Please enable JavaScript.

Coggle requires JavaScript to display documents.

Hematology - Anemia (Types of Anemia (dropped image link (*Microcytic…

- - - - CRC
        normal CRC = 2%
        
        Hemolytic Normocytic
        
        reticulocyte count ↑ 2%
        
        trying to replace lysed RBCs
        
        EXTRINSIC - Hemolytic Normocytic
        
        EXTRINSIC hemolytic = problem outside the RBCs
        --> RBCs are normal
        
        reticulocyte count ↑
        
        trying to replace lysed RBCs
        
        note that EXTRINSIC hemolytic anemias are broken further into either
        --> autoimmune destruction from the outside on RBCs
        --> physical barrier destruction on the RBCs
        --> Malaria + other infections destruction on the RBCs
        
        3 more items...
        
        INTRINSIC - Hemolytic Normocytic
        
        INTRINSIC hemolytic = problem is inside the RBCs themselves
        
        reticulocyte count ↑
        
        trying to replace lysed RBCs
        
        1 more item...
        
        *NON-hemolytic Normocytic
        
        "NORMAL RATS like IRON AND PLASTIC KINDER eggs"
        
        reticulocyte count ↓ (or normal)
        
        NO need to replace RBCs or bone marrow not producing RBCs = Aplastic Anemia
        
        "NORMAL RATS like IRON AND PLASTIC KINDER eggs"
        
        NORMAL RATS = normocytic anemia with Reticulocyte down or normal
        
        IRON = IDA (early stage) --> moves to micro IDA
        
        AND = ACD (early stage) --> moves to micro IDA
        
        PLASTIC = Aplastic anemia
        
        KINDER eggs = CKD
        
        EX
        
        *CKD = Chronic Kidney Disease
        
        "NORMAL RATS like IRON AND PLASTIC KINDER eggs"
        
        1 more item...
        
        *Aplastic Anemia
        
        "NORMAL RATS like IRON AND PLASTIC KINDER eggs"
        
        1 more item...
        
        IN
        
        2 more items...
    - - T = *Thalassemia
        
        Alpha globulin defect
      - L = *lead poisoning
        
        consider this for ANY male construction worker
        --> ONLY after you have ruled out IDA
        --> since IDA is the most common cause
        
        *Basophillic strippling
        
        is a non-specific sign of anemia where protein products = heme, iron, etc. pile up in RBCs
        
        Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
      - S = *sideroblastic Anemia
        
        Notes:
        
        sideroblastic anemia is interruption of ALAS = ALA synthase to make ALA for RBC's
        
        note that
        
        Tx = VB 6 = pyridoxine (Peter PAtrixx) = cofactor for ALA synthase
        
        δ-aminolevulinic acid (ALA) synthase
        
        Sideroblastic anemia comes often after Isoniazid treatment for TB
        --> whenever you have TB and Isoniazid tx
        --> think of sideroblastic anemia
        
        note that VB 6 = pryidoxine needs to be activated for it to work
        
        Isoniazid directly inhibits the enzyme pyridoxine phosphokinase
        --> which normally converts pyridoxine (vitamin B6) to its active form, pyridoxal 5' phosphate
        
        Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
        
        Pernicious Anemia Case
        
        Notes:
        
        δ-aminolevulinic acid (ALA) synthase
        
        key for sideroblastic anemia is the Prussian blue stain
        
        Clinical Case
        
        *Porphyrias and Lead poisoning
        
        all effect heme synthesis
        
        broken into EARLY vs LATE porphyrias
        
        EARLY porphyrias
        --> GI pain + neuropsych problems
        
        LATE porphyrias
        --> activated by UV sunlight, then oxygen reactive
        --> dermatitis int he skin
        
        *LATE porphyrias
        
        activated by UV sunlight, then oxygen reactive
        --> dermatitis int he skin
        
        anything AFTER PBG Deaminase = late porphyria
        --> this is the cutoff
        
        PCT = Porphyrin Cutaneous Tarde
        --> this is the most COMMON porphyria also
        
        UROD = Uroporphyrinogen Decarboxylase
        
        *PCT = Porphyrin Cutaneous Tarde
        
        this is the most COMMON porphyria also
        
        UROD = Uroporphyrinogen Decarboxylase
        --> deficient in this enzyme
        
        1 more item...
        
        *EARLY porphyrias
        
        GI pain + neuropsych problems
        
        EARLY porphyrias
        
        *AIP = acute intermittent Porphyria
        
        inhibits the PBG DA = Deaminase enzyme
        
        tx = heme
        --> for acute AIP attacks
        
        the heme inhibits ALAS and production of the excess PBG and ALA that builds up
        
        1 more item...
      - A = *ACD Anemia of Chronic Disease
        
        LATE phase
        --> initial phase of ACD is NORMOCYTIC
        
        I = *Iron-deficient Anemia
        
        LATE phase
        --> initial phase of ACD is NORMOCYTIC
        
        most common cause of hypochromic microcytic anemia
        
        Presenting Signs and symptoms:
        
        normal signs of anemia
        --> tires, fatigued, irritable
        
        key differential = craving for chewing ice
        
        Clinical Cases
        
        Clinical Case
        
        Clinical Case
        
        Notes:
        
        note that
        
        Iron-deficient Anemia Case
        
        Clinical Case
        
        Notes:
        
        note for possible iron-deficient anemia underlying causes, consider the gender and age of the patient
        
        young women of child-bearing age
        --> most common cause of Iron-deficient anemia is menstruation
        
        men and older postmenopausal women
        --> MUST first rule out loss of iron through occult blood of the GI tract, especially for men need to rule out colorectal cancer
        --> then consider other causes of loss of blood
        
        *plummer Vinsen Syndrome
        
        key presentation for man with IDA
        
        Hypochromic RBCS in IDA
    - - Megaloblastic Macrocytic Anemia
        
        Orotic Anemia
        
        Vit. B12 = *Cobalamin Deficiency Anemia
        
        PA = *Pernicious Anemia
        
        autoimmune parietal cells
        
        loss of intrinsic factor
        
        V B12 deficiency
        
        Pernicious Anemia Case
        
        5 more items...
        
        Presentation of VB12 vs VB9
        BOTH have a rise in HOMOCYSTEINE
        --> since they are both in the Methionine cycle
        VB12 has raised MMA
        --> MMA kick to the illeum in VB12
        VB12 has NEURO symptoms
        --> MMA kick to the HEAD in VB12
        --> VB 9 does NOT
        
        1 more item...
        
        VB12 and VB9 both have
        HYPERSEGMENTED neutrophils
        
        seen in both so can't tell which one
        think there is not enough DNA synthesis so the nucleu branches out from normal
        
        A mature neutrophil exhibits a segmented nucleus with three to five distinct lobes which are connected by thin filaments.
        
        1 more item...
        
        Vit. B9 = Folate Deficiency Anemia
      - NON-Megaloblastic Macrocytic Anemia