Hematology Ch 12-17
Microbial agents associated with anemia of inflammation:
-Bacterial (M. tuberculosis) -Fungal (C. neoformans) -Viral (HIV, Cytomegalovirus)
Iatrogenic Agents
-Benzene and benzene derivatives -Trinitrotoluene -Insecticides and weed killers -Inorganic arsenic -Antimetabolites -Antibiotics
Signs and symptoms of aplastic anemia depend on the degree of the deficiencies and include the following:
-Bleeding from thrombocytopenia (low platelets) -Infection from neutropenia (low wbc's) -Signs and symptoms of anemia -Splenomegaly and lymphadenopathy are absent
Fanconi's Anemia
-Congenital for of aplastic anemia; condition is produced due to one or more mutations in the FAC gene -Diagnosis is usually made in children 5 to 10 years of age
Laboratory assays that suggest inflammation or infection include the following:
-Elevated platelet counts -Elevated total leukocyte counts -Evidence of acute-phase reactants
Chronic blood loss is frequently associated with disorders such as
-GI Tract -Heavy menstruation in women -Urinary Tract abnormalities
Hereditary Hemochromatosis
-Genetic error of metabolism that produces inappropriately increased GI absorption of iron due to hepcidin deficiency -Typically not seen in females
Laboratory characteristics of AOI/ACD
-Hematocrit fixed in the 28% to 32% range -In some cases hemoglobin may be as low as 5 g/dL
Laboratory Characteristics SA
-Hypercellular marrow with normal reticulocyte count -Mature, nonnucleated RBC's are generally hypochromic with normocytic and/or microcytic
Acute Blood Loss Anemia Laboratory Findings
-Increased WBC and platelets -Normal reticulocytes -Normal HCT -No iron deficiency
Chronic Blood Loss Adaptation
-Increased erythropoietin production -Increased 2,3 DPG production -Decreased hemoglobin-oxygen affinity
Acute Blood Loss Adaptations
-Increased respiratory rate -Increased heart rate and cardiac output -Redirected blood flow from the periphery of the body to the vital body core i.e heart and brain
Anemia results in illnesses as diverse as
-Inflammation -Infection =Malignancy -Various systematic diseases
Iron overload can result from
-Inherited alterations in factors that control iron uptake and retention -Chronic disorders like sideroblastic anemia -Iron therapy or transfusion -Hemolytic anemias -Hereditary hemochromatosis
Idiopathic aplastic anemia
-Major form of aplastic anemia, occurs in patients with no established history of chemical or drug exposure or viral infection -Most occur due to immune process
Porphyrias: clinical presentation
-Neurological symptons -Skin problems
Chronic Blood Loss Anemia Laboratory Findings
-Normal WBC and platelets - Normal or slightly increased reticulocytes -Decreased HCT -Iron deficiency
C-Reactive Protein (CRP)
-Number 1 blood test used to diagnose inflammation in the body; increases before anything else goes up; quicker, faster, more accurate than ESR -May or may not correlate with hepcidin levels
Aplastic Anemia
-One of a group of disorders known as hypoproliferative disorders, that are characterized by reduced growth or production of red blood cells -Bone marrow failure
The cause of IDA is
-nutritional deficiency -faulty iron absorption -excessive loss of iron
Iron deficiency is still common in
-toddlers -adolescent girls -women of childbearing age
Diagnosis of aplastic anemia is made when at least __ of the three PB values fall below critical levels
2
In acute blood loss, the return of the red cell profile to previous values takes longer than __ weeks.
2
Acute blood loss occurs within
24- 48 hours
It can be ___ to ___ hours after the hemorrhage until the full extent of the red cell loss is apparent.
48 to 72
Shock
A condition where severe hemorrhage or rapid blood loss amounts to more than 20% of the circulating blood volume reduces and individuals total blood volume
Hepcidin
A small plasma protein that is a key molecule in controlling iron absorption and recycling
Is a hypoproliferative defect not related to any nutritional deficiency
AOI/ACD
Clinical signs and symptoms of Fanconi's Anemia
About 50% of patients show clinical abnormalities such as short stature, microcephaly, malformed thumbs, strabismus, and mental retardation
The systemic diseases that produce AOI are accompanied by the release of __________________ in the blood.
Acute Phase Reactants: --Elevated C-Reactive Protein --Fibrinogen --Haptoglobin --Ceruloplasmin
Anemias can be caused by
Acute or Chronic Blood Loss
Pancytopenia
All cell lines show a decrease
Cytopenia with a hypocellular marrow can impact:
All three cell lines, resulting in a pancytopenia as in constitutional aplastic anemia
In acute blood loss, the body itself adjusts to the situation by expanding the circulatory volume, which produces the subsequent ___________________.
Anemia
ACD
Anemia of Chronic Disease
AOI
Anemia of Inflammation
Acute Loss of Blood
Associated with traumatic conditions such as an accident or severe injury; may occur during or after surgery
Hypoproliferative
Bone marrow not making enough cells
IDA Indice progression
MCV-normocytic to microcytic MCHC-normochromic to hypochromic Retic count- normal or low
Iron Deficiency with Severe Anemia (Iron Study)
Marrow iron stores- 0 Serum Iron Level- Decreased Fe binding capacity- Increased Hemoglobin- Decreased Microcytic/Hypochromic- 4+ Ferritin- Decreased Free RBC protoporphyrin level- Decreased
AOI/ACD cases can be caused by:
Neoplasms Rheumatoid Arthritis Rheumatic Fever Systemic lupus erythemotosus (SLE) Uremia Chronic liver disease
Sequential phases of iron deficiency:
Prelatent-Decrease in storage iron (ferritin) Latent-Decrease in functional and circulating iron for erythropoiesis (decreased serum iron and increased TIBC/UIBC) Anemia-Decrease in circulating red blood cell parameters (RBC/H&H); decrease in oxygen delivery to peripheral tissues
The cytochemical stain that can demonstrate iron, hemosiderin, and ferritin is
Prussian Blue
Absolute Iron Deficiency
Represents a decrease in total body iron caused by blood loss, decreased intake of iron, or increased utilization of iron
Functional Iron Deficiency
Represents inadequate utilization of iron stores; such as iron sequestration syndromes like ACD/AOI
ACD/AOI Iron Levels
Serum Iron-- Decreased TIBC-- Normal or decreased Serum Ferritin--Normal to increased Transferrin Saturation--Decreased RBC morphology-- Normocytic or microcytic, hypochromic
IDA Iron Levels
Serum Iron-- Significant decrease TIBC-- Increased Serum Ferritin-- Decreased Transferrin Saturation--Decreased RBC morphology--microcytic/hypochromic
In this type of anemia, the body has a sufficient amount of iron but unable to incorporate into hemoglobin
Sideroblastic Anemia
ACD/AOI Treatment
Treatment of the underlying cause of anemia is the most direct approach
Hemogloblin and hematocrit do not fall immediately during acute blood loss.
True; but fall as tissue fluids move into the blood circulation
Constitutional Aplastic Anemia
Designates a congenital or genetic predisposition to bone marrow failure
iatrogenic
Drug related
Increased platelets can be observed in
acute blood loss
Increased iron utilization can be the result of
adolescent growth spurt
The sudden appearance of aplastic anemia or pure red cell aplasia is often caused by
an immune process
The chronic and continual loss of small volumes of blood does not disrupt the
blood volume
True aplastic anemia is characterized as a
bone marrow failure and results in inadequate production of hemopoietic cells
Faulty iron absorption can result from
celiac disease
Disorders of the GI system or heavy menstruation can cause
chronic blood loss
Results in an iron deficiency and hypochromic RBC morphology on a peripheral blood smear
chronic blood loss
The blood volume is not disrupted in
chronic blood loss
Retic count increase in
chronic blood loss situation
Cytopenia
deficiency of cells
If only one cell line is involved it is usually the
erythrocytic cells
In acute blood loss anemia, an increased number of reticulocytes reach the circulating blood because of increased____________________. This phenomenon takes place beginning approximately __ to __ days after the blood loss and reaches a maximum approximately 10 days late
erythropoiesis; 3-5
Anemia caused by chronic blood loss is characterized by
hypochromic, microcytic erythrocytes
In chronic blood loss anemia, platelets are______________ and only later in severe iron deficiency the are likely to be ________________.
increased; decreased
Gradually chronic bleeding results in ______________________ and the newly formed cells are morphologically ________________ and ______________________.
iron deficiency; hypochromic and microcytic
Long term survivors of acquired aplastic anemia may be at high risk for _________________, both leukemic and solid tumors, years after remission.
malignancy
Serum Iron
measures circulating iron bound to transferrin
Transferrin Saturation
measures percentage of transferrin occupied by iron
Serum Ferritin
measures storage iron
The peripheral blood smear demonstrates______________ red blood cells in IDA
microcytic/hypochromic
Abnormal bone marrow has
more fat and less cells
In acute blood loss, it takes about 2 weeks for the ________________________to disappear.
morphological picture
In acute blood loss, it takes 2 to 4 days after the blood loss for the total blood cell count to return to
normal
In chronic blood loss anemia, white blood cell count is
normal or slightly decreased
The RBC morphology associated with smears in an otherwise healthy individual caused by acute blood loss is usually
normochromic
In acute blood loss anemia the peripheral blood smear film at 24 hours should be
normochromic and normocytic with normal RBC indices (MCV/MCH.MCHC)
In aplastic anemia RBCs are usually
normochromic with varying degrees of anisocytosis and poikilocytosis with normal RDW in most cases.
They typical blood film of a patient with AOI typically reveals _____________ erythrocytes.
normocytic/normochromic
Chronic blood loss occurs over
periods of months to years
Decreased iron intake can result from
red meat deficient diet
Iron deficiency anemia is a progressive disease so
results may shift as disease progresses
A common feature of sideroblastic anemia is
ringed sideroblasts
In chronic blood loss regeneration of red blood cells occur at a ______________ rate.
slower
In chronic anemias, blood loss of _______ amounts occurs over an extended period, usually months.
small
A noticeable anemia does not usually develop until after______________ iron is depleted
storage (ferritin)
White count and platelet increase when body is
stressed (acute situation)
Approximately half of AOI/ACD cases are caused by
subacute or chronic infections
A characteristic of Fanconi's anemia is
the best described congenital form of aplastic anemia
After acute blood loss, blood smears may not initially look anemic due to
the body releasing plasma to expand blood that is already there
Prussian Blue
this stain reveals the excess iron as blue deposits circling the nucleus like a pearl necklace
Acquired aplastic anemia may be caused by
-benzene/ benzene derivatives -ionizing radiation and vitamin B12 -purine/pyrimidine analogues
Sideroblastic anemia can be caused by
-congenital defects -drugs -associated with malignant disorders
If a patient with aplastic anemia is referred to as exhibiting pancytopenia, which cell lines are affected?
-erythrocytes -leukocytes -thrombocytes
Anemias of inflammation/chronic diseases can be caused by
-inflammation and infection -increased hepcidin production -malignancy
Acute blood loss does not produce an
Immediate Anemia
Sideroblastic Anemia
Inherited or acquired disorder characterized by ringed sideroblasts in the bone marrow
IDA
Iron Deficiency Anemia; can be caused by an absolute or functional iron deficiency
