Anemia Flashcards
Red blood cells are produced through_______? Production is stimulated by the hormone _____, synthesized in the _______. Immature erythrocytes are call______?
Erythropoiesis, erythropoietin (EPO), kindey, reticulocytes.
Value for hemoglobin, hematocrit, RBC, MCV, reticulocyte count?
Hgb: M-13.5-17.5 F-12-16. Hct: M-45, F-35, RBC: M-4.5-6 F-4-5.4 MCV- 81-90, recticulocyte count 20,000-100,00
What is anemia?
Significant reduction in mass of circulating RBCs which causes O2 binding capacity of blood to diminish. Anemic pts can have decreased RBCs or hemoglobin
What is microcytosis? Causes of microcytosis?
Small erythrocytes caused by abnormal erythroid maturation
What is and causes macrocytosis?
Increase in size of erythrocytes caused by abnormal erythroid maturation, MCV >100. RBC aplasia, alcoholism, aplastic anemia, myelodysplastic syndromes, hemolytic anemias
Causes of normocytosis?
ACD, acute hemorrhage, hemoglobinopathies, primary bone marrow (decreased erythroid progenitors), secondary to chronic disease
Symptoms of anemia?
Often asymptomatic. Fatigue, dyspnea, pallor, palpitations, decreased exercise tolerance.
Features of decreased red blood cell production?
Onset is insidious, reticulocyte count is inappropriately low, bone marrow examination is often required for diagnosis, MCV are informative
Features of increased red blood cell destruction?
Onset is abrupt or insidious, reticulocyte count is increased, red cell morphology on peripheral smear is usually informative, dont need BM biopsy
Test for anemic workup?
CBC, peripheral blood smear, bone marrow examination
Significant increase in reticulocyte on CBC count could indicate?
Hemolytic anemia
A low reticulocyte count on CBC suggest what mechanism for anemia?
Failure to produce RBCs
What are some signs of acute anemia due to blood loss?
Increase of pulse of 25% or more or a fall in systolic BP of 20mm Hg when going from supine to sitting (indicating hypovolemia), MCV will increase initially due to young RBC, increase leukocytosis and “left shift” in WBC due to stress, retics increase after a few days.
Causes of anemia due to chronic blood loss?
Usually d/t lesions in GI tract or uterus. Need to test stool specimens fo occult blood
How do endocrine disease cause anemia and what are some of the diseases?
Hormones help stimulate erythroid cells causing mild-moderate anemia. Hypothyroidism, hypoadrenalism, hypogonadism, hypopituitarism
Disease that can cause anemia of chronic disease?
Renal insufficiency, aging, endocrine disease, liver disease, inflammatory disease
Risk factors that can cause anemia of chronic disease (ACD)?
Chronic inflammatory conditions like autoimmune d/o (SLE, RA, sarcoidosis, vasculitis, IBD), Cancer, CKD, infection, chronic rejection after organ transplant
Work up for ACD?
CBC, reticulocyte count and index, peripheral blood smear, serum iron lvl, TIBC, transferrin saturation, ferritin, EPO lvl
What would the test results look like for ACD?
Hgb-8.5-9, low retic ct (ineffective erythropoiesis), low serum iron and transferrin, serum ferritin normal or increased, smear will have hypochromic normocytic RBCs
Treatment for ACD?
Treat underlying disease. Acute-transfusion saved for severe anemia. Chronic- Erythropoiesis-stimulating agents (ESA) (for CKD, chemotherapy, zidovudine), possible supplemental iron
Possible complications of ESA?
High dose ESA in CKD- increase CV and thromboembolic events. ESA in cancer correlated with tumor progression and mortality.
What is aplastic anemia?
Bone marrow failure syndrome defined by peripheral blood pancytopenia and hypocellular bone marrow aplasia
What are some of the clinical presentations of aplastic anemia?
Mucosal bleeding, easy bruising, petechiae, heavy menstrual bleeding secondary to thrombocytopenia. Fatigue, lasstitude, pallor, DOE, palpitations secondary to anemia. Fever and sore throat due to neutropenia. Can have short stature, skeletal/nail changes.
What test would you order for AA workup and what would you see on test?
BM aspiration or biopsy (dec. erythropoietic and myelopoietic precursor cells), CBC ( pancytopenia, macrocytic, toxic granulation of neutrophils, reticulocytopenia) HAM test, MRI ( high fat content in bone marrow)
Treatment for acute moderate AA?
Anti-thymoctye globulin ATG (kills T lymphocytes allowing bone marrow to resupply stem cells). Non-responders- Cyclosporine A (prevent T-lymphocyte activation), androgen
Treatment of acute severe AA?
Kids/young adults- Human leukocyte antigen (HLA) typing for BMT- if none treat with CSA and ATG. Older adults- ATG and CSA. No response- non match BMT, androgens, 2nd immunosuppresent
Treatment for chronic AA?
Allogenic BM transplantation. ATG. ISAs (cyclosporin, cyclophosphamide, corticosteroids). Androgen (danazol). Oral thrombopoietin mimetic (eltrombopag)
What is hemolytic anemias?
Anemia resulting from an increased rate of erythrocyte destruction in peripheral circulation.
What is an abnormality of the RBC membrane, which make the RBC unusually sensitive to lysis by complement?
Paroxysmal nocturnal hemoglobinuria. Acquired disease
What is a congenital defect of erythocyte cell membrane, becoming abnormally permeable to Na, resulting in thickened and almost spheric erythrocytes that are fragile and susceptible to spontaneous hemolysis?
Hereditary spherocytosis.
Disease where RBC appear spiculated and are destroyed prematurely, predominantly in the spleen?
Spur cell anemia
HIV can induce which type of AIHA?
Warm and cold AIHA “mixed-type”
What type of antibodies are involved in warm antibody mediated AIHA? Where does destruction take place?
IgG which are characterized by phagocytosis of RBC. It allows phagocytic cells to bind to complex. RBCs are destroyed in the spleen. Associated with AI diseases.
What type of antibodies are involved in cold antibody mediated AIHA? Where does destruction take place?
IgM is potent activator of complement pathway which caused complement mediated lysis of RBCs. IgM AIHA takes place in Kupffer cells of liver.
Phagocytic AIHA is termed ________, while complement mediated lysis of RBCs is termed _______ AIHA which requires overwhelming ______ activation?
extravascular, intravascular, complement activation.
Test performed to determine which autoantibody is causing AIHA?
Coombs test, aka antiglobulin test. There are indirect and direct types of Coombs test.
Clinical presentation of AIHA?
Fatigue, dyspnea, pallor, jaundice, tachycardia with flow murmur (pronounced anemia). Intravascular hemolysis may present with dark urine and back pain. Hepatomegaly, lymphadenopathy, splenomegaly may be present
Lab test for AIHA and expected results?
CBC (reticulocytosis, low haptoglobin) CMP (elevated indirect bilirubin, elevated LDH), peripheral smear, Coombs (direct antiglobulin test), Hep serology, ANA, UA for hemosiderinuria and hemoglobinuria, CXR (rule out lymphoma), CT chest, abdomen, pelvis (r/o lyphoma)
DAT results: +IgG alone or with IgG+ C3D, which type of AIHA?
Most likely due to warm AIHA
DAT result: + C3d alone
Most likely due to cold AIHA
Treatment for acute and chronic cold AIHA?
Acute: transfusions of prewarmed PRBCs, antibxs, +/- corticosteroids, supportive care. Chronic: supportive and symptomatic, avoid cold, treat febrile infections, +/- vaccines
Treatment for warm AIHA?
Prednisone 1-2mg/kg/day w/ Danazol. Splenectomy if inadequate response to steroids. ISA if the above fail (Azathioprine, cyclophosphamide, cyclosporine, rituximab)
At what value would you see cardiac symptoms such as increased CO, HR, SV
Hemoglobin less than 7.5
