anemia Flashcards
iron deficiency
-MC anemia -> reproductive age women
-low iron
-low ferritin
-high TIBC
-low transferrin sat
-high RDW
-mostly bleeding causes- menstruation, acute blood loss, chronic nosebleed, urinary loss
-pregnant
-children with cow milk
-atrophic glossitis, aphthous ulcer, restless leg syndrome, angular cheilitis
-tx- oral iron -> IV iron in severe, pre/post op
-ferrous sulfate
lead poisoning
-Pica, burton lines on gyms, high ICP, htn, pallor, hyperactivity, CNS
-basophilic stippling!
hereditary hemochromatosis
-autosomal recessive- C282Y
-TRIAD- hepatomegaly, skin hyperpigmentation, diabetes
-high ferritin
-high transferrin sat!
-tx- phlebotomy, erythrocytapheresis
macrocytic megaloblastic anemia
-hypersegmented neutrophils- >5 lobes and impaired DNA synthesis
-FOLATE DEFICIENCY
-neural tube defects in pregnancy- encephalocoele, anencephaly, spina bifida
-greens and grains
-VITAMIN B12 DEFICIENCY
-neurologic symptoms
-methyl acid
-TX- oral, shot, inhale
hemolytic anemia
-normocytic normochromic anemia
-high reticulocytes
-high MCV
-high bilirubin
-low haptoglobin
-high plasma hemoglobin
-high urinary hemoglobin
-high ferritin
-high lactate dehydrogenase
-spherocytosis
-G6PD deficiency
-thalassemia
hereditary spherocytosis
-jaundice, splenomegaly
-spherocytes on peripheral blood smear -> round
-aplastic crisis if virus (parvovirus MC)
-MCHC- high
-osmotic fragility high
-EMA binding test
-tx-
-phototherapy
-blood transfusion
-splenectomy
-cholecystectomy
hereditary elliptocytosis
-Hgb high
-elliptocytes / ovalocytes
-autosomal dominant
-defects in skeletal protein, spectrin
-tx- transfusion, splenectomy, prophylactic folic acid
G6PD deficiency
-resistant to malaria
-M>F
-fava beans, drugs (dapsone, primaquine, sulfa, nitro), infection!!, chemicals
-antimalarial, sulfa, analgesics, henna
-heinz bodies
-basophilic stippling
-blister cells
-polychromasia
-urine- brown w/ hemosiderinuria
alpha thalassemia
-MC genetic ds
-Silent Carrier- 1 out of 4 alpha-globin genes deleted -> asymptomatic with normal/mild labs
-Alpha-Thalassemia trait- 2 out of 4 alpha-globin genes deleted -> no or mild microcytic, hypochromic anemia with normal ferritin
-Hb H disease- 3 out of 4 alpha-globin genes are deleted. Moderate to severe microcytic, hypochromic anemia is present
-splenomegaly, fatigue, jaundice, and anemia
-transfusions. (Less severe than beta-thalassemia major)
-Hydrops Fetalis- All 4 alpha globin genes are deleted -> incompatible with life -> stillbirth -> Hb Bart -> tetramers
-def dx- DNA level- gene mapping
-differentiate from beta with Hb electrophoresis -> normal Hb A2 and F
-HbH inclusion bodies
-severe hypochromia
beta thalassemia
-differentiate from alpha by Hb electrophoresis -> normal levels of Hb and A2 and F for alpha thalassemia
-high Hb A2 and F for beta
-minor- heterozygous
-major- homozygous -> transfusion dependent
-low MCV, high RDW
-high Hb F and Hb A -> this is low in iron deficiency
-no anisocytosis with a lot of target forms
-very low hmg and MCV
-basophilic stippling, normoblasts
-poikilocytosis, hypochromia , anisocytosis
-erythropoiesis -> hyperactive bone marrow, bone deform, early death
-chipmunk face, frontal bossing, paravertebral masses, short
-tx- transfusions, iron chelation, folic acid
-stem cell transplant
sickle cell anemia
-autosomal recessive
-morbidity -> vaso-occlusion
-high MCV
-Hb electrophoresis - HbS (decrease HbA)
-Howell-Jolly body
-tx-
-hydration
-analgesia
-steroid
-NO transfusions -> do exchange transfusion
-bone marrow transplant
-hydroxyurea for severe!!
hemoglobin C
-trait (Hb AC) - asymptomatic, hypochromia, target cells
-disease (Hb CC):
-mild hemolytic anemia
-splenomegaly
-rod shaped crystals in RBC
-normochromic, normocytic
-target cells
-oblong and hexagonal RBCs
warm autoimmune
-IgG
-idiopathic or secondary (SLE, CLL, lymphoma, drugs)
-jaundice, splenomegaly
-reticulocytosis
-spherocytes
-+ coombs -> IgG AND C3 +
-tx:
-steroids
-splenectomy
-immunosuppressive- azathioprine
-folic acid
cold agglutinin disease
-IgM
-primary or secondary (lymphoproliferative, infection, immunidef, autoimmune, tumors)
-red cell agglutinates
-macrocytosis
-reticulocytosis
-+ coomb ONLY C3+ (-IgG
-raynauds
-tx-
-avoid cold
-blood transfusion
-rituximab
-chlorambucil
-plasmapheresis
-steroids and splenectomy- not really
splenectomy
-pneumococcal vaccine and meningococcal vaccine and Hib vaccine -> 2 weeks before
-antibiotic prophylaxis for minimum 2 years after
-howell jolly body -> sickle cell, megaloblastic
paroxysmal cold hemoglobinuria
-rare
-children after virus
-Donath-Landsteiner in syphilis
-intravascular hemolysis -> pallor, dark urine, ab pain, collapse
