Anemia Flashcards
What is a CBC
Complete blood cell count
What does hemoglobin (Hgb) measure
Total amount of hemoglobin in the peripheral blood
What is the job of hemoglobin
carry oxygen
What is an immature RBC
Reticulocyte
What is Hematocrit (Hct)
Measures total blood volume
made up of RBCs
How is Hct expressed with lab results
percentage
*can also be called packed cell volume
What values are included with a CBC
MCV (mean corpuscular volume)
MCH(Mean corpuscular hemoglobin)
MCHC (mean corpuscular hemoglobin concentration)
RDW( red cell distribution width)
What does the reticulocyte level tell us on labs
Bone marrow function
*reticulocytes increase in response to anemia = competent BM
Which cells are acute phase reactants
WBC
If there is an elevation in WBC, what is it indicative of
Infection
trauma
malignancy
leukemias
tissue necrosis
What is a Diff on lab work helpful with
ID underlying cause of leukocytosis
What are neutrophils responsible for
nom-nom Spiderman
If there is an increase in neutrophils, what is it indicative of
Bacterial infection
“the left shift”
What are examples of lymphocytes
T and B cells
What will cause an increased lymphocyte count
Immune response, chronic bacterial, viral infection
What oxygen deprivation effects can occur with anemia
Fatigue
Dyspnea on exertion
Headache
Dyspnea at rest (more severe)
What symptoms can occur with hypovolemia
Lethargy
confusion
Angina
Arrhythmias
MI
CHF
What is the textbook diagnosis of Anemia
Low number of circulating RBCs
What is MCV
Size of RBC
What is MCH
Average Hgb per RBC (color or redness in RBC)
If there is low MCH, what does it indicate
Hypochromia (paler RBC)
If someone presents with a B12 or folate deficiency, what will be seen with their blood smear
Megaloblastic process
What is another word for fragmented RBCs
Schistocytes (helmet cells)
What are abnormally shaped RBCs known as
Poikilocytosis
What diseases will you see hypochromia
Thalassemia
Iron deficiency
Sideroblastic
What diseases cause Target RBCs
Liver disease
Thalassemias
What disease causes Speculated cells
Liver disease
Uremia
What are speculated cells
Disorganization in cell membrane (spiky)
What are burr cells indicative of
uremia
What are acanthocytes indicative of
Liver disease
What are Howell-jolly bodies
Nuclear remnants
What diseases will cause Howell-jolly bodies
Aplenia
Hyposplenia (sickle cell)
What type of stain is Howell-jolly bodies seen on
Wright giemsa stain
What are Heinz bodies
denatured hemoglobin
What will you see on a smear when there is oxidative injury to the RBC
Heinz-bodies
What is basophilic stippling
precipitation of ribosomes
What can cause basophilic stippling
Lead / heavy metal poisoning
Thalassemias
ETOH abuse
What are the types of microcytic anemia
Thalassemias
Iron deficiency
Chronic disease
Sideroblastic
What is one of the most common autosomal recessive conditions in the world
Thalassemias
What happens to the RBCs in thalassemia
RBC destruction in bone marrow
or
intravascular hemolysis due to damaged red cell membranes
What is hemoglobin Barts
Error in the alpha chains early in life causing more gamma chains to form and is not compatible with life
What allows hemoglobin to be exchanged between mom and baby
Gamma chains… has a higher affinity for O2
what nationality is Alpha thalassemia most common in
African Americans
When is Alpha Thalassemia detected
Generally less than 6 months of age
What nationality is beta thalassemia common in
African american
AND
Mediteranean
When is beta thalassemia diagnosed
Around 6+ months of age
What may occur anatomically in someone who has thalassemia
Bone expansion (chipmunk facies)
Due to marrow working harder to make RBCs
How do you get a definitive diagnosis of thalassemia
Hemoglobin analysis
-electrophoresis
-Genotyping
-HPLC
What will be abnormal in labs with someone who has thalassemia
Significantly reduced MCV
How can you treat thalassemia
Folic Acid
Transfusions
Iron chelation therapy
NO IRON
What is the number 1 cause of anemia world wide
iron deficiency
What are the main causes of iron deficiency anemia
Blood loss (most common)
inadequate dietary intake
What are some signs of iron deficient anemia
Pica
Brittle nails
Spoon shaped nails
Smooth tongue
Esophageal webs
Cheilosis
What is Ferritin
Protein cells that store iron
What is transferrin
Protein that regulates Iron in the blood
What is the best test for Iron deficiency anemia diagnosis
Low plasma Ferritin <30
How often will you take PO iron with iron deficiency anemia
3 times a day (start 1x and slowly titrate up)
How long should treatment last with iron deficiency anemia
minimum of 3 months but typically 6-12 months
What in your diet do you need to avoid when taking iron
dairy- will prevent iron absorption
What is anemia of inflammation
Anemia of chronic disease
What are some etiologies of anemia of chronic disease
Chronic inflammation
Organ failure
Any active malignancy**
impaired marrow function
What is the cause of aplastic anemia
bone marrow failure
What is pancytopenia
Anemia plus reduction in all other cell lines
What can you give to treat the anemia aspect of anemia of chronic disease
erythropoietin (Epo)
Where is aplastic anemia most prevalent
Asia and middle eastern populations
What are some causes of aplastic anemia
idiopathic
SLE
Chemo
Radiation
Toxins
Drug induced (chloramphenicol / ASM)
Hereditary
How does aplastic anemia typically present
Increased incidence of infection
pupura / petechiae
Abnormal bruising
What will be seen in a biopsy of aplastic anemia
Hypocellular marrow with fatty infiltration
What criteria makes aplastic anemia severe
ANC<500
Plts <20,000
Reticulocytes <1%
Bone marrow cellularity <20%
*3 of 4 of these
If someone has severe aplastic anemia, how do you treat them
<40 w/ compatible sibling donor = BMT
> 40 OR <40 with NO sibling donor = immunosuppression
What is the prognosis of aplastic anemia
20% survive to 1 year without treatment
What is Sideroblastic anemia
Impaired heme synthesis = iron accumulation
What can cause Sideroblastic anemia
Myelodysplasia
Chronic alcoholism
Hereditary
Drug induced
Lead poisoning*** –> until proven otherwise
What on labs will indicate lead poisoning
Basophilic stippling
How do you get a definitive diagnosis for sideroblastic anemia
Bone marrow eval
What causes normocytic anemia
Acute blood loss
Bone marrow failure
Chronic disease
Destruction (hemolysis)
If a patient >50y/o with unexplained new anemia, what must be ruled out
Colon CA
What is an intrinsic cause of hemolytic anemia
Problem with the RBC
What is an extrinsic cause of hemolytic anemia
problem is outside of the RBC (often autoimmune)
What will be seen on labs with hemolytic anemia
Elevated reticulocyte count
Elevated unconjugated bilirubin (leading to jaundice)
If you have a positive combs test… what do you have
Autoimmune hemolytic anemia
What is the most common genetic hemolytic anemia
hereditary spherocytosis
What happens to RBC in hereditary spherocytosis
Shape changes from concave to spherical
What is the treatment of choice for hereditary spherocytosis
Splenectomy
What is G6PD deficiency
Hereditary X-linked recessive disorder
Why is G6PD deficiency also called Favism
Also found in fava beans
*confers some protection from malaria
What happens if you have G6PD deficiency
Episodic hemolytic anemia
What can cause G6PD deficiency
Exposure to oxidative drugs (aspirin, quinidine, Dapsone), fava beans or infection
When do symptoms start in sickle cell anemia
around 6 months
How does sickle cell anemia present
Vascular occlusion (painful crisis)
*sickle under stress
Delayed growth / puberty
Splenic sequestration (pooling of blood in spleen)
What are sickle cell patients at risk for
Cholelithiasis
Splenomegaly
Leg ulcers
Retinopathy
Renal infarcts
priapism
What are some treatments of sickle cell
Pain management
Prevention: Hydroxyurea
Prevention of complications
Possible BMT in kids
Prenatal testing
Which hemoglobin is less likely to sickle and why
Hgb F because it binds more tightly to oxygen
What happens to the RBCs with G6PD deficiency
bite cells
What are 3 main causes of Vitamin B12 deficiency
Pernicious anemia
Dietary insufficiency
Malabsorption
What are causes of Macrocytic anemias
Pregnancy
Alcohol abuse
Thyroid disease
Reticulocytosis
B12 / folate deficiency
Cirrhosis
What are the primary sources for B12
Fish
Eggs
Dairy
Red meat
Poultry
Shellfish
What is the average age of onset for pernicious anemia
70-80 y/o
What is the common presentation with B12 deficiency
Normal anemia symptoms
Neuro symptoms
Psych symptoms
What happens intracellularly with B12 deficiency
Cytoplasm continues to grow while DNA / nucleus matures = megaloblastic
What will you see in labs for someone with B12 deficiency
Low serum B12
Elevated MMA
+/- elevated serum folate
How can you treat pernicious anemia
IM B12 injections
*B12 and folate supplementation often initiated simultaneously
What is the typical cause of a folate deficiency
Primarily due to nutritional deficiency
Why is folate so important in pregnancy
neural tube defects
What is required for folate absorption
Intrinsic factor
How does a folate deficiency differentiate from B12 deficiency
No neurologic symptoms
What is Myelodysplastic syndrome
Group of neoplasms involving hematopoietic cells
What is the risk with someone who has myelodysplastic syndromes
High risk to transform into Acute myelogenous Leukemia
How are Myeloblastic syndromes classified
Type and number of cell lines involved
Amount of blasts present
Chromosomal abnormalities
What is pathognomonic in myelodysplastic syndromes
Pancytopenia
What is Polycythemia vera
Myeloproliferative disorder
-neoplastic process
What population is polycythemia vera seen in
Ashkenazi Jewish patients
What is the average age of presentation for polycythemia vera
60
*median survival 15-20 years
What can polycythemia vera progress too
CML
AML
Myelofibrosis
What is the primary mutation in polycythemia vera
JAK2 (diagnostic)
What is a secondary cause of polycythemia vera
Increased EPO activity
What happens to the blood with polycythemia vera
Increased volume and viscosity
How is polycythemia vera typically found
Increased HCT on routine lab exam
What some clinical presentations of polycythemia vera
Ruddy complexion (plethora)
Redness in extremities
Engorged retinal veins
generalized pruritus after showering***
What is the treatment for polycythemia vera in low risk patients
Serial phlebotomy
What is the treatment for polycythemia vera in high risk patients (majority)
Myelosuppression w/ Hydroxyurea
OR
Bisulfran (inhibit JAK2)
What qualifies a patient with polycythemia as high risk
Age >60
Hx of thrombosis
What is hemochromatosis
Iron overload
When do clinical symptoms generally present with hemochromatosis
After age 50
What is the most common cause of hemochromatosis
inherited gene mutation
(reduced hepcidin levels)
How does hemochromatosis generally present
Iron deposition
Fatigue
vertigo
Bronze skin
Hepatomegaly
How do you treat someone with iron overload / organ injury with hemochromatosis
Regular therapeutic phlebotomy
