Anemia Clinical Care 2 Flashcards
Folic acid deficiency is almost always due to _____.
Decreased oral intake
Folate deficiency is common is conditions where the skin turns over often, such as ______ (4).
- pregnancy
- desquamating skin disorders
- sickle cell anemia
- chemotherapy
Folate is normally absorbed in the ______ part of the intestines.
- duodenum
- proximal jejunum
(wider area than B12 absorption in the ileum)
Diseases that decrease folate absorption
- celiac
- regional enteritis
- amyloidosis
Folic acid deficiency will show _____ in the blood smear
- macrocytosis
- hypersegmented neutrophils
(same as B12 deficiency)
In general, thalassemia is ____
defect in hemoglobin synthesis (alpha or beta chain)
How is thalassemia dx made?
electrophoresis
(these are the other findings in the image)
alpha thalassemia and beta thalassemia are prevalent in the Mediterranean and Asia, which locations are specific to alpha-thalassemia? Beta-thalassemia?
- alpha: Africa & Middle East
- beta: India & Pakistan
Thalassemias show _____ on blood smear
- Target cells
- Heinz bodies
(microcytic & hypochromic)
Thalassemia tx
folate (support cell wall synthesis)
(anemia will remain)
Thalassemia produces a ______ anemia
- microcytic
- hypochromic
How can you tell the difference between a thalassemia & iron deficiency anemia?
- Thalassemia: ⇣ RDW
- Iron deficiency: ⇡ RDW
(both are microcytic; major has an increased RDW)
List the 5 causes of hemolytic anemia, in addition to spherocytosis, trauma, infection and sickle cell.
- pyruvate kinase deficiency
- G6PD deficiency
- TTP
- HUS
- Autoimmune
______ is the MC enzyme defect in RBCs.
G6PD Deficiency
G6PD Deficiency is a _____ (genotype) disease that affects which populations?
- X-linked
- Mediterranean/African
G6PD Deficient patients may experience Brisk Hemolysis when exposed to _____ (3)
- infections
- drugs
- toxins
(oxidative stressors)
TTP is a microangiopathic hemolytic anemia that presents with _______ (3 sx).
- renal insufficiency
- neurologic sx (AMS)
- fever
Which 3 symptoms do TTP & HUS have in common
- thrombocytopenia (used in clots)
- microangiopathic hemolytic anemia
- renal insufficiency (damage to vessels)
2 types of autoimmune hemolytic anemia
- Warm-antibody mediated
- Cold agglutinin disease
Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)
- Warm-antibody: IgG
- Cold-agglutinin: IgM
What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?
- Warm antibody: corticosteroids, splenectomy, immunosuppression
- Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.
Hemolytic anemia will show ______ on blood smear
schistocytes
(broken up RBCs)
Autoimmune hemolytic anemia is diagnosed by ______
direct Comb’s test
(must wait until you know they are hemolyzing already! It’s not part of the workup)
4 Lab findings for hemolytic anemia?
- indirect bilirubin in urine (urobilinogen)
- LDH ⇡ (this is sensitive, not specific)
- reticulocyte ⇡ (>3%)
- haptoglobin ⇣
(direct = from liver problem)
sickle cell anemia
(SS, SC, Sickle thalassemia)
Sickle cell disease is characterized by chronic _____
hemolytic anemia from mutant hemoglobin → clog vessels
4 major presentations of sickle cell crisis complications
- Hyper hemolytic crisis/ acute hemolytic anemia
- Vaso-occlusive crisis
- Splenic sequestration crisis
- Aplastic crisis
What is acute chest syndrome?
- Second most common complication of sickle cell (25% of deaths)
- vaso-occlusive crisis of lungs
Why is it important to ask patients with sickle cell anemia about difficulty breathing?
- acute chest syndrome (25% of sickle cell deaths)
- CP, fever, pulmonary infiltrate & hypoxemia
What is splenic sequestration crisis and sickle cell crisis?
Splenic sequestration of defective and ruptured cells (schistocytes lead to infection)
aplastic crisis is due to ______
parvovirus 19 in sickle cell patients
Sickle-cell precipitants
- Physical or emotional stress
- Hypoxia
- Infection
- Dehydration
(retic count may reach 25%)
Acute Sickle cell crisis tx (4)
- morphine (opens vessels→prevent infarct)
- O2
- ABX
- IV fluids
(folic acid & stop infarction)
Why is it important to use caution with transfusion in Sickle Cell crisis and thalassemia patients?
They absorb iron better than the average patient → iron overload
(hemochromotosis)
Maintenance Sickle Cell tx
- Hydroxyurea
- Folic acid
- Hydration
- Avoid high altitude
Cure for sickle cell anemia
children can be cured with bone marrow transplant in childhood
spherocytosis
TTP/HUS - microangiopathic hemolysis w/schistocytes
(little pacwomen)
Malaria
Malaria
babesiosis
Hemoglobin and hematocrit values to dx anemia
- female = Hgb < 12 or Hct < 36
- male = Hgb < 13.5 or Hct < 41
4 medical conditions that can lead to anemia?
- sickle cell disease
- thalassemia
- renal disease
- hereditary spherocytosis
If white count and platelets are both low it is _____ until proven otherwise!
aplastic anemia
If you have a patient with anemia and low platelets, consider _____ (2 diseases)
- TTP
- HUS
(check for schistocytes; sign of microangiopathic hemolytic anemia)
If a patient has low platelets, renal failure, and E coli exposure, the diagnosis is _____
- HUS
- toxin attaches to WBC → carried to glomerular vessels → toxins cause apoptosis
(may have fever; may look like TTP)
If a patient has low platelets, renal failure, neurologic changes, the diagnosis is _______.
TTP
(may have fever; looks like HUS)
If an anemic patient has high platelets consider _____ (dx)
iron deficiency
(especially in microcytic anemia)
Anemic patient with low hemoglobin and hematocrit but RBC count is normal or high, it is ______ (dx).
thalassemia
(they make normal amount of cells, but they are small - normal count)
Hematochezia is _____; while melena is _____.
- bright red blood per rectum
- black tarry stool
(either way - consider colonoscopy)
If a patient is anemic and has abdominal pain or recent femoral vein/artery manipulation (stent placement) or trauma, the cause may be _____.
bleeding into the retroperitoneal or thigh compartment hematoma
If other cell lines are ok, and MCV < 80 check _______ (3)
- serum iron
- ferritin
- TIBC
In iron-deficiency anemia, look for _____
sources of chronic bleeding: menstrual
(consider colonoscopy)
In iron-deficiency anemia consider ________ 3 causes in addition to chronic bleeding.
- lead poisoning
- copper deficiency
- thalassemia
If a patient has normocytic anemia (MCV 80-100), check ______ (4 lab values)
- indirect bili
- LDH
- haptoglobin
- retic
Iatrogenic causes of macrocytic anemia (3)
- Hydroxyurea
- AZT
- Methotrexate
______ is the MC enzyme defect in RBCs.
G6PD Deficiency
G6PD Deficiency is a _____ (genotype) disease that affects which populations?
- X-linked
- Mediterranean/African
2 types of autoimmune hemolytic anemia
- Warm-antibody mediated
- Cold agglutinin disease
Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)
- Warm-antibody: IgG
- Cold-agglutinin: IgM
What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?
Warm antibody: corticosteroids, splenectomy, immunosuppression
Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.
If a patient has a normal Hgb electrophoresis and iron levels, but microcytosis, what is the dx? Why?
- alpha-thalassemia trait
- there is no increase in Hgb A2
(DNA testing to confirm absence of alpha chain gene deletion)
