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)
Hemolytic anemia + bite cells or Heinz bodies
G6PD deficiency
Iron labs for iron deficiency anemia
Low iron, low ferritin
High TIBC/transferrin
Low Iron:TIBC ratio (<12%)
Iron labs for lead poisoning anemia
Normal/high iron
Normal ferritin, TIBC/transferrin
Iron labs for anemia of chronic disease
Low iron
Normal/high ferritin
Low TIBC/transferrin
Normal Iron:TIBC ratio (>18)
Iron labs for sideroblastic anemia
High iron, ferritin
Low TIBC/transferrin
Iron labs for thalassemia
Normal
Blood smear for iron deficiency anemia
Microcytic, hypochromic
Blood smear for lead poisoning anemia
Microcytic
Basophilic stippling
May have ringed sideroblasts in BM
Blood smear for anemia of chronic disease
Hypochromic
Normocytic or microcytic
Blood smear for sideroblastic anemia
Microcytic
May have ringed sideroblasts in BM
Blood smear for thalassemia
Microcytic Target cells (alpha) Basophilic stippling (beta)
Megaloblastic anemia
Macrocytic; hypersegmented neutrophils
B12/folate deficiency (Folate = MC)
Caused by problem w/ DNA synthesis
Causes of aplastic anemia
Radiation = MC Drugs (chloramphenicol, sulfonamides, phenytoin, chemo) Toxins Viral (parvovirus, EBV, HIV) Idiopathic Congenital
Schistocytes
Hemolytic anemia
DIP/TIP/HUS
Acanthocytes (spur cells)
Irregular spokes
Abetaproteinlipidemia
Echinocytes (burr cells)
Regular spokes
Hemolytic anemia
Bite cells
G6PD deficiency
Basophilic RBC stippling
Lead poisoning
Thalassemia
Peripheral neuropathy + ringed sideroblasts in BM
Lead poisoning
Hypersegmented neutrophils
Megaloblastic anemia (folate/b12)
Heinz bodies (denatured Hgb in RBC)
G6PD deficiency