Signup and view all the answers

    How is hemophilia A usually treated?

    <p>Plasma-derived factor VIII concentrates</p> Signup and view all the answers

    What is a risk factor for patients with severe hemophilia A who develop antibodies inhibiting factor VIII?

    <p>Plasma-derived factor VIII concentrates</p> Signup and view all the answers

    Which therapy has bypassed the need for factor VIII in some hemophiliacs?

    <p>Bispecific antibodies binding factor IXa to factor X</p> Signup and view all the answers

    Before the development of recombinant factor VIII therapy, what unfortunate outcome occurred in many hemophiliacs receiving treatments?

    <p>Development of AIDS</p> Signup and view all the answers

    What is the role of factors VIII and IX in the clotting process?

    <p>Function together to activate factor X</p> Signup and view all the answers

    What is a current focus of efforts for treating hemophilia?

    <p>Somatic gene therapy</p> Signup and view all the answers

    'Christmas Disease' is also known by what other name?

    <p>'Factor IX Deficiency'</p> Signup and view all the answers

    What are the two major mechanisms that trigger Disseminated Intravascular Coagulation (DIC)?

    <p>Release of procoagulants and injury of endothelial cells</p> Signup and view all the answers

    In DIC, how does endothelial injury contribute to the initiation of the coagulation pathway?

    <p>By exposing the subendothelial matrix</p> Signup and view all the answers

    Which factor is implicated in the development of DIC associated with sepsis?

    <p>Tumor Necrosis Factor (TNF)</p> Signup and view all the answers

    How does mucus released from certain adenocarcinomas act as a procoagulant?

    <p>By directly activating factor X</p> Signup and view all the answers

    What is the role of tissue factor in triggering DIC?

    <p>Directly activating platelets</p> Signup and view all the answers

    Which molecule's expression on endothelial cells is decreased in DIC, tilting the hemostasis balance towards coagulation?

    <p>Thrombomodulin</p> Signup and view all the answers

    What is the primary role of tumor necrosis factor (TNF) in the context of endothelial injury in DIC?

    <p>Expressing tissue factor on endothelial cells</p> Signup and view all the answers

    How can subtle endothelial injuries contribute to procoagulant activity in DIC?

    <p>By unleashing procoagulant activity</p> Signup and view all the answers

    How does TNF contribute to endothelial injury?

    <p>By promoting leukocyte adhesion and releasing reactive oxygen species</p> Signup and view all the answers

    What is a common trigger for disseminated intravascular coagulation (DIC)?

    <p>Major trauma</p> Signup and view all the answers

    How do endotoxins from bacterial infections affect thrombomodulin expression on endothelial cells?

    <p>Inhibit thrombomodulin expression</p> Signup and view all the answers

    What is a characteristic trigger for widespread endothelial injury?

    <p>Temperature extremes</p> Signup and view all the answers

    Which condition is NOT commonly associated with triggering disseminated intravascular coagulation (DIC)?

    <p>Anemia</p> Signup and view all the answers

    How do antigen-antibody complexes contribute to endothelial injury?

    <p>Cause endothelial cell damage</p> Signup and view all the answers

    What role do endotoxins play in activating coagulation factors?

    <p>Activate factor XII directly</p> Signup and view all the answers

    What is a characteristic condition associated with widespread endothelial injury?

    <p>Heat stroke</p> Signup and view all the answers

    What is a common association with disseminated intravascular coagulation (DIC)?

    <p>Malignant neoplasms</p> Signup and view all the answers

    In what conditions can the onset of disseminated intravascular coagulation (DIC) be insidious and chronic?

    <p>Carcinomatosis and retention of a dead fetus</p> Signup and view all the answers

    What type of onset of DIC is associated with sepsis or amniotic fluid embolism?

    <p>Rapid and fulminant</p> Signup and view all the answers

    What distinguishes the onset of DIC in sepsis compared to other conditions?

    <p>Rapid progression to organ failure</p> Signup and view all the answers

    Which condition is NOT mentioned as potentially leading to a fulminant onset of DIC?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    What can cause an insidious and chronic onset of DIC?

    <p>Disseminated cancer and fetal death retention</p> Signup and view all the answers

    What is the major trigger for disseminated intravascular coagulation in massive trauma and severe burns?

    <p>Tissue factor release</p> Signup and view all the answers

    What can enter the circulation in obstetric conditions and serve as procoagulants in disseminated intravascular coagulation?

    <p>Amniotic fluid</p> Signup and view all the answers

    Which factor coexist in very ill patients and can cause widespread endothelial injury, leading to disseminated intravascular coagulation?

    <p>Hypoxia, acidosis, and shock</p> Signup and view all the answers

    What can complicate the problems of widespread endothelial injury in disseminated intravascular coagulation?

    <p>Supervening infections</p> Signup and view all the answers

    In what condition do procoagulants such as tissue factor serve as a major trigger for disseminated intravascular coagulation?

    <p>Severe burns</p> Signup and view all the answers

    Which term describes the process where there is consumption of clotting factors and platelets leading to ischemic tissue damage in disseminated intravascular coagulation?

    <p>Microangiopathic hemolytic anemia</p> Signup and view all the answers

    What is the consequence of widespread microvascular thrombosis in disseminated intravascular coagulation?

    <p>Vascular occlusion</p> Signup and view all the answers

    'Endothelial injury' plays a crucial role in disseminated intravascular coagulation. What can further complicate this issue?

    <p>'Thrombotic thrombocytopenic purpura (TTP)'</p> Signup and view all the answers

    What are the two main consequences of Disseminated Intravascular Coagulation (DIC)?

    <p>Ischemia of organs and microangiopathic hemolytic anemia</p> Signup and view all the answers

    Where are thrombi most frequently found in cases of DIC?

    <p>Brain, heart, lungs, kidneys, adrenals, and spleen</p> Signup and view all the answers

    What is the characteristic pulmonary manifestation seen in cases of DIC?

    <p>Hyaline membranes resembling ARDS</p> Signup and view all the answers

    Which organs are least affected by thrombi in cases of DIC?

    <p>Spleen and liver</p> Signup and view all the answers

    What is the primary action of Plasmin in the context of DIC?

    <p>Cleaves fibrin and digests clotting factors V and VIII</p> Signup and view all the answers

    How does DIC lead to microangiopathic hemolytic anemia?

    <p>Through fragmentation of red cells in narrowed microvasculature</p> Signup and view all the answers

    What is the primary consequence of widespread fibrin deposition in DIC?

    <p>Ischemia of organs</p> Signup and view all the answers

    In DIC, what leads to the activation of plasminogen and consumption of platelets?

    <p>Overwhelming fibrin degradation products</p> Signup and view all the answers

    What is the probable basis for the massive adrenal hemorrhages seen in Waterhouse-Friderichsen syndrome?

    <p>Thrombi formation in adrenal microcirculation</p> Signup and view all the answers

    Which syndrome is associated with the formation of thrombi within neoplasms due to stasis and recurrent trauma to fragile blood vessels?

    <p>Kasabach-Merritt syndrome</p> Signup and view all the answers

    Which condition is characterized by sudden or progressive circulatory failure and shock as part of its clinical features?

    <p>Disseminated Intravascular Coagulation (DIC)</p> Signup and view all the answers

    What is a common feature of chronic DIC as seen in cancer patients?

    <p>Thrombotic complications</p> Signup and view all the answers

    Which type of DIC is typically dominated by a bleeding diathesis?

    <p>Acute DIC associated with sepsis</p> Signup and view all the answers

    In what scenario would convulsions and coma be potential manifestations according to the text?

    <p>Acute DIC in sepsis</p> Signup and view all the answers

    Which condition is NOT commonly associated with a fulminant onset of DIC according to the text?

    <p>Carotid artery stenosis</p> Signup and view all the answers

    What distinguishes Hemolytic Uremic Syndrome (HUS) from Thrombotic Thrombocytopenic Purpura (TTP)?

    <p>TTP manifests as microangiopathic hemolytic anemia.</p> Signup and view all the answers

    What characterizes the onset of DIC associated with sepsis or amniotic fluid embolism?

    <p>Fulminant</p> Signup and view all the answers

    In Waterhouse-Friderichsen syndrome, what contributes to variable neurologic signs and symptoms according to the text?

    <p>Thrombi formation in adrenal blood vessels</p> Signup and view all the answers

    What is the primary cause of febrile nonhemolytic reactions after transfusion of red cells or platelets?

    <p>Inflammatory mediators derived from donor leukocytes</p> Signup and view all the answers

    What is the most common cause of severe bleeding into soft tissues and joints in affected males with Hemophilia A?

    <p>Mutations in factor VIII</p> Signup and view all the answers

    Which factor's deficiency results in a clinical presentation clinically identical to Hemophilia A?

    <p>Factor IX</p> Signup and view all the answers

    What is the function of von Willebrand Factor (vWF) in the circulation with respect to platelets?

    <p>Promotes platelet adhesion and stabilizes Factor VIII</p> Signup and view all the answers

    Which factor plays a critical role in promoting the adhesion of platelets and stabilizing Factor VIII in individuals with von Willebrand Disease?

    <p>von Willebrand Factor</p> Signup and view all the answers

    What is the primary pathogenic basis for Hemophilia B?

    <p>Mutations in factor IX</p> Signup and view all the answers

    In individuals with Hemophilia B, which clotting factor is affected by mutations leading to severe bleeding?

    <p>Factor IX</p> Signup and view all the answers

    What is the only definitive treatment for the conditions discussed in the text?

    <p>Removal or treatment of the inciting cause</p> Signup and view all the answers

    In Thrombotic Thrombocytopenic Purpura (TTP), what deficiency leads to abnormally large von Willebrand factor multimers that activate platelets?

    <p>Deficiency of ADAMTS 13</p> Signup and view all the answers

    What initiates platelet activation, platelet aggregation, and microvascular thrombosis in Hemolytic Uremic Syndrome (HUS)?

    <p>Shiga-like toxin</p> Signup and view all the answers

    Which feature is more typical of Thrombotic Thrombocytopenic Purpura (TTP) as compared to Hemolytic Uremic Syndrome (HUS)?

    <p>CNS involvement</p> Signup and view all the answers

    What is the proximal cause of Immune Thrombocytopenic Purpura?

    <p>Autoantibodies against platelet antigens</p> Signup and view all the answers

    Which condition manifests with thrombocytopenia, microangiopathic hemolytic anemia, and renal failure?

    <p>Hemolytic Uremic Syndrome</p> Signup and view all the answers

    What triggers Immune Thrombocytopenic Purpura in some cases?

    <p>Infections or lymphomas</p> Signup and view all the answers

    What distinguishes Thrombotic Thrombocytopenic Purpura from Hemolytic Uremic Syndrome?

    <p>Presence of ADAMTS 13 deficiency</p> Signup and view all the answers

    What is the most likely cause of acute hemolytic reactions during transfusions?

    <p>Preformed IgM antibodies against donor red cells</p> Signup and view all the answers

    In which patient population are severe allergic reactions to blood products most likely to occur?

    <p>Patients with IgA deficiency</p> Signup and view all the answers

    What is the primary cause of urticarial allergic reactions during transfusions?

    <p>Antigens in the donated blood products</p> Signup and view all the answers

    What is the frequency of occurrence of severe allergic reactions to blood products in patients with IgA deficiency?

    <p>1 in 20,000 to 1 in 50,000 transfusions</p> Signup and view all the answers

    Which complication of transfusion is primarily associated with hemolytic reactions?

    <p>Acute hemolytic reactions</p> Signup and view all the answers

    What is a common trigger for severe allergic reactions to blood products?

    <p>Sepsis</p> Signup and view all the answers

    Which antibody type is responsible for triggering urticarial allergic reactions during transfusions?

    <p><strong>IgE</strong> antibodies</p> Signup and view all the answers

    What is the primary mechanism of action that leads to intravascular hemolysis in ABO-incompatible blood transfusions?

    <p>Complement-mediated lysis induced by natural IgM antibodies</p> Signup and view all the answers

    Which symptom is typically NOT associated with a hemolytic reaction due to ABO incompatibility during blood transfusions?

    <p>Nasal congestion</p> Signup and view all the answers

    In cases where all donor red cells have lysed, what would be the expected result of the direct Coombs test?

    <p>Negative</p> Signup and view all the answers

    Why are the signs and symptoms of a hemolytic reaction in ABO-incompatible transfusions attributed to complement activation rather than direct intravascular hemolysis?

    <p>Complement activation causes rapid cytokine release</p> Signup and view all the answers

    What may be a severe complication if a hemolytic reaction due to ABO incompatibility progresses rapidly?

    <p>Disseminated intravascular coagulation (DIC)</p> Signup and view all the answers

    What does the text suggest about the importance of blood products in healthcare?

    <p>'The gift of life' analogy emphasizes their life-saving role</p> Signup and view all the answers

    How many red cell transfusions are approximately given each year in US hospitals?

    <p>Over 5 million</p> Signup and view all the answers

    What is a major reason for platelet preparations being more prone to bacterial contamination compared to red cell preparations?

    <p>Platelets must be stored at room temperature, promoting bacterial growth.</p> Signup and view all the answers

    What is the estimated rate of HIV transmission through blood transfusions?

    <p>1 in 1.5 million</p> Signup and view all the answers

    Why might broad-spectrum antibiotics need to be started in symptomatic patients awaiting laboratory results post-blood transfusion?

    <p>To treat potential bacterial infections from the transfusion.</p> Signup and view all the answers

    How has the incidence of viral transmission by blood products been significantly reduced?

    <p>Via improvements in donor screening and infectious disease testing.</p> Signup and view all the answers

    Which condition can result from transfusion-related transmission of viruses like HIV and hepatitis C?

    <p>Sepsis</p> Signup and view all the answers

    Why is it rare for viral transmission from blood products to occur even with modern testing technologies?

    <p>Some donors may be acutely infected with undetectable viruses.</p> Signup and view all the answers

    What action has dramatically decreased the incidence of viral transmission by blood products?

    <p>Advancements in donor selection, screening, and infectious disease testing.</p> Signup and view all the answers

    What measure may be necessary for symptomatic patients post-blood transfusion due to potential bacterial contamination?

    <p>Initiating broad-spectrum antibiotics.</p> Signup and view all the answers

    What is the most common trigger for TRALI?

    <p>Antibodies to neutrophil-specific antigens</p> Signup and view all the answers

    What are the typical chest imaging findings in TRALI?

    <p>Diffuse bilateral pulmonary infiltrates</p> Signup and view all the answers

    Which blood products are more likely to lead to TRALI?

    <p>Fresh-frozen plasma</p> Signup and view all the answers

    What is the primary treatment approach for TRALI?

    <p>Supportive care</p> Signup and view all the answers

    What has significantly reduced the incidence of TRALI?

    <p>Excluding multiparous women from platelet donation</p> Signup and view all the answers

    What is the mortality rate in uncomplicated cases of TRALI?

    <p>&lt;2%</p> Signup and view all the answers

    What symptom is commonly associated with TRALI?

    <p>Hypoxemia</p> Signup and view all the answers

    What feature distinguishes TRALI from TACO (Transfusion-Associated Circulatory Overload)?

    <p>Intravascular volume overload</p> Signup and view all the answers

    What antibodies are most commonly associated with TRALI in multiparous women?

    <p>IgG antibodies to major histocompatibility complex antigens</p> Signup and view all the answers

    What is the potentially fatal complication in transfusion-related acute lung injury (TRALI)?

    <p>Neutrophil sequestration and priming in the lung</p> Signup and view all the answers

    What is the underlying pathogenesis model favored for TRALI?

    <p>'Two-hit' hypothesis</p> Signup and view all the answers

    What causes the activation of neutrophils in TRALI?

    <p>Factors in the transfused blood product</p> Signup and view all the answers

    Which antibodies are implicated as potential 'second hits' in TRALI?

    <p>Antibodies recognizing antigens expressed on neutrophils</p> Signup and view all the answers

    How does TRALI primarily differ from ABO mismatches in terms of reactions?

    <p>Activates neutrophils rather than fixing complement</p> Signup and view all the answers

    What organ is primarily affected by factors triggering TRALI?

    <p>Lung microvasculature</p> Signup and view all the answers

    How is endothelial cell involvement crucial in the pathogenesis of TRALI?

    <p>By up-regulating adhesion molecules</p> Signup and view all the answers

    What is the incidence rate of TRALI?

    <p>&lt;1 in 10,000 transfusions</p> Signup and view all the answers

    In TRALI, what triggers the activation of neutrophils in the lung microvasculature?

    <p>Factors present in the transfused blood product</p> Signup and view all the answers

    What is the main focus of the article by Saha et al.?

    <p>Thrombotic thrombocytopenia purpura</p> Signup and view all the answers

    In the study by Zuffery et al., what is the main focus of discussion?

    <p>Immune thrombocytopenia</p> Signup and view all the answers

    Which article provides an update on the molecular pathogenesis of a specific disorder?

    <p>Noris M, Remuzzi G on Atypical hemolytic uremic syndrome</p> Signup and view all the answers

    The research by Saha et al. primarily focuses on which condition?

    <p>Thrombotic thrombocytopenia purpura</p> Signup and view all the answers

    According to Kapur et al., what is the key topic of discussion?

    <p>Hemolytic uremic syndrome</p> Signup and view all the answers

    Which article emphasizes the role of the alternative complement pathway in a specific disorder?

    <p>Noris M, Remuzzi G on Atypical hemolytic uremic syndrome</p> Signup and view all the answers

    Which disorder is mainly focused on in Zuffery et al.'s work?

    <p>Immune thrombocytopenia</p> Signup and view all the answers

    What is the main topic of discussion in Salter et al.'s comprehensive review?

    <p>Atypical hemolytic uremic syndrome</p> Signup and view all the answers

    In what year was a landmark paper published defining the molecular basis of hemoglobin switching and how to reverse it, providing a therapeutic strategy in certain thalassemias?

    <p>2018</p> Signup and view all the answers

    Which disorder is primarily discussed in Leebeek and Eikenboom's article?

    <p>Disseminated intravascular coagulation</p> Signup and view all the answers

    What is the primary focus of the review by Muckenthaler MU, Rivella S, Hentze MW?

    <p>Normal iron metabolism</p> Signup and view all the answers

    Which publication provides an updated discussion of how sickle cell disease leads to tissue damage?

    <p>Red cell membrane disorders</p> Signup and view all the answers

    What is the effect of direct promoter repression by BCL11A on the fetal to adult hemoglobin switch?

    <p>Reverses it</p> Signup and view all the answers

    Which publication offers an excellent overview of common hemolytic anemias caused by red cell membrane disorders?

    <p>Red cell membrane disorders</p> Signup and view all the answers

    What is the primary focus of the review by Higgs DR, Engel JD, Stamatoyannopoulos G?

    <p>Molecular pathogenesis of thalassemia syndromes</p> Signup and view all the answers

    Which publication provides a discussion of pathophysiology of paroxysmal nocturnal hemoglobinuria and the therapeutic impact of inhibiting C5b-C9 membrane attack complex?

    <p>Paroxysmal nocturnal hemoglobinuria</p> Signup and view all the answers

    What is the focus of the publication by Liu N, Hargreaves VV, Zhu Q et al?

    <p>Fetal to adult hemoglobin switch</p> Signup and view all the answers

    Which paper reviews red cell disorders and mentions a low risk of 'exotic' infectious agents like West Nile virus?

    <p>Thalassemia</p> Signup and view all the answers

    Study Notes

    Anemias

    • Anemia is defined as a reduction of the total circulating red cell mass below normal limits.
    • Anemia reduces the oxygen-carrying capacity of the blood, leading to tissue hypoxia.
    • Classification of anemia can be based on underlying mechanisms, such as blood loss, increased red cell destruction, and decreased red cell production.

    Intravascular Hemolysis

    • Intravascular hemolysis is a less common type of hemolysis, compared to extravascular hemolysis.
    • Causes of intravascular hemolysis include:
      • Mechanical injury due to trauma, cardiac valves, or microcirculation narrowing.
      • Complement fixation, which occurs when antibodies recognize and bind red cell antigens.
      • Exogenous toxic factors, such as clostridial sepsis, which releases enzymes that digest the red cell membrane.

    Extravascular Hemolysis

    • Extravascular hemolysis is the most common type of hemolysis.
    • Causes of extravascular hemolysis include:
      • Alterations that make red cells less deformable.
      • Reduced deformability makes it difficult for red cells to navigate the splenic sinusoids, leading to sequestration and phagocytosis by macrophages.

    Hereditary Spherocytosis

    • Hereditary spherocytosis is an inherited disorder caused by intrinsic defects in the red cell membrane skeleton.
    • Defects lead to red cells becoming spheroid, less deformable, and vulnerable to splenic sequestration and destruction.
    • Pathogenesis involves mutations that affect the membrane skeletal components, such as ankyrin, band 3, spectrin, or band 4.2.
    • The spleen plays a crucial role in the premature demise of spherocytes.

    Clinical Features of Hereditary Spherocytosis

    • The diagnosis is based on family history, hematologic findings, and laboratory evidence.
    • Characteristic features include:
      • Anemia
      • Splenomegaly
      • Jaundice
      • Increased mean cell hemoglobin concentration
      • Increased red cell sensitivity to osmotic lysis

    Morphology of Hemolytic Anemia

    • Common features of hemolytic anemia include:
      • Reticulocytosis
      • Marrow erythroid hyperplasia
      • Hemosiderosis
      • Mild jaundice
      • Cholelithiasis (pigment stones)

    Red Blood Cell Indices

    • Red blood cell indices are used to classify anemias based on morphology.
    • Indices include:
      • Mean cell volume (fL)
      • Mean cell hemoglobin (pg)
      • Mean cell hemoglobin concentration (g/dL)
      • Red cell distribution width (coefficient of variation of red cell volume)### G6PD Deficiency
    • Several hundred G6PD genetic variants exist, but only two variants, G6PD and G6PD Mediterranean, are associated with clinically significant hemolytic anemia.
    • G6PD deficiency is an X-linked recessive trait, placing males at higher risk for symptomatic disease.
    • The deficiency leads to hemolysis due to the inability to protect against oxidative stress.
    • Triggers for hemolysis include infections, drugs, and certain foods, such as fava beans, which generate oxidants when metabolized.
    • Oxidant stress causes the cross-linking of reactive sulfhydryl groups on globin chains, forming Heinz bodies that damage the red cell membrane.
    • Hemolysis can be intravascular or extravascular.

    Clinical Features of G6PD Deficiency

    • Hemolytic crises are produced by intercurrent events leading to increased splenic destruction of red cells.
    • Gallstones are common in patients with G6PD deficiency.
    • Splenectomy treats anemia and its complications, but increases the risk of sepsis due to the loss of the spleen's filtering function.

    Pathophysiology of Sickle Cell Disease

    • Sickle cell disease is caused by a point mutation in the β-globin gene, leading to the replacement of a charged glutamate residue with a hydrophobic valine residue.
    • The abnormal physiochemical properties of sickle hemoglobin (HbS) are responsible for the disease.
    • Polymerization of HbS leads to red cell distortion, hemolytic anemia, microvascular obstruction, and ischemic tissue damage.

    Morphology in Sickle Cell Disease

    • Peripheral blood demonstrates variable numbers of irreversibly sickled cells, reticulocytosis, and target cells.
    • Bone marrow is hyperplastic due to compensatory erythroid hyperplasia.
    • Extramedullary hematopoiesis may occur.
    • Spleen is enlarged in early childhood, but eventually undergoes autosplenectomy due to chronic erythrostasis.
    • Infarctions can occur in various tissues, including bones, brain, kidney, liver, retina, and pulmonary vessels.

    Pernicious Anemia

    • Pernicious anemia is caused by autoimmune destruction of gastric parietal cells, leading to a deficiency of intrinsic factor and vitamin B12.
    • Autoantibodies are formed against intrinsic factor and parietal cells.
    • Vitamin B12 deficiency can also arise from other causes, such as achlorhydria, gastrectomy, insufficiency of the exocrine pancreas, and ileal resection or disease.### Anemias
    • Anemia is a reduction of the total circulating red cell mass below normal limits, leading to tissue hypoxia.
    • Anemia can be classified based on underlying mechanisms, such as:
      • Inadequate production of red cells (e.g., vitamin B12 deficiency)
      • Increased destruction of red cells (e.g., hemolysis)
      • Blood loss
    • Anemia can also be classified based on alterations in red cell morphology, including:
      • Red cell size (normocytic, microcytic, or macrocytic)
      • Degree of hemoglobinization (normochromic or hypochromic)
      • Shape

    Pernicious Anemia

    • Pernicious anemia is a type of anemia caused by vitamin B12 deficiency.
    • Vitamin B12 deficiency can lead to a relative deficiency in certain settings, such as:
      • Pregnancy
      • Hyperthyroidism
      • Disseminated cancer
      • Chronic infection
    • Morphological changes in the bone marrow and blood in pernicious anemia are similar to those in other forms of megaloblastic anemia.
    • The stomach typically shows diffuse chronic gastritis, with fundic gland atrophy and replacement of glandular epithelium with mucus-secreting goblet cells.
    • The tongue may take on a shiny, glazed, "beefy" appearance (atrophic glossitis).

    Folate Deficiency

    • Folate deficiency results in a megaloblastic anemia with the same pathologic features as vitamin B12 deficiency.
    • Folate is essential for the transfer of one-carbon units, such as formyl and methyl groups, to various compounds.
    • Folate derivatives act as intermediates in the transfer of one-carbon units, and are regenerated from their one-carbon carrier derivatives.
    • Important metabolic processes dependent on folate include:
      • Purine synthesis
      • Conversion of homocysteine to methionine (also requires vitamin B12)
      • dTMP synthesis
    • Folate deficiency can be caused by:
      • Decreased intake (e.g., inadequate diet, malabsorption)
      • Increased demand (e.g., pregnancy, cancer)

    Sickle Cell Disease

    • Sickle cell disease is a genetic disorder caused by a mutation in the HBB gene, leading to the production of abnormal hemoglobin (HbS).
    • The disease is characterized by:
      • Moderately severe hemolytic anemia
      • Reticulocytosis
      • Hyperbilirubinemia
      • Presence of irreversibly sickled red cells
    • Crises in sickle cell disease include:
      • Vaso-occlusive crises (e.g., pain crises, acute chest syndrome)
      • Sequestration crises
      • Aplastic crises
    • Complications of sickle cell disease include:
      • Chronic tissue hypoxia
      • Organ damage (e.g., spleen, heart, kidneys, lungs)
      • Increased susceptibility to infection
    • Treatment for sickle cell disease includes:
      • Hydroxyurea (inhibits DNA synthesis, increases HbF levels, and has anti-inflammatory effects)
      • L-glutamine (may decrease pain crises)
      • Hematopoietic stem cell transplantation (offers a chance at cure)
      • Gene editing (CRISPR technology) to reverse hemoglobin switching

    Thalassemia

    • Thalassemia is a genetically heterogeneous disorder caused by germline mutations that decrease the synthesis of either α-globin or β-globin, leading to anemia, tissue hypoxia, and red cell hemolysis.
    • β-Thalassemia is caused by mutations that diminish the synthesis of β-globin chains, leading to:
      • Ineffective erythropoiesis
      • Imbalance in α- and β-globin synthesis
      • Unpaired α-chains precipitating within red cell precursors
      • Membrane damage and red cell hemolysis
    • α-Thalassemia is caused by mutations that decrease the synthesis of α-globin chains, leading to:
      • Ineffective erythropoiesis
      • Imbalance in α- and β-globin synthesis
      • Unpaired β-chains precipitating within red cell precursors
      • Membrane damage and red cell hemolysis

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    Explore the chapter discussing diseases of red cells, anemias, bleeding disorders, and complications of blood transfusion. Learn about the reduction of total circulating red cell mass and its impact on oxygen-carrying capacity.

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