Anemia

Question 1

Definition

Answer 1

Reduced red cell mass quantitated by Hb and Hct and RBC count

Question 2

Factors to determine severity and type

Answer 2

• chronicity (tachycardia, hypotension, dyspnea, fatigue, decreased LOC, angina)
• retic count (high = blood loss/destruction, low = evaluate MCV)
• MCV -
  — macrocytic - megaloblastic (vit B12 deficiency, methotrexate, hydroxyurea, folate deficiency); nonmegaloblastic (alcohol use disorder, liver dx, hypothyroidism, BM disorders)
  — microcytic - iron deficiency, thalassemia, lead poisoning, sideroblastic anemia
  — normocytic - blood loss, hemolysis, anemia of chronic disease, BM disorder

Question 3

Aplastic Anemia

Answer 3

• hypoproliferative disorder - autoimmune destruction of red-cell lineage cells with hypo plastic marrow
• acquired or inherited
• risk of developing AML

Question 4

AA causes

Answer 4

• cytotoxic drugs, radiation, benzene - chemical/physical damage –> supportive care, growth factors, stem cell transplant
• idiopathic, seronegative hepatitis, eosinophilic fasciitis, thymoma - immune destruction –> immunosuppressive tx, stem cell tx, eltrombopag
• telomere dx, fanconi anemia, germline gene mutations - genetic defects –> sex hormones, stem cell tx

Question 5

Hemolytic anemia

Answer 5

• acquired - hyper spleen, immune (autoimmune, malignancy, drugs, infections, transfusions); microangiopathy (hemolytic anemia, DIC, TTP, HUS, eclampsia, prosthetic valve, malignant HTN); infection (malaria, babesiosis); paroxysmal nocturnal hemoglobinuria, liver dx, spider/insect bites)
• hereditary - membrane defects (spherocytosis, elliptocytosis); Hb defects (sickle cell, thalassemia); enzymatic (G6PD, pyruvate kinase deficiency)

Question 6

Evaluation for hemolytic anemia

Answer 6

• CBC
• Red cell indices
• peripheral blood smear
• metic count
• LFTs
• LDH and haptoglobin
• Coombs test

Question 7

Study for Rituxan + steroids vs just steroids for autoimmune hemolytic anemia

Answer 7

• Showed that Rituxan + steroids improved response rate and relapse-free survival in patients with warm autoimmune hemolytic anemia

Question 8

CHOIR study

Answer 8

• use of EPO targeted at higher Hb level (13.5 vs 11/5) associated with greater risk of death and hospitalizations for heart failure in patients with non-dialysis dependent CKD and anemia