ANEMIA Flashcards
What is the threshold for blood transfusion? How much does 1 unit pRBC increase Hgb?
Hgb < 70 AND symptomatic
1 pRBC raises Hgb by 10 g / L
5 clinical features/Symptoms
Fatigue Shortness of breath Faintness / Light head Syncope / Presyncope Palpitations
4 Red Flags
Tachycardia
Hypotension
Hypothermia
Decreased LOC
3 vital signs
HR: Tachycardia
RR: Tachypnea
BP: HoTN
6 Physical Exam Features
Murmur Hyperdynamic precordium Pallor Koilonychia Petechiae / Purpura Enlarged lymph nodes Enlarged spleen (hemolysis) DRE Proprioception deficits (Romberg)
6 specific lab tests
Serum Hemoglobin Mean Cell Volume Consider platelets (r/o pancytopenia) Reticulocyte Serum Ferritin Serum Iron Total Iron Binding Capacity Peripheral Blood Smear Beta-HcG Hb Electrophoresis LDH Bilirubin Haptoglobin Consider COOMB’s test TSH / B12 / Folate DIC Panel
2 specific adjunct investigations
Colonoscopy
Bone Marrow Biopsy
Differential Diagnosis for Microcytic Anemia (MCV < 80)
TAILS • Thalassemia • Anemia of Chronic Inflammation • Iron Deficiency • Lead Poisoning • Sideroblastic Anemia
D/Dx / Risk Factors for Iron Deficiency Anemia
Women
Children
↓Supply: dietary, malabsorption
↑Loss: hemorrhage (PUD, menorrhagia, GI bleed etc).
3 specific iron studies and what their values will be
↓↓ Serum Ferritin
↓Serum Fe
↑TIBC
What is the treatment for iron deficiency anemia? What are recommended doses? How long do you treat for after resolution? What has the highest content iron? What timing of dosing is best absorbed, with what adjunct? What is best for children? What treatment is used if oral is not adequate?
100-200 mg elemental iron / d Treat for 4-6 months after resolution Highest Content: Ferrous Fumarate Best Absorbed: every other day, with Vit C, NO tea Best for Children: Ferrous Sulfate If Oral is ineffective: IV iron dextran
6 Risk factors for Thalassemia (locations)
Africa Middle East Caribbean Mediterranean South East Asia South American
3 Red Flag questions for Thalessemia
Any chance you’re pregnant
Are you TRYING to get pregnant?
Does your partner have thalassemia?
3 specific iron studies and what their values will be. for Thalessemia? What other blood test is needed to confirm the diagnosis of Thalessemia?
↑/N Serum Ferritin
↑/N Serum Fe
↓TIBC
Hemoglobin Electrophoresis
Clinical Features of Lead Poisoning
L: Lead lines on gingiva + epiphysis of long bones
E: Encephalopathy
A: Abdo Colic
D: Foot / Wrist Drop
First line treatment of Lead Poisoning
Dimercaprol + EDTA
3 specific iron studies for anemia of chronic disease and what their values will be.
↑/N Serum Ferritin
↓Serum Fe
↓TIBC
D/Dx for normocytic anemia with an elevated reticulocyte count (RBC > 2%)
Hemorrhage
Hemolysis
6 D/Dx for normocytic anemia with a decreased reticulocyte count (RBC < 2%)
CKD Marrow Disorder (Pure Red Cell Aplasia) Marrow Suppression (↓WBC, ↓platelets) Infiltrative (leukemia, infection) Anemia of chronic disease Sequestration Pregnancy Endocrinopathy
4 specific labs when suspecting hemolysis
LDH
Haptoglobin
Indirect Bili
Blood Smear: Red Cell Fragmentation, Tear Drop RBC, Microspherocytes
6 D/Dx for hemolytic anemia
spherocytosis G6PD sickle cell thalassemia autoimmune MAHA thrombotic thrombocytopenic purpura malaria PNH
3 clinical features of hemolysis
Jaundice
dark urine
cholelithiasis
5 risk factors for B12 deficiency
Gastric Surgery Strict Vegan Breastfed Children of # 2 Elderly Psychiatric
