Anemia Flashcards
Right shift Hgb-O2 curve
Increases O2 delivery to tissues Acidosis Increased temp High altitude Exercise Increased CO2 Increased 2,3-DPG
Left shift Hgb-O2 curve
Decreases O2 delivery to tissues Alkalosis Decreased temp Increased Hgb F concentration Decreased CO2 Decreased 2,3-DPG
Microcytic anemias
Iron deficiency (MC) Lead poisoning Sideroblastic Thalassemias Chronic disease (usu normocytic)
Normocytic anemias
Hemolytic
Chronic disease (rarely microcytic)
Hypovolemia
Macrocytic anemias
Folate deficiency
B12 deficiency
Liver disease
Alcohol abuse
Hemolytic anemia labs
Decreased H/H Increased reticulocytes Increased bilirubin (indirect) Increased LDH (from RBC lysis) Normal MCV Decreased serum haptoglobin (used up)
Hemolytic anemia blood smear
Schistocytes, spherocytes, burr cells
Coombs test, direct
Agglutination indicates presence of IgG and complement on RBC membranes (eg warm/cold agglutinin)
Coombs test, indirect
Agglutination indicates presence of anti-RBC antibodies in serum (eg Rh alloimmunization)
Direct Coombs+ hemolytic anemia + antidrug antibodies, immune complexes or anti-Rh antibodies
Drug-induced hemolytic anemia
Drugs causing drug-induced hemolytic anemia
Penicillin Methyldopa Quinidine Cephalosporins NSAIDs
Drugs causing G6PD deficiency hemolysis
High dose ASA Sulfa drugs Dapsone Quinine,quinidine, primaquine Nitrofurantoin
Direct Coombs+ hemolytic anemia + anti-RBC antibodies
Warm-reacting (IgG) or cold-reacting (IgM) immune mediated hemolytic anemia
Hemolytic anemia + schistocytes
Mechanical (eg prosthetic heart valve)
Hemolytic anemia + spherocytes
Hereditary spherocytosis (+osmotic fragility test, +MHCH, decreased diameter)