Anemia- Krafts Flashcards
Symptoms of Anemia
Pale skin/mucous membranes Jaundice Tachycardia Breathlessness Dizziness Fatigue
Koilonychia
Spoon shaped nails
in IDA
3 ways to get anemic
- Lose blood
- Destroy too much blood (intracorpusular or extracorpuscular reasons)
- Make too little blood
- too few building blocks
- Too few erythroblasts (aplastic anemia)
- Not enough room
3 Morphologic Groups of Anemia
- Weird Size
- Weird Shape
- Normal size and shape
Weird Size
Iron- deficiency anemia
Thalassemia
Megaloblastic anemia
Iron Deficiency Anemia
- Most important cause–> GI bleeding
- Microcytic, hypochromic anemia
- increased anisocytosis (varying cell sizes) & poikilocytosis (abnormal shape)
- Abnormal iron studies
Iron:
Absorption?
Circulation?
Absorbed in duodenum
Carried in circulation by transferrin
Iron:
Absorption?
Circulation?
Absorbed in duodenum
Carried in circulation by transferrin
Hemoglobin
4 globin chains (2 alpha, 2 beta)
4 heme molecules
-iron only binds O2 in ferrous (Fe2+) state
Fe3+/ferric state=methemoglobin
Ferritin vs hemosiderin?
Ferritin is quick iron storage
Hemosiderin is long term
Causes of iron deficiency
Decreased iron intake (bad diet/absorption)
Increased Iron loss( GI bleed, menses, hemorrhage)
Increased iron requirement (prego)
IDA in premenopausal women?
IDA in everyone else?
premen women–> MENORRHAGIA
everyone else–> GI BLOOD LOSS
Signs/symptoms of IDA:
Asymptomatic
Fatigue, dizziness
Signs: pale, spoon nails, smooth tonue
Pica
First sign of ID?
Poikilocytosis: see elliptocytes –cigar shaped cells
Blood smear in IDA?
- hypochromic, microcytic anemia
- anisocytosis
- poikilocytosis
- decreased reticulocytes
- increased platelets
Bone marrow biopsy findings in IDA?
- erythroid hypoplasia (not as many RBC as you would expect)
- dyserythropoiesis (funny looking RBCs)
- decreased iron stores
Labs in IDA? **
- decreased serum iron
- increased TIBD
- decreased ferritin
Labs in IDA? **
- decreased serum iron
- increased Total iron binding capacity
- decreased ferritin *** only ID will make this low
Do look at what lab test first for diagnosis of IDA?
Ferritin
DECREASED in IDA!
Tx of IDA?
Figure out why they are iron deficient
-give oral iron
Megaloblastic anemia
THINGS TO KNOW
- Defective DNA synthesis
- Nuclear/cytoplasmic asynchrony (nuc lags behind in maturity)
- decreased B12/folate
- Macocytic anemia with oval macrocytes and hypersegmented neutrophils
Megaloblastic anemia
Retarded DNA syn & unimpaired RNA syn —–>
BIG BIG Cells
Immature nucleus
Mature cytoplasm
B12 sources & absorption
Meat, dairy, cereal. (NOT veggies, dude!)
Need IF secreted by parietal cells to get absorbed in distal ileum
Causes of B12 Deficiency
diet lack of IF (pernicious anemia) pancreatic damage Ileal damage Tapeworm
Megoloblastic symptoms?
Atrophic glossitis –beefy tongue, lack of papilli
Long term B12 def
Subacute combined degeneration
-sensory & motor probs
Need B12 to convert homocysteine –> methionine
Folate: sources & absorption
Green leafy veggies
-Absorbed in jejunum
Causes of folate def
diet
alcohol abuse
jejunal damage
drugs
What will you see in a blood smear with megalobastic anemia?
- macrocytic anemia
- oval macrocytes
- Hypersegmented neutrophils (*only happens with this)
What will you see in a blood smear with megaloblastic anemia?
Labs?
- macrocytic anemia
- oval macrocytes
- Hypersegmented neutrophils (*only happens with this)
MCV >100
What do you see in BM biopsy with megaloblastic anemia?
- megaloblastic erythroblasts
- megaloblastic neutrophils
Weird Shaped Anemias?
Hemolytic anemias!
- HS
- AIHA
- Sickle cell anemia
- G6PD deficiency
- MAHA
Weird Shaped Anemias?
Hemolytic anemias!
- HS
- AIHA
- Sickle cell anemia
- G6PD deficiency
- MAHA
Symptoms of acute hemolytic anemia
back, abdominal, limb pain
headache malaise, fever
jaundice, pallow, tachycardia
Types of hemolytic Anemia
- Chronic (hereditary) -well compensated
- Acute (acquired)
- Inherited- defects in RBCs
- Acquired -infection or drug related
Bottom line of hemolytic anemia, you’ll see signs of both:
increased RBC destruction ——–> Increased RBC production
Signs of Increased RBC Destruction
- increased serum bilirubin
- increased LDH
- Decreased haptoglobin
Signs of Increased RBC PRODCUTION:
- Reticulocytosis
- Nucleated RBCs in blood
Signs of Increased RBC PRODCUTION:
- Reticulocytosis
- Nucleated RBCs in blood
Labs test in hemolytic anemia
- direct antiglobulin test (DAT)- look for Abs on RBC surface by using a anti-human globulin (+ = immune process)
- Osmotic fragility test: +=spherocytes present
Morphology of hemolytic anemia
- Normochromic, normocytic anemia
- Spherocytes
- Poikilocytes: targets, sickles, fragmented
How to diagnose Hemolytic anemia
Look for signs of destruction & production
Determine cause with DAT (immune vs non immune)
Tx of hemolytic anemia
Depends on cause
Acute: tx shock
Splenectomy if needed
Hereditary Spherocytosis (HS)
- Tons of spherocytes
- Defect in RBC cytoskeleton (spectrin)
- Splenectomy is curative
Triad of Hereditary Spherocytosis
- anemia
- jaundice
- spenomegaly
Pathogeneisis of HS:
- abnormal RBC cytoskeleton
- loss of surface area
- spleen removes spheres (macrophages)
HS Morphology
- mild normochromic, normocytic anemia
- numerous spherocytes
HS tx:
Splenectomy
Autoimmune Hemolytic Anemia (AIHA)
Warm and cold types
THINGS TO KNOW
- IgG bind to RBCs
- destruction happens in spleen
- Spherocytes
Pathogenesis of WAHA
IgG coats RBCs —>Macs eat whole cell OR nibble and cell becomes spherocytes
Get Splenomegaly
WAHA dx and tx
Dx: DAT (direct antiglobulin test)
Tx: steroids and maybe splenectomy
WAHA dx and tx
Dx: DAT (direct antiglobulin test)
Tx: steroids and maybe splenectomy
Cold AIHA
THINGS TO KNOW:
-IgM, complement bind at colder temp areas, hands ears feet. falls off in warm body parts
- some intravasulcar hemolysis (b/c of complement)
- mostly spleen
- Agglutination: IgM forms petamers and clumps RBCs up (bridges RBCs)
Clinical signs of Cold AIHA
chronic hemolysis aggravated by cold. Pallor, cyanosis in cold body parts
Morphology of Cold AIHA
Red cell agglutinates (from IgM)
Rare spherocytes
Cold AIHA dx and tx
Dx: DAT positive for complement (doesn’t pick up IgM)
tx: keep patient warm, treat underlying cause
