Anemia I and II

Question 1

What is the definition of anemia?

Answer 1

Decrease in RBC mass (hemoglobin) to:

• — < 12g/dL in women
• —< 14g/dL in men

Question 2

What is the clinical presentation of anemia?

Answer 2

—Related to a decrease in O₂-carrying capacity. Vary according to the etiology, severity, and rapidity of onset.

• —Fatigue
• —Dyspnea on exertion
• —Exertional chest pain
• —Palpitations/tachycardia
• —Symptoms of hypovolemia in acute blood loss
• —Pallor (conjunctival, palmar creases)
• —Flow murmur

Question 3

What are some common lab studies performed for anemia?

Answer 3

• —Complete blood count (CBC): Hgb, Hct, MCV.
• —Reticulocyte count: Immature blood cells. Presented as percentage of total RBCs (Nl 0.5-1.5%)
• —Reticulocyte production index corrects for the degree of anemia: Normal RPI ~1. RPI > 2 or more denotes adequate BM response
• —Peripheral blood smear
• —Other test according to clinical scenario

Question 4

What are three etiologies of anemia?

Answer 4

1. Decreased production
2. Increased destruction
3. Bleeding

Question 5

What are the causes of decreased hemoglobin production?

Answer 5

• —Substrate deficiency: Iron, Folate, Vit B12
• —Stem cell dysfunction: MDS, Aplastic anemia
• —Bone marrow infiltration: infection, malignancy fibrosis
• —Inherited disorders: Thalassemia
• —Dysregulation: decreased Erythropoietin

Question 6

What is microcytic anemia, and what are its most common causes?

Answer 6

MCV < 80. AKA iron deficiency anemia.

• —Increased iron loss: menstrual, GI
• Decreased supply: nutritional, celiac disease, gastrectomy
• —Increased demand: pregnancy (less common)

Question 7

What are the clinical and lab findings of microcytic anemia?

Answer 7

• —General symptoms/signs of anemia.
• —Melena, menorrhagia
• —Pica
• —Koilonychia (spoon nails)
• —Plummer-Vinson’s syndrome (glossitis, dysphagia, esophageal webs)

—

• Decreased hemoglobin and MCV
• —Platelets may be elevated
• —Iron studies: low ferritin (<10 ng/ml), low serum Iron (<50 mcg/dL), high iron binding capacity (>420 mcg/dL),
• 4.Low iron saturation: serum iron/ TIBC.
• —Bone marrow biopsy is the gold standard.

Question 8

Hb slides

Question 9

Thalassemias

Question 10

Thalassemia slide

Question 11

What is macrocytic anemia, and what are its most common causes?

Answer 11

MCV > 100

—Megaloblastic (with hypersegmented neutrophils):

• Vitamin B12 deficiency
• Folic acid deficiency
• Antimetabolites/antiviral

—Non-megaloblastic:

• Alcoholism
• Liver disease
• Myelodysplatic syndrome (MDS)
• Hypothyroidism
• Drugs

Question 12

What are some symptoms associated with vitamin B12 deficiency?

Answer 12

• Decreased vibratory sensation and proprioception
• Ataxia
• Parasthesias
• Confusion
• Dementia

Question 14

How do we characterize hemolytic anemia?

Answer 14

• —Intravascular (hemoglobinuria) vs. extravascular
• —Intrinsic RBC defect vs. extrinsic defect
• —Hereditary vs. acquired

Question 15

What are some severe medical complications of sickle cell anemia?

Answer 15

• —Acute chest syndrome. Indistinguishable from pneumonia
• —Splenic sequestration crisis. Splenic infarction may occur
• —Priapism. Transfusion and surgical drainage if >24hrs
• —Osteonecrosis of femoral and humeral heads
• —Stroke most commonly in children <10yrs
• —Leg ulcers
• —Renal tubular defects → inability to concentrate urine → dehydration → increased risk of further vaso-occlusive events

Question 16

What is acute hemolytic anemia?

Answer 16

Autoantibodies target antigens on the patient’s own RBC → extravascular hemolysis.

2 types:

• Warm AIHA: —IgG autoantibody. Assoc. with malignancy, collagen vascular disease or drugs
• —Cold AIHA: IgM. Secondary to infection or idiopathic