Heme Final Review

Anemia Morphology Classification

Microcytic Anemia
- Iron Deficiency Anemia (most common)
  - Caused by depleted iron stores due to dietary intake, malabsorption, increased demand, or increased loss.
  - Stages:
    - Stage 1: Depletion of iron stores
    - Stage 2: Iron deficient erythropoiesis
    - Stage 3: Iron deficiency anemia
    - Stage 4: Decreased oxygen delivery
  - Chronic Blood Loss:
    - Small quantities over a long period, commonly from GI tract bleeding.
- Anemia of Chronic Disease
  - Associated with long/short-term inflammation and systemic diseases.
  - Normal RDW, decreased serum iron, increased iron stores in bone marrow.
- Sideroblastic Anemia
  - Can be acquired or inherited.
  - Idiopathic: Myelodysplastic syndrome (MDS).
  - Secondary: Follows drug exposure.
  - Iron not utilized in hemoglobin synthesis, leading to excess accumulation in mitochondria.
  - Lab Findings: Dimorphic, increased RDW, Pappenheimer bodies, increased serum & ferritin.
- Thalassemia
  - Most common type is Beta; characterized by an unstable hemoglobin molecule.
Normocytic Anemia
- Hemolytic Anemia: Caused by spleen removing RBCs.
- Acute Blood Loss:
  - Results from traumatic conditions.
  - Initial hours show no change in HGB & HCT.
  - Features polychromasia and increased platelet count during bleeding.

Macrocytic Anemia
- Non-Megaloblastic:
  - Aplastic Anemia: Failure in production of RBCs, WBCs, and platelets; hypocellular bone marrow replaced by fat.
  - Chronic Liver Disease
  - Alcoholism
- Megaloblastic:
  - Evaluation schemes for B12 and folic acid deficiencies.

Normocytic Anemia
- Hemoglobin Types & Disease Correlations:
  - Hemoglobin SC: Moderate anemia, less severe than sickle cell.
  - Sickle Cell Trait: Hgb A levels higher than Hgb S.
  - Hgb C Disease/Trait: Homozygous (>90% Hgb C) indicates disease; heterozygous (<40% Hgb C) indicates trait.
  - Hemoglobin D: Does not sickle.
  - Hemoglobin E: Thalassemia-like characteristics.
  - Hemoglobin S: Crescent-shaped RBCs, associated with sickle cell disease.
- Thalassemia Types:
  - Major, Minor, Intermediate, and Alpha Thalassemia.

Homozygous vs. Heterozygous
- Homozygous: Both alleles are the same (dominant or recessive).
- Heterozygous: Two different alleles; only one mutated allele may cause disease.
Hemoglobin Electrophoresis
- Techniques for differentiating hemoglobin types based on migration patterns.
Iron Information
- Types of Iron:
  - Heme iron (from meat) and non-heme iron (plant-based).
- Proteins of Iron Metabolism:
  - Serum iron, transferrin, ferritin, hepcidin, and HFE.

Iron Kinetics
- Daily recycling of iron and storage forms (ferritin and hemosiderin).
- Lab Analysis: Serum ferritin levels and bone marrow estimation using Prussian blue stain.
Non-Malignant Disorders Associated with WBC
- Neutrophil Disorders:
  - Neutrophilia and neutropenia with various causes and characteristics.

Eosinophil and Basophil Disorders
- Eosinophilia and basophilia with increased or decreased counts.
Gaucher’s Disease
- Autosomal recessive trait with beta-glucosidase deficiency leading to glycolipid accumulation.
Niemann-Pick Disease
- Rare autosomal recessive disorder with sphingomyelin accumulation.
Tay-Sachs Disease
- Autosomal recessive disorder with hexosaminidase A deficiency.

Quick Comparisons
- Differentiating neoplasms based on specific characteristics and staining profiles.

Neoplastic Disorder Categories
- Acute Leukemia: N/N anemia, fatigue, and variable WBC.
- Chronic Leukemia: CLL, PLL, HCL, etc.
- Myeloproliferative Neoplasms (MPN): Excess cell production.

Staining Profiles
- Techniques for differentiating myeloid and lymphocytic cells using specific stains.

Hodgkin Lymphoma
- Characterized by Reed-Sternberg cells and various subtypes.
Non-Hodgkin Lymphomas
- More common than Hodgkin lymphoma, lacking Reed-Sternberg cells.
Multiple Myeloma (MM)
- Plasma cell myeloma with associated symptoms and laboratory findings.