Anemia - CC3 Flashcards
3 components to blood
- plasma -55%
2. WBC/plateles -
3 steps to CBC review
- review Hb and MCV
- review WBC and DDx
- review platelet count
what does a marrow problem look like
loss of all cell lines
3 ways a single cell line can be low
- low prod
- destruction
- sequestration
what is anemia
low RBC
- very common
- abnormalities often found before Sx
what is too much RBC
polycythemia/erythrocytosis
- much less common
-
sign and Sx of anemia
- faigue
- HA
- lightheaded
- nausea
- chest pain
- SOB
- tachycard.
- HF
- hypotension
2 key part to approach to anemia
- cell size - MCV
2. retic count - underprod vs. destruction/sequestration
how to ID retics
- inceased color
- larger
- increased central pallor
- have RNA
DDx for microcytic
- Thallasemia
- Anemia of chronic disease
- Iron def
- Lead poisoning
- Sideroblastic
how is iron moved in body
- absorbed in duod
- transported by transferritin
- stored by ferritin in heart and liver and in Hb
- no excretion mechanism
how is Fe regulated
- taken up by ferrroportin
- ferroportin blocked by hepcidin
- ## hepcidin produced in liver
3 measures of Fe in body
- ferritin - primary storage
- transferritin
- serum iron/transferritin - used to assess Fe overload
what would be seen in Fe def. (5)
- low ferritin
- low MCV
also, but don;t need to measure
- low retic
- low serum Fe
- high transferritin (TIBC)
what to do in Fe def.
- in male and non-mens. females, always look for blood loss
- diet, bleeds
- treat Fe def., even if not anemia in women of child bearing age
2 types of Fe
- oral - may not be tolerated well
2. IV
def. anemia of chronic disease
- can be micro or normo
- due to acute or chron. inflammation
- caused by cytokines increasing hepcidin
5 things seen in anemia of chronic disesase
- high ferritin
- retics inapproriately low
- low serum Fe
- low TIBC
- low transferritin sat.
- low EPO
2 treatments of anemia of chronic disease
- treat underlying cause
2. EPO
what is thallasemia and 2 types
- abnormal prod. of Hb
- can be a or B
2 types of macrocytic
- megalobalstic - cells cannot mature
2. non-megaloblastic
4 causes of megaloblastic
- B12 def.
- folate def.
- cytotoxic drugs
- genetics
what is B12
- cobalamin
- found in animal products
- absorbed via inrinsic factor
- needed for blood
4 causes of B12 def.
- strict veganism
- unable to absorb - terminal ileum
- pernicious anemia - no intrisic factor
- Gi infection
4 nonmegaloblastic causes
- myelodisplastic syndrome
- retics bleeding or hemolysis
- liver disease - target cells
- hypothyroidism - uncommon
what do we need to check in normocytic
retics
2 causes of low retics
- primary or secondary bone marrow failure
2. low EPO
what is term when RBC destroyed too soon
hemolysis
2 causes
- extravascular - RBC don’t make it full life and destroyed
2. intravascular - lose all the good stuff inside liek FE
4 things that happen with hemolysis
- incr. retics
- incr. bili
- incr. LDH
- dec. haptoglobin
2 tests for intra vs. extravascular hemolysis
- DAT antiglobin tests
2. blood film spertocytes (EV) vs. schistocytes (IV)
3 intrinsic RBC factors causing hemolysis
- hemoglobin - sickle cell
- enzymes
- cytoskeleton problem
5 external factors causing hemolysis
- drug!
- infection
- ABs against RBC antigens
- structural probs - mechanical valves ets
- DIC
2 treatments of hemolyssi
- underlying cause
2. suportive care
2 other causes of anemia
- dilution
2. sequestration in spleen
when is transfusion reccomended
HB
what is Hct formula
Hb x 3
what does retic count indicate
2% excessive destruciton
signs of hemolysis
- signs of anemia
- signs of underlying disease
- dark urine
- jaundice
- hepatoplenomeg, cholelith, lymphadenopathy
test findings in hemolysis
- HB levels depend on degree
- elevated retics
- peripheral smear
- schistocytes - intravasc
- pherocytes or helmet - extravasc. - haptoglobin
- low - normally binds to Hb - high indirect bili
- high LDH
- direct coombs - +ve in autoimmune
Tx of hemolysis
- Tx underlying cause
- PRBCs
- folate suppluments
patho of sickle cell
HbA replaced by mutant hemoglobin
- under reduced O2 times, they sickle and obstruct
4 complications of SCC
- severe, lifelong hemolytic anemia
- occlusions Sx
- infections
- functional asplenia - delayed growth and maturation
Sx of SCC oclusion
- bone pain - most common
- hand-foot syndrome - dactylitis
- acute chest
- similar to PNA - repeated splenic infarcts
- avasc. joint necrosis
- most common in hip - priapism
- CVAs
- optho infarcts
- leg ulcers
Dx for SCC
- anemia
2. sickle smear
Tx for sickle
- avoid low O2
- early vaccinations
- prophylactic pen for kids
- folic acid supplements
- mgmt of crises
- hydroxyurea
- transfusions
- marrow transplant
what is spherocytosis
hereditary
- defect in spherin gene
- loss of RBC membrane area without loss of volume
- get trapped and destroyed by spleen
Sx of spherocytosis
- hemolytic anemia
- jaundice
- splenomegaly
- gallstones
5
Tx
splenectomy
what is G6PD def.
X-linked - male
- get H2O2 that breaks down RBCs
- preciptated by certain ABx and fava beans
Sx of G6PD
- episodic anemia that is drug induced
- dark urine and jaundice on Phx
what is seen on smear
- bite cells
2. heinz bodies
what is autoimmune hemolytic anemia (AIHA)
- produce autoantibodies to RBCs
- more fulminant in childs
2 types of AIHA
- warm
- due to IgG which binds at 37
- extravascular hemolysis
2 cold
- due to IgM
- intravasuclar - in liver
Sx of AIHA
- anemia
2. jaundice if sig
Dx of AIHA
- direct coombs
- IgG or cpmplement - cold agglutinatin
Tx of AIHA
often none
- warm
- steroids - cold
- avoid cold
- transfusions
