1 Anemia Part I Flashcards
What is the normal Hb to Hct ratio? What are anemic Hb levels in men and women?
1:3 (hb:Hct)
<14 Hb Men
<12 Hb Women
Normal retic count?
0.5-2%
Normal ranges of MVC?
MCH? MCHC?
78-100fL -MCV
27-34 pg - MCH
31-37 g/dL- MCHC
What is RDW and it’s normal ranges?
(red cell distribution width) = measure of degree of variation in RBC size.
Normal RDW= 11-15%.
Causes of microcytic hypochromic anemia?
Iron def, thalassemia, sideroblastic anemia.
Causes of Normocytic normochronic anemia?
Hypothyroidism, liver disease, chronic disease
Causes of macrocytic (megaloblastic) anemia?
Folate def, vitamin B12 def (d
Causes of iron def anemia?
- Blood loss (most common)
- decreased dietary intake
- decreased iron absorption (celiac disease, bariatric surgery, H. pylori infection
Labs of iron def anemia?
-Low Fe/ Ferritin (these 2 go hand in hand)
-High TIBC
-Increased RDW
-Low RBC/Hg/Hct
(note MCV can be normal early in IDA)
Clinical signs of iron def anemia?
Atrophic glossitis, angular cheilitis, koilonychia.
-Pica, RLS
What is the syndrome associated with dysphagia for iron def anemia?
Dysphagia (plummer-vinson syndrome difficulty swallowing 2/2 to anemia
If a patient is Dx with iron def anemia? Do you given iron supplements and stop there?
NO! Always find underlying cause.. worried about occult malignancy!
Tx for iron def anemia?
- oral Ferrous sulfate 325mg daily-TID, on empty stomach
- should increase Hg 2-4g/dL every 3 weeks
- continue 3-6 months after anemia has corrected to replenish stores.
What is Thalassemia? Inherited or congenital?
Inherited hemoglobinopathy. Reduction in synthesis of globin chains (alpha or beta).
How many alphas and beta’s does a normal Hg chain have?
Normal hemoglobin A= 4 alphas 2 betas (alpha2beta2)
What does thalassemia lead to/ cause?
- *Can lead to ineffective erythropoiesis and hemolysis!
- Extrameduallary hematopoiesis
- iron overload, bone changes, impaired growth
Explain the severity if 1 alpha chain is lost compared to all 4 chains?
No replacement for alpha, so 1 deletion is mild (silent carrier), 3 is moderate microcytic anemia, and 4/4 deletions, fetus will die
If Blake were a member of the Spice Girls who would she be?
Scary Spice aka Mel B duh
Explain the difference between beta thalassemia minor, intermedia, and major?
- If loss of 1–> minor, asymptomatic, mild microcytic anemia.
- Thalassemia intermedia–> chronic hemolytic anemia.
- Thalassemia major–>Dysfunction of both chains, severe hemolytic anemia, if untreated will die by 5.
Labs of Thalassemia anemia?
- Normal to high Fe/Ferritin
- Any TIBC
- Normal to increased RBC
- MCV often low
- RDW normal
What will you see on the Blood smear of thalassemia anemia?
Target cells
Physiological condition of thalassemia anemia?
Splenomegaly
+ family hx! (is inherited)
What supports the dx of thalassemia anemia?
Hemoglobin electrophoresis! Detects type of Hg present.
Tx for thalassemia anemia?
- Folic acid supplementation if chronic hemolysis.
- Avoid iron supplementation!!
- If severe thalassemia= regular transfusion schedule.
- If severe beta thalassemia= hematopoietic cell transplantation.
- Genetic counseling.
What is Sideroblastic anemia?
- Hereditary or acquired RBC disorder.
- Abnormal RBC iron metabolism–> diminished heme(iron) synthesis –>iron accumulates in the cells
What conditions is sideroblastic anemia typically seen with?
Myelodysplastic syndrome (MDS), or chronic alcoholism, meds, copper def.
Labs for sideroblastic anemia?
- Normal to high Fe/Ferritin
- Any TIBC
- MCV low, normal, or slightly increased
- elevated RDW
- Normal to low restock count
What will you see on peripheral and bone marrow smear of sideroblastic anemia?
- Siderocytes w/ pappenheimer bodies on peripheral smear
- Ring Sideroblasts on bone marrow
Tx of sideroblastic anemia?
- Patient education/ ref to hematology.
- Treat underlying cause. D/c offending drugs. Remove toxic agents
- Pyridoxine (Vit B6)
- Transfusion/management of iron overload.
What are some examples of chronic diseases associated w/ anemia of chronic disease?
Inflammatory diseases, Rheum disorders, Malignancy, chronic infection, organ failure.
What happens in anemia of chronic disease? (pathogenesis)
Reduction in RBC production by BM, w/ component due to mild shortening of RBC survival
3 things that contribute to the pathogenesis of anemia of chronic disease?
- Hepcidin-induced alteration in iron metabolism
- Inability to increase erythropoiesis
- Decrease in erythropoietin production
What is Hepcidin?
Key regulator of entry of iron into circulation. Traps iron in macrophages and decreased gut iron absorption.
Labs for anemia of chronic disease?
- Low Fe and TIBC
- Normal- increased serum ferritin
- Retic count decreased-normal
- Mild anemia
Treatment for anemia of chronic disease?
Treat underlying disease. Erythropoietin may be beneficial.
