Anemia Flashcards
1
Q
Mechanisms of anemia
A
- Blood loss
- Increased destruction
- Decreased production
2
Q
Increased destruction
A
1. Inherited G6PD PK deficiency Hb->thalasemia, sickle cell 2. Membrane lipid abnormality Hepatocellular Renal failure 3. Sequestration Hypersplenism 4. Acquired defect Paroxysmal nocturnal anemia 5. Antibody mediated New born transfusion Autoimmune 6. Mechanical HUS, DIC, TTP Valves 7. Infections Malaria 8. Toxic/chemical Clostria Lead Snake venom
3
Q
Decreased RBC production
A
1. Inherited genetic Fanconi 2. EPO deficiency Renal failure Chronic disease 3. Nutritional deficiency Vitamin B12 Folate Iron 4. Inflammation induced iron sequestration Anemia of chronic disease 5. Immune injury progenitors Aplastic anemia Red cell aplasia 6. Infection of progenitor Parvovirus 7. Space occupying BM Metastatic Granulomatous 8. Primary hematopoietic Leukemia MDS MPS 9. Unknown Endocrine->hypothyroid Liver
4
Q
Microcytic anemia
A
- Iron deficiency
- Thalassemia
- Sideroblastic
5
Q
Normocytic
A
- Acute blood loss
- Anemia of chronic disease
- BM failure
- Renal failure
- Hypothyroidism
- Hemolysis
- Pregnancy
6
Q
Macrocytic
A
- B12 or folate
- Alcohol and liver
- Reticulocytosis
- Cytotoxicx
- Myelodysplastic
- Marrow infiltration
- Hypothyroid
- Antifolate drugs
7
Q
When to suspect hemolysis
A
- Jaundice
- Reticulocytosis
- Mild macrocytosis
- Low haptoglobins
- Increased bilirubin
- Increase urobilinogens
8
Q
Severe anemia with HF
A
- Slow infusion of pRBCs with frusemide
- Monitor for fluid overload
- If immediate transfusion needed->exchange transfusion
9
Q
History
A
- Features of anemia: breathless, fatigued, reduced exercise. Duration, previous blood results
- Fever->infection, neoplasms, vasculitis
- Stools->malabsorption
- Diet
- Blood loss
Pregnancy, miscarriage, menstrual
Change in bowel, melena
Hemoptysis
Dark urine
Hx peptic ulcer/NSAID use, diverticular, IBD
Renal/hepatic
Anticoagulants - Cold intolerance->hypoT, SLE->rash, joint
- Family Hx->anemia, jaundice, cholelithiasis, splenectomy, Hb, bleeding
- Occupation, social (alcohol), medical history
- Medication, transufsions, drugs, exposure to solvents/insecticide
10
Q
Physical examination
A
1. Evidence of anemia Pallor, wide pulse pressure, systolic flow murmur 2. Evidence of complications-> CV Displaced Lung base crackles S4 Arrythmia 3. Evidence of underlying General->malnourished, chronic disease Liver Renal Jaundice Rashes Bruising LN, organomegaly Neurological (TTP) Thyroid PR Pelvic
11
Q
Investigations
A
1. Microcytic Iron studies FOBT Upper GI endoscopy IgA-tTG Colonoscopy Flow cytometry TVUS Stool MCS 2. Normocytic->hypoproliferative FBC B aspirations, biopsy Antiparvovirus Hepatitis serology MS test Peripheral smear TSH, free T4 ANA RF CK CXR EPO 3. Normocytic->hyperP Creatinine Coagulation Direct coombs test CMV/EBV 4. Macrocytic Vitamin B12, folate Anti-intrinsic, parietal cell antibodies BM aspiration Cytogenetics
12
Q
What indicates IDA
A
Low serum iron
High TIBC
Low ferritin
13
Q
What indicates ACD
A
Low serum iron
Low TIBC
Low ferritin
14
Q
Causes of IDA
A
1. Decreased uptake Inadequate diet Achlorhydria Gastric surgery Celiac Pica 2. +Iron loss PUD Diverticulosis Neoplasm IBD Hemorrhoids Menorrhagia Blood donation GoodP, HHT, angiodysP Renal failure Runner's anemia Hemaglobinuria 3. +requirements Infancy Pregnancy Lactation 4. Unknown
15
Q
Investigations in iron deficiency anemia
A
- FBC->low
- Iron studies->low serum iron, low ferritin, low TIBC, low transferrin saturation
- PLT->N or elevated
- Smear->microcytic, hypochromic
- Reticulocyte count->low
Tests to consider
- Celiac serology
- H pylori
- AutoI gastritis
- Upper GI endoscopy, small bowel biopsy
- Lower GI endoscopy, sigmoidoscopy
