#26 - RBC disorders Flashcards
What reticulocyte index indicates insufficient marrow response?
less than 2.0
Which results in a bigger increase in reticulocytes: blood loss or hemolysis?
hemolysis.
acquired hyperproliferatve anemia diseases - 4
- autoimmune hemolytic anemia
- TTP-HUS
- DIC
- Malaria
inherited hyperproliferative anemia diseases - 3
- spherocytosis
- sickle cell
- thalassemia
microcytic anemias- 3
- iron deficiency
- thalassemic disorders/ hemoglobinopathies
- anemia of chronic disease (also normocytic)
normocytic anemias - 4
- acute blood loss
- iron deficiency (early)
- anemia of inflammation/ chronic disease. (also microcytic
- bone marrow suppression
macrocytic anemias - 4
- alcohol abuse
- folate, B12 deficiency
- hemolytic anemia
- bone marrow disorders such as MDS (myelodysplastic syndromes)
diagnostic testing for iron deficiency anemia
- iron saturation will go down
- ferritin will go down (ferritin correlates with blood iron levels)
How can inflammation interfere with an anemia diagnosis?
Ferritin rises as an acute phase reactant in inflammation. This can mask the low level expected in iron deficiency. Iron saturation can also be borderline. Ferritin should drop though!!
If a person has iron deficiency without anemia, what will labs look like?
hemoglobin and serum iron will be normal, but ferritin will be low!
Vit B12 deficiency anemia - associations
- vegans
- autoimmune history
- neurologic symptoms
- gait ataxia
- sensory loss/parasthesia
Folate deficiency anemia - associations
-malnourished
-alcoholic
NOT associated with autoimmune tendency
*NO neurologic signs**
You see a patient which you think has B12 or folate deficiency anemia but you aren’t sure. What do you do?
test for methylmalonate and homocysteine can confirm either diagnosis.
When should methylmalonate and homocysteine testing be done
When you see a patient which you think has B12 or folate deficiency anemia but you aren’t sure.
T/F - Anemia of chronic disease is always inflammatory
True. Thought to be cytokines interfering with action of EPO
Labs for anemia of chronic disease
- low iron
- low TIBC
- low reticulocyte count.
- normal RBC morphology.
- iron deficiency may also be present.
- may see kidney damage (decreased EPO)
What is the most common cause of anemia in the Western world?
iron deficiency
3 key features of iron deficiency anemia
- hypochromia (pale RBCs)
- microcytosis (MCV
anisocytosis
RBCs of different sizes. present in iron deficiency anemia.
Therapy for B12 deficiency
lifelong cobalamin therapy (monthly B12 injections)
Therapy for folate deficiency
folate + cobalamin
Schistocytes on smear - likely diagnosis?
TTP
Spherocytes on smear - likely diagnosis?
-autoimmune condition
bite cells on peripheral blood smear
-G6PD deficiency
Case: Patient with dark urine, jaundice. What is the next step/likely diagnosis?
Get a smear - likely to be hemolytic anemia.
bleeding = free hemoglobin damages kidney, jaundice = indirect bilirubin
malaria = what type of anemia
hemolytic
TTP - HUS = what type of anemia
Hemolytic
Case: young woman -fatigue for several years -family history of anemia -MCV 60 -targetoid cells on smear. Diagnosis?
Thalassemia
labs in thalassemia
abnormal -hemoglobin electrophoresis
-microcytic anemia
Associated symptoms - thalassemia
skeletal changes/ abnormalities
- hepatomegaly
- splenomegaly
- iron overload.
Treatment of thelassemias
**chronic blood transfusions!!!!: 2 units every 2-5 weeks to keep target Hb of 9-10 . Usually started in first decade of life.
Bone marrow transplant is curative, but not always done.
sickle cell substitution
valine in place of glutamic acid on B globin gene - chromosome 11
sickle cell disease =
recessive inherited, chronic hemolytic anemia
Manifestations of sickle cell
- RBCs only survive 10-25 days
- hemolystic anemia
- multiorgan involvement.
- chest syndrome, pulmonary fibrosis
- vascular occlusion, organ ischiemia, vasoconstriction
Treatment for sickle cell
mainly supportive
- hydration and analgesia for painful crisis.
- RBC transfusions sometimes indicated
hallmark of sickle cell disease
painful crisis
