Anemia Flashcards
Soluble transferrin receptor level in IDA
HIGH
IV iron recommended for pregnancy
Ferric gluconate (ferrlecit)
Iron sucrose
AICD lab profile
Low serum iron
low transferrin
low TSAT (<20% in 80% of cases, normal range 20-45% (**can be pseudo-normal if very low transferrin concentration (<200))
ferritin normal or increased
AICD mechanism
- ## increase in hepcidin (and other cytokines) causes iron to be retained within cells of the reticuloendothelial system (inhibits release of iron from macropa
Mechanism of anemia of pregnancy
- increase in plasma volume (dilutional)
- can be folate and iron and b12 deficiency
What is megaloblastic anemia?
- form of macrocytic anemia in which nucleic acid metabolism is impaired, leading to reduced efficiency of cell division and nuclear-cytoplasmic dyssynchrony (eg B12, folate deficiency)
Drugs associated with macrocytic anemia
- MTX
- azathioprine
- hydrea
Smear findings with B12 deficiency
- hypersegmented neutrophils (see photo online, will prob show photo)
clinical features of copper deficiency 2) clinical context in which it is seen
macrocytic anemia + older people with gastric surgeries (bypass) OR denture cream leading to zinc excess OR excessive zinc use
*bone marrow biopsy looking like MDS
Max hgb goal for anemia of CKD
12
Site of folate absorption
Duodenum or proximal jejenum
HS inheritance
autosomal dominant
HS 1) pathophys 2) most common mutation
1) affected proteins involved in VERTICAL ASSOCIATIONS that link the membrane cytoskeleton to the lipid bilayer
2) ankyrin (anchoring)
HS diagnosis
- now done with genetic testing
- previously by osmotic fragility test
Spherocyte differential *common board question
- HS
- immune mediated hemolytic anemia
- CAD
- extensive thermal burns
- snake bites
- scorpion bites
- brown recluse spider bites
- clostridium sepsis
elliptocytosis/ovalocytosis 1) inheritance 2) phenotype 3) pathophys 4) mutation
- autosomal dominant
- mild, minimal hemolysis
- affected proteins involved in horizontal associations that link the membrane cytoskeleton to the lipid bilayer
- spectrin
hereditary pyropoikilocytosis 1) mutation 2) presentation 3) smear
*always on boards, love to show smear
- spectrin (also
- variable hemolysis (worse in early childhood), many asymptomatica
- rod-shaped elliptocytes (see photo)
G6PD 1) clinical features 2) ethnicity
- acute hemolytic episodes after exposure to medication or infection
- early/prolonged neonatal jaundice
- Possible family history
- Mediterranean, middle east, africa, SE asia
G6PD diagnosis - how to determine during acute hemolysis
- blister cells on peripheral smear at time of hemolytic event (see photo).
*G6PD level is falsely elevated during acute hemolysis so always need to screen after crisis has resolved
G6PD management
supportive, transfusions as needed during hemolytic events
Pyruvate kinase deficiency 1)clinical features 2) gene 3) population
- moderate hemolytic anemia at baseline + episodes of worsening hemolysis
- PKLR
- Amish
Pyruvate kinase deficiency treatment
- mitapivat (PK activator)
Pyruvate kinase deficiency response to splenectomy
- mild hgb response
- BUT retic count markedly increases due to preferential sequestering of reticulocytes in spleen with PK deficiency
Buzz words for marrow findings with megaloblastic anemia (anemia from b12 or folate deficiency)
Impaired nuclear maturation but abundant cytoplasm due to
large marrow progenitors.
Key term is -
*“nuclear-cytoplasmic dyssynchrony” (large immature appearing nucleus with open chromatin pattern and mature appearing cytoplasm)
