4. Anemia Flashcards
Describe : Anemia (2)
- Usually defined as low hemoglobin or hematocrit
- (Approximately Hb <135 for men <120 for women)
Describe transfusion in anemia (3)
- Restrict transfusions if stable, consider maintain Hb>70-80 (if underlying cardiovascular disease, planned surgery)
- Consider transfusions in symptomatic, unstable, ongoing losses
- If transfused, may repeat post-transfusion hemoglobin levels even after 15 minutes (1pRBC usually raises Hb by 10g/L)
Name causes MICROCYTIC anemia
TAILS
* Thalassemia (alpha, beta)
* Anemia of chronic disease
* Iron deficiency
* Rare
Describe : Thalassemia (3)
- Alpha, beta
- Africa, Mediterranean, Southeast Asia
- Mild Splenomegaly
Name iron deficiency causes (2)
- Nutrition
- Chronic blood loss (GI, celiac, menstruation)
Name rare causes of microcytic anemia
- Lead poisoning
- B6 deficiency
- Cuivre or Zinc deficiency
- Sideroblastic (iron metabolism defect)
Name NORMOCYTIC causes of anemia (4)
ABCD
* Acute blood loss
* Bone marrow failure (Insuffisance médullaire)
* Chronic disease
* Destruction (Hemolysis) : Inherited, Acquired
Name DDX of INHERITED destruction (hemolysis) anemia (3)
- Hemoglobinopathy: Sickle cell, Thalassemia, Unstable Hb
- Membrane: Spherocytic
- Metabolic: HMP shunt, glycolytic
Name DDX of ACQUIRED destruction (hemolysis) anemia (4)
- Immune
- Infection
- MAHA
- Oxidative
Name DDX of MACROCYTIC anemia (6)
- Folate / Fetus (pregnancy)
- Alcoholism / Liver disease
- Thyroid (hypo) / Endocrine
- Reticulocytosis
- B12 deficiency
- Cytotoxic Drugs / Dysplasia
Name causes of DECREASED RBC PRODUCTION (4)
- Nutrients (B12, iron)
- Bone marrow disorder/suppression
- Low trophic hormones (EPO, thyroid hormone, androgens)
- Note: Inflammation reduces available iron, EPO, and RBC lifespan
Name causes of INCREASED RBC DESTRUCTION (6)
Extravascular (spleen/liver)
* Inherited (spherocytosis, sickle, thalassemia)
* Acquired (autoimmune, thrombotic thrombocytopenic purpura, malaria, paroxysmal nocturnal hemoglobinuria)
* Hypersplenism
Intravascular
* MAHA
* Paroxysmal nocturnal hemoglobinuria
* Cold agglutinin
Consider iron profile when ? ()
consider if
* blood loss
* or low VGM
* low hémoglobine corpusculaire moyenne
* high RDW
Describe : Hemolysis work-up ()
- LDH
- Bilirubin (indirect)
- Haptoglobin (reduced in hemolysis)
- Consider Coombs’ test
- Consider urinary hemoglobin and hemosiderin for intravascular hemolysis in paroxysmal nocturnal hemoglobinuria
Bone marrow biopsy indicated when? (2)
Usually indicated in pancytopenia or blast cells (rule out malignancy)
Describe history of anemia in children (12)
- Lethargy, tachycardia, pallor
- Signs of hemolysis (urine color, scleral icterus, jaundice)
- Failure to thrive
- Bleeding history
- PMH (birth, jaundice, anemia, medical conditions)
- Family History : Bleeding disorder, hemoglobinopathy, IBD
- Poverty
- Non-iron-fortified formula
- Ethnicity
- Whole cow’s milk diet
- Exclusive breastfeed after 6 months of age
- Poorly controlled maternal diabetes
What type of anemia in black/hispanic people ?
Hb S and C
What type of anemia in Mediterranean/Southeast Asian people ?
Thalassemia
Name DDX of anemia in 0-3 months (6)
Newborns
* Blood loss
* hemolysis (Rh or ABO incompatibility)
* congenital infection
* twin-twin transfusion
* congenital hemolytic anemia (spherocytosis, G6PD deficiency)
* Physiologic anemia (nadir of 110 at 6-9w of age due to decrease in EPO)
What type of anemia in Jews/Filipinos/Greeks/Sardinians/Kurds/black people ?
G6PD
Name DDX of anemia in 3-6 months (2)
Hemoglobinopathy (thalassemia, sickle cell)
Name DDX of anemia in 9-12 months (2)
- Acquired (iron deficiency anemia)
- WHO recommends screening in all children 9-12 months : Consider targeted screening if risk factors (poverty, poor weight gain, excessive milk intake + low iron-rich foods [malnutrition], malabsorption, GI blood loss, obesity)
Comment évaluer le risque de décompensation chez les patients anémiques ? (4)
- état du volume sanguin
- présence d’une insuffisance cardiaque congestive (ICC)
- angine
- autres états pathologiques
Vrai ou Faux
Chez tous les patients anémiques, déterminez la réserve en fer avant de débuter le traitement.
Vrai
Chez un patient présentant une carence en fer, poussez plus loin l’investigation afin d’en déterminer l’étiologie.
Recherchez une anémie chez les patients à risque qu’ils soient symptomatiques ou non.
Nommez les patients a risque (5)
- ceux qui sont à risque de perte sanguine
- anticoagulothérapie
- patients âgés qui prennent des AINS
- les patients atteints d’hémolyse (valvules mécaniques)
- les patients qui présentent de nouveaux symptômes ou une détérioration de leurs symptômes d’angine ou d’ICC)
Chez les patients atteints d’anémie macrocytaire, quoi faire ?
- Considérez la possibilité d’une carence en vitamine B12
- Recherchez d’autres manifestations de carence (p. ex. symptômes neurologiques) afin de poser le diagnostic d’anémie pernicieuse s’il est présent.
Lorsque vous découvrez un faible taux d’hémoglobine chez un patient, recherchez minutieusement la cause puisqu’on ne peut présumer qu’il s’agit d’un état normal.
Nommez des causes possibles (4)
- hémoglobinopathies
- ménorragie
- saignement occulte
- maladie chronique non diagnostiquée
Chez les patientes anémiques souffrant de ménorragie, déterminez la nécessité de rechercher d’autres causes pour expliquer l’anémie.
