An Approach to Anemia Flashcards
Definition of anemia
Decrease in blood Hb concentration
Can be due to either decreased total red blood cells or an increase in plasma volume
Normal Hb range for
- Women
- Men
- 120 to 160
2. 140 to 170
3 factors that can help identify the severity and urgency for work up and management
Time course (rapid vs chronic)
Current clinical context (symptoms)
Hb level
What does anemia look like that gives slight concern?
Chronic/stable anemia Asymptomatic Isolated anemia Hb > 110 Just do basic investigations and follow over time
What does anemia look like that gives moderate concern?
Slowly progressive
Co-existing abnormalities in white cells or platelets (increased likelihood of marrow disorder)
Worrisome symptoms/signs
Asymptomatic
Hb < 110
More extensive investigation +/1 referral to hematologist
What does anemia look like that gives major concern?
Rapidly progressive
Symptomatic (usually < 80/90 - rarely above 100)
Active bleeding
Concerning morphologic abnormalities (blasts, spherocytes, fragments/schistocytes sickle cells)
Investigate and refer - may also need transfusion/treatment
Pathogenesis approach
Look at the reticulocyte count
Low or normal: decreased production
High: blood loss, increased destruction
MCV approach
Look at the MCV
Can be microcytic (under 80)
Normocytic (80-100)
Macrocytic (> 100)
What are the normal values for
- WBC count
- Platelet
- 4 or higher
2. 150-400
Microcytic anemia
Under 80
Can be thought of as red cell underfilling
Due to abnormalities in iron availability, heme or globin production
5 main causes of microcytic anemia (and what is most common)
TAILS! T: thalassemia trait A: anemia of chronic disease I: iron deficiency L: lead poisoning S: sideroblastic anemia T and I are the most common, L and S are rare
What is the best test for iron deficiency?
Ferritin!
3 iron studies that are not ferritin
TIBC: indicates the maximum amount of iron needed to saturate plasma or serum transferrin
Serum iron level
Transferrin saturation (serum iron/TIBC x 10)
Serum ferritin levels in
- Iron deficiency
- Chronic inflammation or malignancy
- Thalassaemia
- Reduced
- Normal or raised
- Normal
Serum iron levels in
- Iron deficiency
- Chronic inflammation or malignancy
- Thalassaemia
- Reduced
- Reduced
- Normal
TIBC levels in
- Iron deficiency
- Chronic inflammation or malignancy
- Thalassaemia
- Raised
- Reduced
- Normal
Causes of iron deficiency resulting in microcytic anemia
Increased iron (blood) loss: GI, gynae, intravascular hemolysis, blood donation Decreased iron absorption/intake: GI (celiac, resection, h pylori, PPI), dietary deficiency
Top cause of Fe deficiency in NA
Bleeding
Always this until proven otherwise!!
2 types of macrocytic anemia
Megaloblastic
Non-megaloblastic
5 causes of non-megaloblastic anemia
Liver disease Alcohol consumption Hypothyroidism Multiple myeloma COPD Liver disease and alcohol work by causing abnormal membrane lipids
3 causes of megaloblastic anemia
B12/folate deficiency
Drugs (chemo)
Myelodysplasia
Its from nuclear-cytoplasmic asynchrony due to impaired DNA metabolism
What is the cause of macrocytic anemia with a high MCV and high retics?
Hemolysis
What do the neutrophils look like in macrocytic anemia (MDS)?
Pelgeroid neutrophils
Only have 2 lobes
Sign of dysplasia
Myelodysplastic syndrome (MDS)
Rare type of bone marrow cancer
Results in marrow failure where the early cells in the marrow do not mature into healthy blood cells
Can see the pelgeroid neutrophils on smear
Normocytic anemia with increased retics can be from…
- Increased RBC loss (bleeding or hemolysis)
2. Premature release from the bone marrow (marrow stress, marrow disruption)
Normocytic anemia with low or “inappropriately normal” retics can be from…
- Extrinsic marrow limitation (nutrient deficiency (iron, B12, folate), trophic factor deficiency (EPO, test), suppression (inflammation))
- Intrinsic marrow disorder (abnormal development (myelodysplastic, acute leukemia, aplastic anemia, red cell aplasia), marrow replacement (malignancy infection))
Schistocytes
Ruptured/sheared off RBCs
Aplastic anemia
Normal MCV
Bone marrow biopsy will show only fat
Autoimmune condition
Needs to be admitted to hospital, transfused, and started on treatment immediately
Symptoms of iron deficiency specific to children
All ages: inattention, poor school performance, irritability/depression, growth retardation, unexplained cognitive and intellectual impairment, breath holding spells
Infants: poor feeding, lethargy, failure to thrive, cardiomegaly, tachypnea
Adolescents: similar to adults
