Anemia Flashcards
Which type of bilirubinemia would one expect from a hemolytic process?
Indirect bilirubinemia
How would ferritin be used to determine total body iron levels?
Iron is stored in the bone marrow as ferritin. Therefore, ferritin levels typically reflect iron stores. However, ferritin is also an acute phase reactant and does not accurately reflect iron stores if there is ongoing inflammation.
If a patient presents with anemia, ice-eating, and lethargy, what underlying process would you suspect is the cause of the anemia?
Iron deficiency anemia
If a patient presents with anemia and distal paresthesias, what underlying process would you suspect is the cause of the anemia?
B12 deficiency anemia
If a patient presents with anemia and LUQ pain, what underlying process would you suspect is the cause of the anemia?
Hereditary spherocytosis with splenomegaly
If a patient presents with anemia and RUQ pain or intolerence of fatty foods, what underlying process would you suspect is the cause of the anemia?
Cholelithiasis from chronic hemolysis
If a patient presents with anemia, constipation, and cold intolerence, what underlying process would you suspect is the cause of the anemia?
Hypothyroidism
Which tests are recommended in the initial workup of anemia?
The evaluation starts with a CBC, retic count, and examination of the peripheral blood smear.
What type of anemia is present in this slide?
Iron deficiency anemia. There is thrombocytosis, microcytosis, and hypochromia.
What type of anemia is present in this slide?
B12 or Folate deficiency with pernicious anemia. Low-power view shows a hypersegmented neutrophil and macrocytosis.
List four potential etiologies of microcytic anemia.
Iron deficiency anemia, Thalassemias, Sideroblastic anemia, and anemia of chronic disease.
List five potential etiologies of normocytic anemia.
Acute blood loss, hemolytic anemia, anemia of chronic disease, chronic renal disease, and aplastic anemia.
List four potential etiologies of macrocytic anemia.
Folate deficiency, B12 deficiency, Drug-related (e.g. valproic acid), and inherited bone marrow failure syndromes.
In which type of anemia would one expect the RDW to be increased?
Iron deficiency anemia
In which type of anemia would one expect the MCHC to be increased?
Hereditary spherocytosis
Which type of anemia is shown in this slide?
Hereditary spherocytosis. Note the lack of central pallor. The normal sized lymphocyte shows that these are microcytic spherocytes.
What type of cell is displayed on this slide?
Target cells
What type of cell is displayed on this slide?
Teardrop cells (dacrocytes)
What condition should one expect based on the findings in this slide? The arrows are pointing to what type of cell?
Uremia. The arrows are pointing to Echinocytes/Burr cells. These are RBCs with regular, short, spiny projections. The membrane changes disappear when the uremia is corrected.
What condition should one expect based on the findings in this slide? The arrows are pointing to what type of cells (1) and (2)?
This slide shows hepatorenal failure. Burr cells (1) as seen in uremia, and spur cells (2) as seen in hepatic failure.
What type of cell is indicated by the arrows in this slide? What condition does its presence usually indicate?
Acanthocytes (spur cells). Also some nucleated RBCs. Spur cells are RBCs with multiple irregular projections that vary in length, width, and regularity. The usual cause is hepatic failure.
How would one differentiate between Burr cells and Spur cells on a blood smear?
Burr cells (echinocytes) are RBCs with regular, short, spiny projections. Spur cells (acanthocytes) are RBCs with multiple irregular projections that vary in length, width, and regularity.
What hematologic condition is characterized by the findings on this blood smear?
Hereditary elliptocytosis
What hematologic condition is characterized by the findings on this blood smear?
Sickle Cell Disease
What are the blue inclusions indicated by the arrows called? When would you expect to see them on a blood smear?
Howell-Jolly bodies. They are present in patients who have had splenectomies.
What is the term for the finding indicated by the arrow in this image?
Basophilic stippling
What condition is represented by the findings in this slide?
Burn hemolysis. Hemolytic anemia, nucleated RBC, and spherocytosis.
In what three situations would one expect to see schistocytes?
Microangiopathic hemolytic anemia (seen in TTP, HUS, HELLP, DIC, and occasionally vasculitis), severe burns, and valve hemolysis.
In what two situations would one expect to see spherocytes?
Autoimmune hemolytic anemia and hereditary spherocytosis
In what four conditions would one expect to see target cells?
Significant liver disease, thalassemia syndromes, sickle cell disease type SC, and homozygous hemoglobin C disease.
In what condition would one expect to see Burr cells (echinocytes)?
Uremia
In what two conditions would one expect to see teardrop cells (dacrocytes)?
Infiltrating bone marrow processes (such as myelofibrosis) and thalassemia
In what condition would one expect to see spur cells (acanthocytes)?
Hepatic failure
In what condition would one expect to see hypersegmented PMNs?
Megaloblastic anemia (e.g. pernicious anemia/B12 deficiency and folate deficiency)
In what two conditions would one expect to see elliptocytes?
Hereditary elliptocytosis and severe iron deficiency anemia
In what condition would one expect to see sickled cells?
Sickle Cell Disease (HbSS and HbS β-thalassemia; less common in HbSC)
In what condition would one expect to see Howell-Jolly bodies?
Asplenia/functional asplenia
In what three conditions would one expect to see basophillic stippling?
Basophilic stippling indicates ineffective erythropoiesis and can be seen in conditions such as: lead poisoning, thalassemia, and pyrimidine 5’-nucleotidase deficiency.
In what condition would one expect to see Heinz bodies?
G6PD deficiency
What are the three categories of β-thalassemia?
Minor (heterozygous), intermedia (homozygous β+/β+), and major (homozygous β0/β0 or heterozygous β0/β+)
What is the significance of elevated HbA2 in the evaluation of microcytic anemia?
An HbA2 >3.5% is diagnostic for β-thalassemia minor.
What is the typical clinical presentation of patients with β-thalassemia minor?
Patients are usually asymptomatic but have a disproportionate degree of microcytosis with no or mild anemia if blood is analyzed.
What would be the expected hemoglobin electrophoresis findings in patients with β-thalassemia intermedia?
Decreased production of β-globin leads to increased production of gamma and delta chains. Therefore, HbA2 (α2δ2) and HbF (α2γ2) are increased on electrophoresis.
How does β-thalassemia intermedia usually present clinically?
Patients with β-thalassemia intermedia have similar presenatations as those with β-thalassemia major, but milder. They generally do not require transfusions.
Why are Heinz bodies present in the RBCs of patients with β-thalassemia major?
In these patients, there is essentially no β-globin production. The remaining, highly insoluble α-globin precipitates into inclusion bodies (Heinz bodies) within the cells.
How do patients with β-thalassemia major usually present clinically?
By 6-12 months of age, most infants show pallor, irritability, growth retardation, hepatosplenomegaly, profound anemia, and jaundice. Extramedullary hematopoiesis in the facial bones leads to characteristic changes such as frontal bossing and prominent malar eminences (i.e. “chipmunk facies” in children).
What are the typical electrophoresis findings in patients with β-thalassemia major?
Hemoglobin electrophoresis shows almost exclusive HbF.
What therapy is required for management of β-thalassemia major and what is the major complication associated with it?
Patients with β-thalassemia major are transfusion dependent and often develop iron overload, which requires chelation therapy.
What are the four categories of α-thalassemia, and what differentiates them?
α-thalassemia trait (1 allele affected), α-thalassemia minor (2 alleles affected), HbH disease (3 alleles affected), and hydrops fetalis (4 alleles affected). Each category involves the deletion/dysfunction of 1 or more of the four α-globin alleles, and the more alleles are affected, the worse the clinical presentation.
What clinical findings would you expect in a patient with α-thalassemia trait?
These patients are asymptomatic and have no hematologic abnormalities (the “silent carrier”).
What clinical findings would you expect in a patient with α-thalassemia minor?
These patients are asymptomatic but have a low MCV and may have no or mild anemia.
What clinical findings would you expect in a patient with HbH disease?
These patients have moderate-to-severe hemolysis.