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Anemia ÃÑ·Ð ´ëÀå°æ

1. reticulocyte production index = absolute reticulocyte count/"shift factor"

Hct: shift factor 45 = 1 35 = 1.5 25 = 2.0 15 = 2.5

2. microcytic anemia: IDA, chronic disease, thalassemia, aluminum toxicity

±âŸ> thyrotoxicosis, hereditary sideroblastic anemia

3. microcytic erythrocytosis + RDW¡è¸¦ º¸ÀÌ´Â Áúȯ 2°¡Áö

hypoxic erythrocytosis, polycythemia vera

4. ºóÇ÷ÀÇ °¨º°Áø´ÜÀÇ Ã¹ ¹øÂ° ´Ü°è¿¡¼­ Áß¿äÇÑ 2°¡Áö °Ë»ç: CBC, reticulocyte index

5. BM cellularity´Â Áõ°¡µÇ¾î ÀÖÀ¸³ª PB cellularity´Â °¨¼ÒµÇ¾î ÀÖ´Â Çö»óÀ» ¹«¾ùÀ̶ó Çϴ°¡?

ineffective hematopoiesis

cf. ineffective erythropoiesis: megaloblastic anemia, thalassemia, sideroblastic anemia

6. ¸¸¼ººóÇ÷ÀÇ º¸»ó±âÀü 4°¡Áö

i) systemic small vessel vasodilatation -> systemic vascular resistance¡é -> CO¡è

ii) 2.3 DPG¡è : O2 dissociation curve right shift

iii) plasma volume¡è

iv) EPO production¡è

cf. acute blood lossÀ϶§´Â peripheral vasoconstriction, central vasodilatation

7. öºÐ ¼Ò½Ç·®(/day)

³²ÀÚ 1mg, ¿©ÀÚ 1.5-2mg

8. ÀúÀåö °¨¼Ò¸¦ Á¶±â¿¡ ÃøÁ¤ÇÏ´Â °¡Àå ÁÁÀº ¼±º°°Ë»ç: serum ferritin

9. öºÐÈí¼ö: duodenum & proximal jejunum

Èí¼öÃËÁø; ascorbic acid, citrate, acid..

Èí¼ö¹æÇØ: tannate, phytate, antacid, phosphate..

10. Transferrin saturation(%) = Fe/TIBC ¡¿ 100

11. IDA¶§ lab: TIBC, RBC protoporphyrin¡è, ³ª¸ÓÁö ÀüºÎ °¨¼Ò

chronic inflammation¶§: ferritinÀº Áõ°¡Çϳª TIBC °¨¼Ò(ÀúÀåöÀº ÃæºÐÇϳª À̵¿ÀÌ °¨¼Ò)

12. ö°áÇ̴ܰè(°ýÈ£¾ÈÀº marrow iron store)

normal -> iron store depletion -> iron deficient erythropoiesis -> iron deficiency anemia

(1-3+) (0-1+) ( 0 ) ( 0 )

13. IDA´Â TS <10%, serum ferritin <15 ug/L

iron deficient erythropoiesis´Â TS 10-30%, serum ferritin <15 ug/L

iron store depletion˼ TS normal, serum ferritin <15 ug/L

14. IDA ¹ß»ý°úÁ¤

serum ferritin¡é => TIBC¡è, Fe¡é, TS¡é => RBC protoporphyrin¡è => anemia(normocytic)

=> MCV¡é => microcytic

15. IDA Ä¡·á: ferrous sulfate 300 mg tid(elemental iron 200-250 mg/d)

HbÀÌ Á¤»óÈ­µÈ ÈÄ¿¡µµ ÃÖ¼ÒÇÑ 6°³¿ù ´õ Ä¡·áÇÑ´Ù.

16. IDA Ä¡·á¹ÝÀÀ¼ø¼­

Áõ»óÈ£Àü(2-3ÀÏ) -> reticulocyte¡è(3-4Àϰ ½ÃÀÛÇØ¼­ 7-10Àϰ peak) -> HbÁ¤»óÈ­

(2ÁÖºÎÅÍ »ó½ÂÇÏ¿© 2°³¿ùÀ̸é Á¤»óÈ­) -> RBC indexÁ¤»óÈ­

17. öºÐÇʿ䷮ °è»ê

60 ¡¿2.3 ¡¿ (15 - Hb) + 500¡­1000

18. IDAȯÀÚ¿¡¼­ Ä¡·á¹ÝÀÀÀ» º¸±âÀ§ÇØ °Ë»çÇØ¾ßÇÒ Ç׸ñ

: reticulocyte count, hemoglobin, ferritin

19. ¸¸¼º¿°Áõ¼º ÁúȯÀÇ ºóÇ÷¿¡¼­ RBCÇü¼ºÀ» ¾ïÁ¦ÇÏ´Â cytokine 2°¡Áö

: IL-1, TNF, IFN-¥â,¥ã

* IL-1, IFN-¥ã: chronic inflammatory states

* TNF, IFN-¥â: bacterial infection and neoplasm

20. ¸¸¼º¿°Áõ¼º Áúȯ¿¡¼­ ºóÇ÷ÀÌ »ý±â´Â ±âÀü 3°¡Áö

i) RBCÆÄ±«Áõ°¡: RES stimulation¿¡ ÀÇÇØ extravascular sequestration, ÁߵÀÇ hemolysis

ii) mobilization & deliveryÀÌ»ó

iii) cytokine inhibition of erythropoiesis: IL-1, TNF, IFN- ¥â,¥ã

-> erythroid precursorÁõ½Ä¾ïÁ¦, EPO release¾ïÁ¦, RES·ÎºÎÅÍ iron delivery¾ïÁ¦

21. cancerȯÀÚ¿¡¼­ ºóÇ÷ÀÇ ±âÀü

i) marrow¿¡¼­ tumor·Î erythroid precursor displacement

ii) marrow fibrosis

iii) marrow necrosis

iv) Ç×¾ÏÁ¦Ä¡·á·Î ÀÎÇØ EPO productionÀå¾Ö ¹× cytotoxic effect

22. myelophthisic anemia: Ư¡ÀûÀ¸·Î tear drop cellÀÌ °üÂûµÈ´Ù.

cf. target cell: liver disease, thalassemia, Hb disorder

23. normal sideroblast: total normoblastÀÇ 30-50%

ACD : 5-20%, IDA : 10% ¹Ì¸¸±îÁö °¨¼Ò

24. ferritinÁ¤»óÄ¡: 50-200 ng/ml

ACDÀ϶§´Â 150-350À¸·Î Áõ°¡

IDA¶§´Â 15 ng/ml¡è

25. thalassemia¶§ ¸ðµç °Ë»ç´Â Á¤»óÀ̰í HbA2¸¸ Áõ°¡

26. acute bacterial infection¶§´Â 24-48½Ã°£ À̳»¿¡ mild anemia°¡ »ý±æ¼ö ÀÖ´Ù.

: ±Þ¼º°¨¿°¶§ ¿À·¡µÈ RBC°¡ RES system¿¡¼­ »¡¸® Á¦°ÅµÇ¹Ç·Î mild anemia°¡ »ý±æ¼ö ÀÖ´Ù.

¼öÀÏÈÄ È¤Àº ¼öÁÖÈÄ¿¡µµ Áö¼ÓµÇ´Â ºóÇ÷À» cytokine¿¡ ÀÇÇØ erythropoiesis°¡ ¾ïÁ¦µÇ±â

¶§¹®ÀÌ´Ù.

27. anemia¸¦ ÀÏÀ¸Å°´Â ³»ºÐºñÁúȯ

: hypothyroidism, hypogonadism, Addison's disease, hyperparathyroidism

cf. Cushing's disease´Â erythrocytosis¸¦ ÀÏÀ¸Å´.

28. hypothyroidism¶§ µ¿¹ÝµÉ¼ö ÀÖ´Â ºóÇ÷ÀÇ ¿øÀÎ

: IDA, folate, vit B12 deficiency, erythropoietin °áÇÌ

°©»ó¼± ±â´ÉÀúÇ϶§ »ê¼Ò¼Òºñ°¡ °¨¼ÒÇÔÀ¸·Î½á erythropoietin»ý¼ºÀÌ °¨¼ÒÇϰí

öºÐ ¹× folateÈí¼ö°¡ °¨¼ÒÇÑ´Ù. ¶ÇÇÑ pernicious anemia°¡ µ¿¹ÝµÇ±âµµ ÇÏ¿© vitB12°¡

°¨¼ÒÇϱ⵵ ÇÑ´Ù.

29. acquired sideroblastic anemia ¿øÀÎ

s: chloramphenicol, i: INH, r: rheumatoid disease, l: lead, a: alcohol

e: endocrine disease, m: malignancy

30. acquired sideroblastic anemia

- »ó´ç¼ö ȯÀÚ¿¡¼­ neutropenia, thrombocytopenia¸¦ µ¿¹ÝÇÑ´Ù.

- ÀϺÎȯÀÚ´Â leukemic transformation ÇÑ´Ù(AML).

- hereditaryÀÇ °æ¿ì¿£ 1/3¿¡¼­ pyridoxine¿¡ ¹ÝÀÀÇÏÁö¸¸, acquired¿¡¼­´Â ¹ÝÀÀÇÏÁö ¾Ê´Â´Ù.

±×·¯³ª pyridoxineÀ» »ç¿ëÇÏ¿©¾ß ÇÑ´Ù.

31. sideroblastic anemiaÀÇ Ä¡·á

¿øÀÎÁ¦°Å(drug or underlying disease)

pyridoxine, androgen - ÀϺο¡¼­ È¿°ú

transfusion & chelating agent(deferoxamine)

32. siderotic granuleÀ» ÇÔÀ¯ÇÑ RBC¸¦ ¹«¾ùÀ̶ó Çϴ°¡? Pappenheimer body

33. alcohol¿¡ ÀÇÇÑ sideroblastic anemia¿¡¼­ alcoholÁß´ÜÈÄ 7-10ÀÏÀ̸é marrow lesionÀÌ

È£ÀüµÇ±â ½ÃÀÛÇÑ´Ù.

34. methemoglobinemia: Á¤»ó ¡Â1%

O2 dissociation curve¸¦ Lt shift½ÃŲ´Ù.(=O2 delivery°¨¼Ò)

> 1.5% : cyanosis

35-40% : headache, exertional dyspnea, fatigue

60% : lethargy, stupor

> 70% : lathal

35. methemoglobinemia ¿øÀξàÁ¦: nitrate, sulfonamide, lidocaine, dapsone, naphthalene

36. methemoglobinemia Ä¡·á

congenital: methylene blue, ascorbic acid

acquired: ¿øÀξàÁ¦ Áß´Ü, methylene blue(G6PD deficiency¶§´Â hyperbaric oxygen)