Anemia: Clinical Diagnosis and Management Flashcards
What labs are clues to hemolysis?
lactate dehydrogenase (LDH), indirect (unconjugated) bilirubin, and haptoglobin
if hemolysis is occurring, what would the LDH level be?
high
if hemolysis is occurring, what would the indirect (unconjugated) bilirubin be?
high
if hemolysis is occurring, what would the haptoglobin be?
low
what four things are included in iron studies?
iron level, ferritin, transferrin, and transferrin saturation
what does ferritin measure/ what is ferritin?
iron storage protein, proportional to iron levels except during inflammatory cases and then it will be opposite the iron level
what is transferrin?
circulating iron transport protein (increased in iron deficiency anemia) (synonymous with total iron binding capacity (TIBC))
what is transferrin saturation (TSAT)?
iron stores/ capacity x 100
what are three things that could cause microcytic anemia?
IDA, thalassemia, sickle cell disease
what three things could cause normocytic anemia?
anemia of chronic disease, renal disease, and acute blood loss
what 4 things could cause macrocytic anemia?
Folate/B12 deficiency, hypothyroidism, EtOH, MDS
what would the iron studies look like in a patient with iron deficiency anemia?
ferritin will be low; transferrin saturation will be low
what is the earliest and most sensitive index that will change in iron deficiency anemia?
RDW
what are the indications that iron is low? (iron studies wise)
low serum iron and low serum ferritin
what are the indications that the body is just waiting for iron (compensating)?
increased total iron binding capacity (TIBC) and increased transferrin receptor (TFR)
in male patients or postmenopausal females, iron deficiency anemia should prompt an evaluation for what?
sources of gastrointestinal blood loss
what are the signs of anemia of chronic disease?
clinical suspicion for systemic inflammation, MCV: normal to low, low serum iron, normal to high ferritin levels, low transferrin, low transferrin saturation
what are the effects of inflammatory cytokines?
they decrease intestinal absorption of iron and they decrease erythropoietin production; they also increase hepcidin
what are the effects of hepcidin?
it decreases ferroportin, decreases transferrin, and increases ferritin
what are the signs of uncompensated blood loss?
normocytic anemia and a normal reticulocyte count
what are the signs of hypovolemic shock?
hypotensive, tachycardia, and weak pulses
coffee ground emesis is often an indication of what?
digested blood (upper GI bleed)
what can happen as a result of anemia from acute blood loss?
hypovolemia, myocardial ischemia, and renal failure
when do you screen pregnant women for development of Rh antibodies?
at 1st prenatal visit and at 28 weeks
