Anemia Flashcards
why does anemia occur?
hemoglobin in blood is too low to fulfill oxygen demands in the body
what is the normal hematocrit relationship to hemoglobin?
hematocrit usually 3x hemoglobin concentration
tells variation in RBC widths/sizes
Red Cell Distribution Width (RDW)
measure of average RBC size
Mean Cell Volume (MCV)
average hemoglobin concentration per RBC; measure of color
mean corpuscular hemoglobin concentration (MCHC)
average amount of hemoglobin per RBC (weight)
mean corpuscular hemoglobin (MCH)
immature RBCs; higher values means increased production of RBCs
reticulocytes
measurement of circulating iron; bound and unbound
serum iron
measurement of a circulating iron storage protein; increase indicates increase in body iron stores
serum ferritin
measurement of circulation transport protein for iron; increases as iron body stores are depleted
total iron binding capacity (TIBC)
disorder described as large, structurally abnormal, immature RBCs (megaloblasts)
B12 deficiency
patient presents with neurological dysfunction like paresthesia, loss of vibratory sense, ataxia, weakness, and change in mental status. They also present with glossitis, cheilosis, diarrhea, and anorexia. Dx?
Treatment?
B12 deficiency
IM vitamin B12 (cyanocobalamin)
associated with hyper-segmented neutrophils, large/oval RBCs, increased RDW, and poikilocytosis. Also associated with increased MMA and homocysteine.
B12 deficiency
what 2 diagnostics and results confirm the diagnosis of B12 deficiency?
elevated MMA (methylmalonic acid) and homocysteine
megaloblastic anemia that results in slower nuclear development with large cytoplasm and decreased RBC life.
folate deficiency
what is the most common cause of folate deficiency?
inadequate dietary intake
patient presents with anemia findings, glossitis, cheilosis, diarrhea, and anorexia. Labs show elevated MCV, hypersegmented neutrophils, and normal B12. Dx?
Treatment?
folate deficiency
folic acid
what can folate deficiency in pregnancy lead to? what should pregnant patient’s take to avoid it?
neural tube defects
prenatal vitamins
what is the most common cause of anemia worldwide?
iron deficiency anemia
what is the most common cause of iron deficiency anemia?
blood loss
a patient presents with anemia findings, glossitis/cheilosis, smooth tongue, rough skin, and koilonychia. Dx?
iron deficiency anemia
what is the treatment for iron deficiency anemia?
ferrous sulfate q other day
continue for 4-6 mo after Hgb is normal
how should ferrous sulfate be taken? (2)
do not give with food
take 2 hours before antacids
deficient or absent synthesis of alpha globin chains
alpha thalassemia
what is alpha thalassemia in which no normal alpha-globin gene is present?
what does it lead to?
hemoglobin barts
stillborn fetus
what is alpha thalassemia in which there is 1 alpha-globin gene present?
what is the treatment?
hemoglobin H disease
chronic transfusions
what is alpha thalassemia in which
2 normal alpha-globin gene are present?
alpha-thalassemia minor
patient presents without symptoms but labs show microcytic mild anemia. Dx?
alpha-thalassemia minor
what is alpha thalassemia in which 3 normal alpha-globin genes are present and the patient presents clinically and hematologically normal?
alpha-thalassemia minima/silent carrier
deficient or absent synthesis of beta-globin chains
beta thalassemia
patient presents with severe microcystic hemolytic anemia; they have hepatosplenomegaly, bony deformities, osteopenia, and fractures requiring regular transfusions. Dx?
transfusion dependent beta thalassemia
patient presents with microcytic hemolytic anemia; they have hepatosplenomegaly, bony deformities, osteopenia, and fractures. Dx?
non-transfusion dependent beta thalassemia
how does a patient with beta-thalassemia minor/trait present? (2)
mild microcytic anemia
clinically normal
CBC shows target cells, acanthocytes, poikilocytosis, basophilic stippling, nucleated RBCs; microcytosis, normal iron levels, and patient has does not have normal family history. Dx?
thalassemia
treatment for thalassemia? (2)
genetic counseling
refer to hematologist
what is the treatment of choice for beta-thalassemia major?
bone marrow transplant
anemia due to inability to incorporate iron into heme; iron accumulates
sideroblastic anemia
what is a cause of sideroblastic anemia?
lead poisoning
patient presents as pale, with abdominal pain, fatigue, learning disabilities, seizures, foot/wrist drop. They also have a lead line on their gums. Dx?
sideroblastic anemia (lead poisoning)
CBC shows low MCV, low MCH, basophilic stippling, increased serum lead levels, increased serum iron, and normal/decreased TIBC. Dx?
sideroblastic anemia
what will an xray of long bones in a patient show if they have sideroblastic anemia?
lead lines
what makes the definitive diagnosis of sideroblastic anemia? what does it show?
examination of bone marrow
prussian blue iron stain with ringed sideroblasts
what is the management for sideroblastic anemia caused by lead poisoning? (4)
remove lead
chelation therapy
+/- transfusion
referral to hematology /toxicology
occurs due to a block in release of iron from macrophages; cytokine inhibition of erythropoietin occurs.
anemia of chronic disease
what is the most common cell size in anemia of chronic disease?
mild normochromic normocytic
what is the management for anemia of chronic disease? (2)
treat underlying disease
erythropoietin
excessive stimulation of RBCs in anemia of chronic disease is associated with what? (2)
MI
CVA
due to bone marrow failure and pancytopenia, most likely due to immune injury of multipotent hematopoietic stem cells
aplastic anemia
a patient presents with anemia findings, neutropenia, mucosal/skin bleeding due to thrombocytopenia, and purpura and petechiae. Dx?
aplastic anemia
what is the diagnostic for aplastic anemia?
what will it show?
bone marrow biopsy
hypocellular marrow
what is the treatment for aplastic anemia? (2)
hematopoietic cell transplant (stem cell)
intensive immunosuppressive therapy
X-linked recessive disorder that leads to RBC oxidative injury and hemolysis
glucose-6-phosphate dehydrogenase deficiency (G6PD)
patient presents with jaundice, dark urine, and abdominal/low back pain. Dx?
G6PD deficiency
CBC with peripheral blood smear reveals low H/H, elevated reticulocyte count, bite/blister cells, and heinz bodies (denatured hemoglobin in RBCs). There are also elevated unconjugated bilirubin and hemoglobinuria. Dx?
G6PD deficiency
what is the screening and diagnostic to diagnose G6PD deficiency?
NADP
what is the treatment for G6PD deficiency? (3)
self limiting
avoid drugs/offending foods
blood transfusion for severe cases
autosomal dominant disease; disorder of the RBC membrane that decreases in surface to volume ratio, leading to spherical shape of the cell that becomes trapped in the spleen
hereditary spherocytosis
patient presents with anemia findings, jaundice, splenomegaly, and gallstones. Dx?
hereditary spherocytosis
CBC reveals decreased H/H, increased reticulocytes, increased MCHC and peripheral smear shows spherocytes (sphere-shaped RBCs). Indirect bilirubin and LDH are both increased. Dx?
hereditary spherocytosis
management for hereditary spherocytosis? (3)
refer to hematologist
folic acid
+/- splenectomy
autosomal recessive disorder of hemoglobin S gene; both copies of the beta-hemoglobin gene are Hbs
sickle cell anemia
when does sickle cell anemia appear?
around 6 months
patient presents with skin ulcers, retinopathy, ischemic necrosis of bones, renal/ hepatic dysfunction, and priapism. Dx?
sickle cell infarction
what is the primary cause of hospitalization in sickle cell anemia?
acute vaso-occlusive crisis
patient presents with fever, dyspnea, hypoxia, chest pain, abdominal pain/swelling, and priapism. Dx?
sickle cell anemia crisis
CBC reveals hematocrit that is NOT 3x higher than hemoglobin, increased reticulocytes, sickled cells, howell-jolly bodies, and target cells. There is also increased indirect bilirubin and hemoglobinuria. Dx?
sickle cell anemia
how to diagnose sickle cell anemia?
Hgb electrophoresis
increased hemoglobin S and F
prevention for sickle cell anemia complications? (4)
daily vitamin
penicillin until 5 yrs old
hydroxyurea
+/- folic acid
treatment for sickle cell anemia complications? (3)
pain meds
oxygen
transfusions
what are 2 curative treatment for sickle cell anemia?
hematopoietic stem cell transplant
gene editing/therapy transplant
