Anemia Flashcards
normal HGB and HCT in men
HGB 14-18 g/dl
HCT 40-50%
normal HGB and HCT for women
HGB 12-16 g/dl
HCT 35-45%
causes of decreased RBC production (4)
iron deficiency
B12 deficiency
folate deficiency
chronic disease
3 big etiologies of anemia
decreased RBC production
increased RBC destruction
Blood loss
causes of anemia due to blood loss
menstrual
GI bleeding
trauma
hypochromic, microcytic anemias (3)
iron deficiency anemia
thalassemias
sideroblastic anemia
normochromic, normocytic anemia (3)
hypothyroidism
liver disease
chronic disease
macrocytic/megaloblastic anemia causes
folate &/or B12 deficiency
causes of iron deficiency anemia
menses
pregnancy
GI blood loss
decreased iron absorption
iron deficiency anemia on a smear
biconcave appearance, central pallor on RBCs
iron deficiency anemia test results (4)
decreased serum ferritin
decreased serum Fe
elevated TIBC
** Elevated RDW
alpha 2 thalassemia presents as
mild hypochromic, microcytic anemia
alpha 3 thalassemia presents as
hemolytic anemia w/ splenomegaly
Beta thalassemia presents as
asymptomatic, hypochromic, microcytic anemia
lab findings for thalassemia
decreased MCV
Smear: poikilocytosis, target cells, nucleated RBCs
Normal RDW
good DDX finding for iron deficiency anemia
Elevated RDW
thalassemia tx (3)
transfusions to keep HGB > 9 g/dl
possible splenectomy
iron chelation therapy needed due to transfusion
how is anemia of chronic disease diagnosed?
exclusion, hx
an acquired disorder of hematopoetic stem cells, resulting in refractory anemia
MDS
refractory anemia due to drugs, lead toxicity, malignancy, inflammation, infection
sideroblastic anemia
variable MCV
anisocytosis & poikilocytosis
ringed sideroblasts may be present
sideroblastic anemia
elevated reticulocyte count w/ no other findings indicates
prior/recent hemorrhage, recent hemolysis
MCV > 100 =
macrocytic anemias
etiology/process of macrocytic anemia
defective DNA synthesis –> larger RBCs
additional symptoms of macrocytic anemia
glossitis, jaundice, splenomegaly, neuro***
macrocytic anemia smear’s most significant finding
hypersegmented neutrophils
Labs for Macrocytic Anemia (4)
serum B12
Schilling Test
IF antibodies
serum methylmalonic acid & homocysteine levels
autoantibodies against intrinsic factor
pernicious anemia- results in B12 deficiency
Lab ddx between B12 and folic acid deficiency
B12: elevated serum methylmalonic acid and homocysteine levels
Folate: elevated homocysteine but normal methylmalonic acid levels
tx for folic acid deficiency
replacement therapy
Treat B12 as well
how do elevated reticulocytes look on a smear?
blue
elevated reticulocyte count, nucleated RBCs and schistocytes on smear, elevated plasma Hb —> ?
hemolytic anemia
how to differentiate between intravascular and extravascular hemolytic anemia (lab test)
serum haptoglobin decreased in intravascular hemolysis
causes of intravascular hemolysis
fragmentation syndromes: traumatic (macroangiopathic) from prosthetic heart valve; fibrin strands in vessels (microangiopathic)
G6PD deficiency
causes of extravascular hemolysis (4)
hereditary spherocytosis
sickle cell
hemolytic anemia (drug induced or autoimmune)
incompatible blood transfusion
RBCs w/ decreased surface area, poorly deformable. RBCs get trapped in splenic sinusoids & are phagocytized by macrophages
hereditary spherocytosis
hereditary spherocytosis etiology
autosomal dominant
lab findings for hereditary spherocytosis (2)
osmotic fragility test for cell wall defects
lack of central pallor on RBC smear
hereditary spherocytosis tx (2)
splenectomy, give pnuemococcal vaccine
primary presentation of back, rib, limb pain
sickle cell anemia
cause of sickle cell pain
vaso-occlusive ischemia
complications of sickle cell (4)
osteonecrosis of femoral/humeral heads
functional asplenism due to infarcts
leg ulcers
bilirubin gallstones due to chronic hemolysis
1st and 2nd line lab tests for sickle cell
Sickledex (1st line)
Hb electrophoresis
sickle cell characteristic finding on peripheral smear
Howell-Jolly bodies: residual nuclear material
precipitating factors of sickle cell (4)
dehydration
hypoxia
altitude
intense exercise
sickle cell tx (2)
Pain crises: analgesics, fluids, oxygen
Hydroxyurea to decrease occurrence of crises
antibodies bind to RBCs, damage cell membrane –> hemolysis –> phagocytized –> destroyed in the spleen
autoimmune hemolytic anemia
smear findings for autoimmune hemolytic anemia? (4)
reticulocytosis
polychromasia
spherocytosis
nucleated red cell
on smear: reticulocytosis, polychromasia, spherocytosis, nucleated red cells
autoimmune hemolytic anemia
autoimmune hemolytic anemia tx (4)
treat underlying autoimmune cause
corticosteroids for short term
splenectomy
folic acid supplementation
anemia characterized by an abnormal iron metabolism
sideroblastic anemia
normal retic count range
0.5-2.5%
normal MCV range
80-100 fl
length of iron deficiency tx
at least 6 mo- replenish stores
decreased serum ferritin, decreased serum Fe, increased TIBC
iron deficiency
normal serum ferritin, normal TIBC
unlikely iron deficiency
decreased Fe, decreased TIBC, normal ferritin
anemia of chronic disease
increased ferritin, increased serum Fe, normal TIBC
Thalassemia
