Anemia 4 Flashcards
ferritin is an ___ ___ reactant? meaning?
acute phase reactant = proteins whose synthesis is upregulated in infection or inflammation
how to interpret ferritin levels
<15 definitely iron def. <30 almost certainly iron def. > 100 probably not def.
how to interpret ferretin levels in patients with inflammation
divide by 3, if <30 iron def is likely
other iron indices
low serum iron, increased TIBC, decreased iron saturation
iron saturation
serum iron divided by total iron binding capacity
vitamin B12 def causes? name of anemia
macrocytic anemia. may also cause decrease in platelet and neutrophil counts. pernicious anemia
vit B12 def: what test do you do and what do you see
blood smear : large red cells, but clear sign = hypersegmented neutrophils because of impaired DNA synthesis
anemia of inflammation: aka? MCV?
anemia of chronic disease. mild microcytosis, usually normocytic
anemia of inflammation: seen in who?
sick, hospitalized patients, cancer, infections, inflammatory disorders, patients in ICU
anemia of inflammation mechanism (4)
iron trapped in macrophages = decreased availability for RBC synthesis. blunted BM response to EPO, less EPO production by kidney, shortened TBC life span.
iron def anemia vs. anemia of chronic disease
hard to distinguish: both have low serum iron and iron saturation. iron has low ferritin, AI has normal/high. iron def has high TIBC, low in AI
how to diagnose anemia of inflammation
very difficult: will be a diagnosis of exclusion, you have to consider and treat other reversible or sinister causes. no clear diagnostic tests for it
anemic patient: basic steps
CBC, MCV, reticulocyte count. do history/physical exam. ask about potential blood loss in all patients!!
anemia workup: what initial investigations do you do if microcytic
ferritin, hemoglobinopathy
anemia workup: what initial investigations do you do if macrocytic
B12/folate, liver enzymes, TSH, retic count
