9 Hematology 1 Flashcards
Sideroblastic anemia
Inadequate/abnormal use of marrow iron–> polychromatic, stippled, targeted RBCs
Part of myelodysplastic syndrome, Hemoglobinopathies (esp thalassemia)
Dx: if microcytic, or high RDW
Labs: CBC w peripheral smear, iron, ferritin, bone marrow biopsy
*check for serum lead
Iron def anemia
Microcytic. Due to…
Absorption in stomach, duodenum, upper jejunum. Best as heme (meat), need gastric secretions, reduced by phytates/tannins/antacids/lead. Reduced by achorohydria, strophic gastritis, H pylori, SIBO, gastric bypass, celiac.
Stool occult blood, cbc w peripheral smear, serum iron, TIBC, ferritin
Anemia of Chronic Disease
causes: infections, inflammation, neoplastic dz, trauma, heart failure, DM, anemia of elderly, immune activation
cytokines: IL beta and TNFalpha
Labs: CBC w peripheral smear, iron, transferrin, trasnferrin receptor, serum ferritin
Hypoproliferative Anemia
low BM activity due to lack of EPO/inability to respond
renal dz due to low EPO
hypo/hyperthyroidism, panhypopituitarism, hyperparathyoidism
severe protein malnutrition
Labs: renal function, TSH, CBC w peripheral smear, BM biopsy
Aplastic/Hypoplastic Anemia
uncommon. pancytopenia of all cell lines.
genetic: Fanconi’s anemia, inability to clear gulatathione S transferase
acquired: chemical exposure, drugs, anticancer, pesticides
Pure red cell aplasia: infections, thymomas, immune sys injury
Labs: CBC w peripheral smear, iron, reticulocytes, BM biopsy
Myelophthisis
displacement of hemopoietic bone-marrow tissue into the peripheral blood, either by fibrosis, tumors or granulomas.. occurs with leukemia, lymphomas, myelofibrosis disorders
Myelophthisic Anemia
marrow replaced by tumor granuloma, lipid storage dz, fibrosis.
may see splenomegaly, bone pain
Labs: CBC w peripheral smear (anisocytosis, poikilocytosis), marrow biopsy
Macrocytic Anemia
causes: alcoholism, B12/folate def (“megaloblastic”), cytotoxic drugs, hypothyroid, liver dz
if severe: stocking glove neuropathy, dementia, glssitis, diarrhea, muscle wasting
Labs: CBC w periph smear, B12, folate. MCV>95, anisocytokis, poikilocytosis, Howell Jolly bodies, hypersegmented neutrophils–>neutopenia
Warm AIHA
most common, more in women, >37C
due to: spontaneous, viral infections, immune def, drugs, SLE, lymphoma, CLL
spleen
Dx: Coomb’s antiglobulin test
Cold AIHA
s antiglobulin test
Hereditary Spherocytosis
congenital RBC membrane defect. autosomal dominant. may be hepato/splenomegaly, cholelithiasis
Dx: spheroidal RBCs, anisocytosis, normal/low MCV, elevated MCHC, osmolytic fragility
Heriditary Ellipocytosis
congenital RBC membrane defect. rare, autosomal dominant.
may be hepato/splenomegaly, cholelithiasis
Dx: oval RBCs, anisocytosis, normal/low MCV, elevated MCHC, osmolytic fragility
Stomatocytosis
rare, RBC membrane disorder, increased fragility. congential--severe, presents early acquired--excess alcohol ingestion RBCs have straight area of central pallor
Hypophosphatemia
low phosphate depletes RBC ATP–>rigid/fragile RBC
small, spheroid RBCs
G6P deficiency
Favism. x linked. Hemolysis if exposed to oxidants, sulfonamides, nitrofuran, Vit K, fava beans
sudden onset jaundice, pallor, dark urine. may be back pain, renal failure
Labs: Heinz bodies. bite cells, G6PD assay
self-limiting (usu)
Sickle Cell Anemia
she did her undg research on this…
chronic hemolytic anemia. heterozygous–>protection from malaria
SSx: painful bony crises, renal damage, punched out leg ulcers, splenic infarcts, severe anemia, splenomegaly
Labs: low RBCs, Hct, Hb, normocytic anemia, levated bilirubn, Hb electrophoresis (to tell bet hetero and homozygous)
Hemoglobin C Disease
genetic, may be assoc w sickle cell dz
Thalassemia
inherited defects in rate of syn, ineff erythrpoiesis, low RBC production
major=homozygous. Beta Thal Major most common
minor=hetero. milder disease
SSx: heart failure, failure to thrive, splenomegaly, jaundice, leg ulces, gall stones,
Labs: microcytic, hypochromic anemia, target cells, basophilic stippling, nucelated RBCs, anisocytosis, poikilocytosis, abnormal Hb electrophoresis
Leukopenia
absolute decrease in WBCs. May be pancytopenic, or only one type
Neutropenia
<200/mm3: rapidly fatal infections
Sxs: only w infection (cellulitis, liver abscesses, furunculosis)
Dx: CBC, PE to see which type of infection, history to determine cause
Intrinsic Neutropenia
rare. defects in myeloid cells/precursors. congenital/idiopathic
Secondary Neutropenia
drugs, BM infiltration (CA, myelofibrosis), splenomegaly, infections (viral infxns, HIV), alcoholism, SLE, folate/B12 def, leukemia, transfusions
Lymphocytopenia
s, alcohol, malnutrition
Ssxs: recurrent infections, absent/1+ tonsils
