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Hema - 6. Approach > Anemia differentials > Flashcards

Anemia differentials Flashcards

1
Q

Lab test result to look for when anemia is noted in a patient

A
  • MCV < 80 fL (microcytic)
  • MCV 80–100 fL (normocytic)
  • MCV > 100 fL (macrocytic)
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2
Q

Causes of microcytic anemia

A
  • Sideroblastic anemia
  • ACD
  • Lead poisoning
  • Thalassemias
  • IDA (late)
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3
Q

Causes of macrocytic anemia

A
  • Megaloblastic
    • Orotic aciduria
    • B12 deficiency
    • Folate deficiency
  • Non-megaloblastic
    • Liver disease
    • Alcoholism
    • Diamond-Blackfan anemia
  • Memory aid:*
  • OBF LADi eagles!
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4
Q

How to differentiate between normocytic anemia?

A
  • Reticulocyte count
    • Normal or decreased
      • Non-hemolytic
    • Increased
      • Hemolytic
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5
Q

Non-hemolytic causes of normocytic anemia

A
  • ACD
  • Chronic kidney disease
  • Iron deficiency (early)
  • Aplastic anemia
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6
Q

How to differentiate between hemolytic causes of anemia?

A
  • Intrinsic
    • RBC membrane defect: hereditary spherocytosis
    • RBC enzyme deficiency: G6PD, pyruvate kinase
    • HbC disease
    • Paroxysmal nocturnal hemoglobinuria
    • Sickle cell anemia
  • Extrinsic
    • Autoimmune
    • Microangiopathic
    • Macroangiopathic
    • Infections

Memory aid:

  • In from SG to PH twice
    • Sickle cell anemia
    • G6PD
    • Paroxysmal nocturnal hemoglobinuria
    • Pyruvate kinase deficiency
    • Hereditary spherocytosis
    • HbC disease
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7
Q

Why is the mean corpuscular volume increased in megaloblastic macrocytic anemia?

A

There is a defect in DNA synthesis: the nucleus takes longer to mature than the cytosol and thus there is excess cytoplasm, creating a megaloblast; this is caused by B12 and folate deficiency

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8
Q

A patient has anemia with a mean corpuscular volume of 110 fL and glossitis and on the peripheral smear you note hypersegmented neutrophils; what are the two possible causes of this condition?

A

B12 or folate deficiency; both present with these features

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9
Q

What laboratory test (other than a vitamin level) will distinguish between B12 and folate deficiency as a cause of megaloblastic anemia?

A
  • Methylmalonic acid is elevated in B12 deficiency but normal in folate deficiency
  • Homocysteine is elevated in both deficiencies
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10
Q

What kind of anemia is associated with congenital deficiencies in purine or pyrimidine synthesis?

A

Macrocytic anemia (eg, orotic aciduria) because of the relative delay in nucleus maturation compared to cytoplasm

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11
Q

Name five medications that can cause macrocytic anemia

A
  • Methotrexate
  • Trimethoprim
  • Fluorouracil
  • Zidovudine
  • Hydroxyurea
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12
Q

What change in mean corpuscular volume would you expect in an otherwise healthy patient who has had moderate to severe blood loss?

A

Increased mean corpuscular volume, because the patient will compensate with reticulocytosis, which have slightly higher mean corpuscular volumes than mature red blood cells

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13
Q

What kind of anemia is seen in a patient with poor dietary vitamin intake?

A

Macrocytic anemia, due to B12 or folate deficiency (remember that alcoholics are also often malnourished)

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14
Q

Anemia caused by veganism

A

Vitamin B12 deficiency anemia

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15
Q

How are normocytic, normochromic hemolytic anemias further classified?

A

First by cause: intrinsic vs extrinsic to the red blood cell; and then by location: intravascular vs extravascular

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16
Q

Name three causes of normocytic, normochromic anemia that are not due to hemolysis

A
  • Anemia of chronic disease
  • Renal disease (decreased erythropoietin)
  • Aplastic anemia (bone marrow failure)

Memory aid:

  • Normal non-hemolytic
    • ARA
17
Q

Name six causes of normocytic, normochromic hemolytic anemia that are intrinsic to the red blood cell

A
  • Hereditary spherocytosis
  • G6PD
  • Pyruvate kinase deficiency
  • Sickle cell anemia
  • Hemoglobin C defect
  • Paroxysmal nocturnal hemoglobinuria
18
Q

Name three causes of normocytic, normochromic hemolytic anemia that are extrinsic to the red blood cell

A
  • Autoimmune hemolysis
  • Microangiopathies like disseminated intravascular coagulation or thrombotic thrombocytopenic purpura–hemolytic uremic syndrome
  • Infections
19
Q

What is a cause of normocytic, normochromic hemolytic anemia that is intrinsic to the red blood cell and occurs in the intravascular space?

A

Paroxysmal nocturnal hemoglobinuria

20
Q

Name two causes of normocytic, normochromic hemolytic anemia that are extrinsic to the red blood cell and occur in the extravascular space

A

Autoimmune hemolysis due to warm agglutinins (not cold) or microangiopathies like disseminated intravascular coagulation or thrombotic thrombocytopenic purpura–hemolytic uremic syndrome

21
Q

Generally, hemolysis that is intrinsic to the red blood cell occurs in the _____ (intravascular/extravascular) space, whereas hemolysis extrinsic to the red blood cell occurs in the _____ (intravascular/extravascular) space with the exception of ____ which is intrinsic and intravascular and ____ which is intrinsice but exhibits both intra- and extravascular hemolysis

A
  • Extravascular
  • Intravascular
  • Paroxysmal nocturnal hemoglobinuria
  • G6PD
22
Q

T/F. All extrinsic types of hemolytic anemia exhibit intravascular hemolysis

A

True

23
Q

Hemolysis can lead to what lab findings?

A

Increases in LDH, reticulocytes, unconjugated bilirubin, urobilinogen in urine

24
Q

Intravascular hemolysis

  • Lab findings
  • Associated disease
A
  • Lab findings
    • ↓ haptoglobin
    • ↑ schistocytes on blood smear
    • Characteristic hemoglobinuria, hemosiderinuria, and urobilinogen in urine
    • ↑ unconjugated hemoglobin
  • Associated disease
    • Mechanical hemolysis (eg, prosthetic valve)
    • Paroxysmal nocturnal hemoglobinuria
    • Microangiopathic hemolytic anemias
25
Q

Extravascular hemolysis

  • Findings
  • Associated pathology
A
  • Findings
    • Spherocytes in peripheral smear
  • Associated pathology
    • Hereditary spherocytosis
    • Autoimmune hemolytic anemia

Hema - 6. Approach (5 decks)

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