Anemia Flashcards
Anemia work-up
1. Acute vs Chronic?
Hemodynamic stability
Timeline of symptoms
Previous CBC
Overt blood loss
Causes of acute anemia?
Acute hemolysis or bleeding
Reticulocytes in acute vs chronic anemia?
Acute anemia - increased reticulocyte
Chronic anemia - variable, depends on cause
Normal reticulocyte count
If greater than 100 x 10^9/L, marrow is responding with increased RBC production
Significance of peripheral “nercs” or nucleated erythrocytes or orthochromatic normoblast
BM working crazy overtime to keep up with a bad bleed or hemolysis
OR
BM is so crowded with abnormal cells like leukemia that it’s squeezed some immature cells into peripheral blood
If chronic, next question is MCV
What is a normal MCV range?
80 - 100 fL
Causes of microcytic anemia
- iron deficiency
- thalassemia trait
- anemia of chronic disease
- sideroblastic anemia (rare)
- lead poisoning (rare)
Cut-off for ferritin in iron deficiency?
less than 30
How to diagnose thalassemia trait?
Hemoglobin electrophoresis
Causes of normocytic anemia
- acute blood loss
- hemolysis (acute or chronic)
- anemia of chronic disease
- chronic inflammation: RA, sLE
Causes of normocytic anemia
Often multifactorial
- acute blood loss (not yet iron deficient)
- hemolysis (acute or chronic)
- anemia of chronic disease
- chronic inflammation: RA, SLE
- chronic infection: TB, SBE, abscess
- malignancy
- anemia of renal failure
- liver failure
- endocrinopathies (addison’s, hypothyroidism, hypogonadotropic states)
- early iron deficiency
- pregnancy (plasma up)
- BM disorders - primary (leukemia) or secondary - malignancy, TB infecting BM
Mechanism of anemia of chronic disease
Chronic inflammation causes problems with iron metabolism
- decreases ability of body to absorb iron from diet
- decreases ability to use iron in storage
Spherocytes
Loss of central pallor of the RBCs
RBC has lost pieces of its membrane
Membrane to volume ratio has gone down
Shape changes from biconcave disk to sphere.
Hemolytic anemia - what are the two components of diagnosis?
- Increased production (elevated retics, BM erythroid hyperplasia)
- RBC destruction (increased indirect bili, increased LDH, decreased haptoglobin, free Hb in plasma) +/- hemoglobinuria, positive direct antiglobulin test
Main test to do in hemolytic anemia
Peripheral smear - points you in the right direction
What does the Direct Anti-globulin Test (DAT) do?
For hemolytic anemia.
Tests if there are auto-antibodies on RBCs.. add anti-IgG antibodies, they clump in the test tube if there are auto-antibodies.
Features of oxidative hemolysis on peripheral smear
Heinz bodies - Hb clumps together –> hemolytic anemia
Bite cells - spleen dislikes hb clumps, macrophages bite it off
Blister cell - like a bite but can still see the membrane
Sign of liver disease on smear
Spur cells or acanthocytes.. rarely can be a sign of lipid metabolism problems (hemolytic anemia)
Microspherocytes
Caused by burn trauma - membrane gets heated up, melts, leads to small spherocytes (hemolytic anemia)
Macro-ovalocytes
Huge RBCs - B12 deficiency
Also hypersegmented neutrophil
Daily requirement of cobalamin/B12
0.1 micrograms
Body stores: 2-4 mg
Source - animal products (meat, eggs, milk, cheese)
GI problems can cause issues with absorption despite adequate intake
Folic acid daily requirement
50 mcg
Mostly from uncooked fruits and vegetables
All grains in Canada are supplemented
Normal Hb level - adult male
130 - 180 g/L
Normal Hb level - adult female
115 - 165 g/L
