Overview of Hema
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Questions and Answers

What is the primary function of embryonic hemoglobin during the first few weeks of gestation?

  • Providing oxygen to rapidly growing embryonic tissues (correct)
  • Transporting carbon dioxide from tissues
  • Regulating iron levels in the blood
  • Facilitating the production of red blood cells in adults

Which type of hemoglobin is predominantly produced from 12 weeks of gestation to 6 months post-birth?

  • Fetal Hemoglobin (HbF) (correct)
  • Hemoglobin Gower 2
  • Hemoglobin Portland
  • Hemoglobin Gower 1

In the context of iron deficiency anemia, what does an elevated RDW indicate?

  • Heterogeneity in red blood cell size (correct)
  • Reduction in hemoglobin concentration
  • Consistent red blood cell size
  • Increased maturation of red blood cells

The transition from embryonic hemoglobin to fetal hemoglobin involves which form of globin chains at approximately 12 weeks gestation?

<p>Two alpha and two gamma (D)</p> Signup and view all the answers

What is a characteristic hematological finding in iron deficiency anemia?

<p>Microcytosis (C)</p> Signup and view all the answers

Which of the following globin chain combinations represents Hemoglobin Gower 1?

<p>ζ₂ε₂ (A)</p> Signup and view all the answers

Which clinical finding is indicative of reduced oxygen-carrying capacity in iron deficiency anemia?

<p>Low hemoglobin levels (B)</p> Signup and view all the answers

What type of hemoglobin is characterized as having minor physiological significance in humans?

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

Which of the following types of anemia is characterized by microcytic, hypochromic red blood cells with normal or elevated ferritin levels?

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

What laboratory finding is commonly associated with sideroblastic anemia?

<p>Basophilic stippling and ringed sideroblasts (C)</p> Signup and view all the answers

In hemolytic anemia, which of the following findings would likely be present?

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

What morphological finding is NOT typically associated with iron deficiency anemia?

<p>Nucleated RBCs (B)</p> Signup and view all the answers

What distinguishes thalassemia from iron deficiency anemia in terms of RBC morphology?

<p>Presence of small blue dots inside RBCs (B)</p> Signup and view all the answers

Which condition may cause low Vitamin B12 levels?

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

What characteristic does a high reticulocyte count indicate?

<p>Effective erythropoiesis (B)</p> Signup and view all the answers

Which test is most appropriate for diagnosing hemoglobinopathies?

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

Which marker is NOT typically associated with hemolytic anemia?

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

Elevated levels of creatinine and urea nitrogen are indicators of which condition?

<p>Chronic kidney disease (D)</p> Signup and view all the answers

Which test can suggest chronic inflammatory disease as a cause for anemia?

<p>C-Reactive Protein (CRP) (A)</p> Signup and view all the answers

In which condition might a peripheral blood smear show microcytic red blood cells?

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

What is the likely result of prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)?

<p>Potential bleeding disorders (B)</p> Signup and view all the answers

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

<p>Vitamin B12 deficiency (B)</p> Signup and view all the answers

Which vitamin deficiency is most commonly investigated in cases of suspected megaloblastic anemia?

<p>Folic acid (A), Vitamin B12 (B)</p> Signup and view all the answers

What condition is characterized by a reduction in hematopoietic cells, leading to insufficient blood cell production?

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

Which of the following hemoglobin functions assists in maintaining blood pH?

<p>Buffering capacity (C)</p> Signup and view all the answers

In which condition would you expect to see increased hematopoiesis?

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

How many molecules of oxygen can one hemoglobin molecule carry?

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

What is one potential consequence of bone marrow failure?

<p>Fat infiltration in red marrow (A)</p> Signup and view all the answers

What primarily influences hemoglobin's oxygen-binding capacity?

<p>Partial pressure of oxygen and pH (B)</p> Signup and view all the answers

Which type of anemia is characterized by a failure to produce enough red blood cells due to bone marrow issues?

<p>Aplastic anemia (C)</p> Signup and view all the answers

Hemoglobin also plays a role in which aspect of gas exchange?

<p>Carbon dioxide transport (B)</p> Signup and view all the answers

What might be a physiological symptom of hemoglobin deficiency?

<p>Pallor (C)</p> Signup and view all the answers

Which stage of hematopoiesis involves the differentiation of stem cells into committed progenitors?

<p>Progenitor stage (B)</p> Signup and view all the answers

Which type of anemia is characterized by a deficiency of iron, leading to microcytic and hypochromic red blood cells?

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

What laboratory test is most essential for evaluating iron deficiency anemia?

<p>Serum ferritin (B)</p> Signup and view all the answers

How does erythropoietin regulate red blood cell production?

<p>Stimulates the production of erythrocytes from bone marrow (A)</p> Signup and view all the answers

Which physiological mechanism primarily causes pallor in anemia?

<p>Reduced red blood cell count (A)</p> Signup and view all the answers

Which type of hemoglobin is primarily present in adults and is responsible for oxygen transport?

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

What changes in the bone marrow can be observed during anemia?

<p>Hyperplasia of red cell precursors (C)</p> Signup and view all the answers

In cases of microcytic anemia, what is often the result of impaired hemoglobin synthesis?

<p>Decreased mean corpuscular volume (B)</p> Signup and view all the answers

How can thalassemia be distinguished from iron deficiency anemia?

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

Which of the following is NOT a typical laboratory finding in iron deficiency anemia?

<p>High mean corpuscular volume (D)</p> Signup and view all the answers

What is the role of reticulocytes in diagnosing anemia?

<p>Reflect the bone marrow's response to red blood cell loss (C)</p> Signup and view all the answers

Flashcards

Embryonic Hemoglobin

Hemoglobin types produced in early fetal development (first 8-12 weeks).

Hemoglobin Gower 1

Embryonic hemoglobin type with zeta (ζ) and epsilon (ε) chains.

Hemoglobin Gower 2

Embryonic hemoglobin with alpha (α) and epsilon (ε) chains.

Hemoglobin Portland

Embryonic hemoglobin composed of zeta (ζ) and gamma (γ) chains.

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Fetal Hemoglobin (HbF)

The predominant hemoglobin type during most of fetal life, with alpha (α) and gamma (γ) chains.

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Elevated RDW

A higher than normal Red Blood Cell Distribution Width, indicating variations in RBC size.

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Low MCV (Microcytosis)

Smaller than normal red blood cells, indicating possible iron deficiency.

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Low Hemoglobin

Reduced ability of blood to carry oxygen because there isn't enough hemoglobin.

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Microcytic vs. Macrocytic Anemia

Different blood test levels help distinguish between these types of anemia.

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Low Vitamin B12

Caused by conditions like pernicious anemia, malabsorption, or dietary deficiencies.

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Low Folate

Can stem from dietary problems, malabsorption, or increased body needs (e.g., pregnancy).

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Anemia of Chronic Disease

Anemia linked to an ongoing illness or inflammation.

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CRP or ESR

Blood tests used to detect infection or inflammation (potentially causing anemia).

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Kidney Function Tests

Tests that indicate possible kidney disease, a cause of reduced red blood cell production.

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Coagulation Studies

Used to evaluate a person's ability to clot blood, useful if bleeding is a suspected cause of anemia.

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Hemoglobin Electrophoresis

A test to identify abnormal hemoglobin types, like in sickle cell disease or thalassemia.

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Iron Deficiency Anemia Tests

Iron studies (e.g., serum ferritin, TIBC) assess iron levels and potential deficiencies or overload.

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Peripheral Blood Smear

A microscopic examination of blood to evaluate red blood cell morphology.

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Bone Marrow Histology and Blood Production

Bone marrow structure reflects blood production capacity. Healthy marrow shows active blood cell production, while deficient marrow indicates reduced production.

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Hemoglobin Function

Hemoglobin carries oxygen throughout the body. Different types exist, and its deficiency leads to reduced oxygen delivery, causing pallor.

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Anemia Epidemiology

Anemia is widespread globally, varies by region and population, and has specific causes related to diet, environment, and genetics.

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Anemia Types and Etiology

Different types of anemia exist based on underlying causes. Iron deficiency, genetic defects, and chronic diseases are common categories.

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Pallor and Anemia

Anemia leads to pallor because of reduced oxygen carrying capacity in blood, causing decreased oxygenation of skin.

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Chronic Blood Loss and Iron Deficiency

Prolonged bleeding depletes iron stores, which is essential for hemoglobin production, leading to iron deficiency anemia.

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Impact of Iron Deficiency on Hemoglobin

Iron deficiency impairs hemoglobin synthesis, resulting in reduced hemoglobin production and decreased blood oxygen carrying capacity.

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Blood Composition Changes in Anemia

Anemia alters the balance between blood plasma and cellular components, lowering the red blood cell count and hemoglobin concentration.

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Erythropoietin in Red Cell Production

Erythropoietin stimulates red blood cell production. In anemia, its levels might be altered depending on the underlying cause.

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Bone Marrow Changes in Anemia

Bone marrow shows adjustments in response to anemia, either increasing or decreasing activity levels depending on the type and severity of the anemia.

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Target Cells

Red blood cells with a central area of hemoglobin surrounded by a pale ring, characteristic of thalassemia.

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Basophilic Stippling

Presence of small blue dots inside red blood cells, indicating abnormal hemoglobin production.

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How does MCV help distinguish Thalassemia and Iron Deficiency Anemia?

In thalassemia, MCV is usually low, but may be normal or even slightly elevated in some cases. In Iron Deficiency Anemia, MCV is consistently low.

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Elevated Ferritin in Thalassemia

Despite the low MCV, ferritin levels are normal or even elevated in thalassemia.

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Anisocytosis and Poikilocytosis

Variation in red blood cell size (anisocytosis) and shape (poikilocytosis) is often more pronounced in thalassemia than in iron deficiency anemia.

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Hemoglobin's Role

Hemoglobin, found in red blood cells, is crucial for transporting oxygen from the lungs to tissues and removing carbon dioxide from the body.

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Oxygen Binding

Hemoglobin binds to oxygen in the lungs where oxygen levels are high, and releases it in tissues where oxygen is needed.

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Bohr Effect

Hemoglobin's oxygen-binding capacity is influenced by oxygen pressure and pH, helping it pick up oxygen in the lungs and release it in tissues.

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CO2 Transport

Hemoglobin also helps carry carbon dioxide, a waste product of cell activity, back to the lungs for expulsion.

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Hemoglobin Buffering

Hemoglobin helps regulate blood pH by acting as a buffer, preventing drastic pH changes, maintaining acid-base balance.

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Hemoglobin Types

Different types of hemoglobin exist, expressed throughout life to meet specific developmental needs.

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Hemoglobin Deficiency

When hemoglobin is deficient, blood's oxygen-carrying capacity is reduced, leading to pale skin (pallor).

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Hemoglobin Synthesis

Hemoglobin is made in the body using building blocks like iron and certain amino acids.

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What is the Bohr Effect?

The Bohr effect describes how hemoglobin's ability to bind oxygen changes depending on the acidity and oxygen pressure of its surroundings.

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Why is Hemoglobin Important?

Hemoglobin is crucial for transporting oxygen and carbon dioxide, regulating blood pH, and contributing to overall blood health.

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Study Notes

Patient Information

  • Patient ID: C.A.
  • Age: 18
  • Sex: Female
  • Marital Status: Single
  • Location: Camalig, Albay

Chief Complaint

  • Fatigue and pallor (paleness) for 3 months

History of Present Illness

  • Progressive fatigue after minimal exertion, including climbing stairs or carrying groceries.
  • Dizziness, shortness of breath with exertion, and difficulty concentrating in school, observed over the past month.
  • Heavy menstrual bleeding for the past month (7-8 days, requiring more than 8 pads a day).
  • No intermenstrual or post-coital bleeding.
  • No significant weight loss, fever, night sweats, or unusual bruising.
  • Diet mostly rice, vegetables, and fish, with occasional meat.
  • Skips meals occasionally due to a busy school schedule.

Past Medical History

  • No previous hospitalizations or surgeries.
  • No known allergies
  • Immunization status up-to-date.
  • No prior diagnosis of anemia or blood disorders

Family History

  • No family history of anemia, bleeding disorders, or chronic illnesses
  • Parents and siblings healthy

Social History

  • College student living with parents
  • No smoking, alcohol consumption, or illicit drug use.
  • No recent travel or exposure to infectious diseases.

Physical Examination (Handout 2)

  • General Appearance: Alert, oriented, but pale and tired.
  • Vital signs: Temperature 36.7°C, Blood Pressure 100/60 mmHg, Heart Rate 92 bpm (regular), Respiratory Rate 18 breaths/min
  • Skin: Pale, no jaundice, cyanosis, or petechiae. No rashes, petechiae, or ecchymosis.
  • HEENT: Pale conjunctiva, no icterus, oral mucosa dry, no lymphadenopathy, thyroid not enlarged, no neck vein distention or carotid bruits.
  • Cardiovascular: Tachycardia, regular rhythm, no murmurs, rubs, or gallops.
  • Respiratory: Symmetrical chest expansion, clear breath sounds bilaterally.
  • Abdomen: Soft, non-tender, no organomegaly, normoactive bowel sounds. No venous hum or abdominal bruits.
  • Extremities: No edema, nails show koilonychia.
  • Neurological: Intact cranial nerves, normal motor strength and sensation, 5/5 strength in all extremities, normal sensation and reflexes, no focal neurological deficits.

Review of Systems

  • Fatigue, pallor, occasional dizziness
  • Shortness of breath on exertion
  • Mild palpitations with exertion, no chest pain
  • No abdominal pain, nausea, vomiting, or changes in bowel habits
  • Heavy menstrual bleeding, no dysuria or hematuria
  • No headaches, limb weakness, difficulty concentrating

Initial Diagnostic Tests (Handout 3)

  • Complete Blood Count (CBC): Hemoglobin and hematocrit low, Mean Corpuscular Volume (MCV) low, Red Cell Distribution Width (RDW) elevated.
  • Peripheral Blood Smear: Hypochromic, microcytic red blood cells.
  • Serum Iron Studies: Serum Iron low, Total Iron Binding Capacity (TIBC) high, Ferritin low.
  • Reticulocyte Count low
  • Stool Occult Blood Test: Negative
  • Urinalysis: Normal
  • Pelvic Ultrasound: Not specified

Assessment

  • Signs and symptoms of iron deficiency anemia likely secondary to chronic blood loss from menorrhagia and suboptimal dietary intake.

Plan

  • Iron supplementation (oral ferrous sulfate 325 mg once daily, with vitamin C to enhance absorption).
  • Dietary counseling to increase intake of iron-rich foods
  • Referral to gynecologist for evaluation and management of heavy menstrual bleeding.
  • Follow-up: Repeat CBC and iron studies in 4 weeks to assess response to treatment

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