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IHO Week 1 > Anemia Overview - Johns > Flashcards

Anemia Overview - Johns Flashcards

1
Q

What is the definition of anemia?

A
  • Operationally defined as reduction in one or more of the major RBC measurements:
  • –Hemoglobin concentration, hematocrit, or RBC count
  • –All of these are concentration measures
  • Anemia is a CONCENTRATION ISSU - ration of plasma to RBCs
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2
Q

With ___ _____ you won’t be anemic.

A

acute bleeding

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3
Q

There are two questions with anemia:

A
  1. Is it caused by production problems?

2. Is it caused by survival/destruction problems?

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4
Q

What is the key test for anemia?

A

Reticulocyte count!!
-Reticulocytes are early precursors of RBCs. The majority of RBCs are in the bone marrow but some are in the blood/periphery

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5
Q

What are the two main approaches (not mutually exclusive) for looking at anemia?

A
  1. Biologic or kinetic approach

2. Morphology

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6
Q

How do you make a reticulocyte count useful?

A

The reticulocyte count must be adjusted for the patient’s hematocrit (erythrocyte volume function). When hematocrit is lower, reticulocytes are released earlier from the marrow - so one can adjust for this phenomenon.

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7
Q

What does reticulocyte count tell us (kinetic approach)?

A
  • Increased reticulocytes (greater than 2-3% or 100,000 mm^3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemia will present with a normal reticulocyte count due to immune destruction of red cell precursors.
  • Reticulocyte counts are most helpful if extremely low (
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8
Q

What does reticulocyte count tell us (kinetic approach)?

A
  • Increased reticulocytes (greater than 2-3% or 100,000 mm^3 total) are seen in blood loss and hemolytic processes, although up to 25% of hemolytic anemia will present with a normal reticulocyte count due to immune destruction of red cell precursors.
  • Reticulocyte counts are most helpful if extremely low (
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9
Q

What is normal hemoglobin in men and women?

A

Men - 13-16

Women - 11.5-14

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10
Q

What is normocytic normochromic anemia?

A

-Reticulocyte count - Index

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11
Q

What is micro or macrocytic anemia?

A

-Reticulocyte count - Index

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12
Q

What is hemolysis/hemorrage anemia?

A
  • Reticulocyte count - Index >/= 2.5
  • Hemolysis/hemorrhage: blood loss, intravascular hemolysis, metabolic defect, membrane abnormality, hemoglobinopathy, immune destruction, fragmentation hemolysis
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13
Q

What does a normal reticulocyte count indicate?

What does a high reticulocyte count indicate?

A

Normal - production problem

High - problem with destruction (cross out blood loss - especially acute)

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14
Q

Whites the morphological approach of investigating anemia?

A

Big vs. little (measurement)

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15
Q

How do you determine RBC size?

A

MCV

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16
Q

What is normal MCV?

A

80-100

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17
Q

What causes MCV of 80-100 (normocytic)?

A
  • Anemia of chronic disease
  • Mixed deficiencies
  • Renal failure
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18
Q

What causes MCV > 100 (macrocytic - over production)?

A
  • B12, Folic acid deficiency (B12 and folic acid go together like ham & eggs!)
  • Drugs that impair DNA synthesis (AZT, chemotherapy, alcohol, azathioprine)
19
Q

What causes MCV

A
  • Iron deficiency
  • Thalassemia trait
  • Anemai of chronic disease (30-40%)
  • Sideroblastic anemias
20
Q

What does CBC tell you?

A

Complete blood count

  • Tells you your white blood cell count - differential (WBC)
  • Hemoglobin
  • Platelets
  • Indices - various measures of red cell size: MCV - mean corpuscular volume, MCHC
21
Q

What is the etiology of Macrocytic Anemia?

A

B12/Folate Deficiency

  • Anemia: Vitamin B12 and folate are needed for DNA synthesis deoxyuridate to thymidylate, including RBC precursors
  • Deficiency: B12 - dietary intake (rare), decreased gastric secretion of intrinsic factor, Folate - poor dietary intake +/- EtOH, malabsorption, increased demand (pregnancy, hemolytic anemias)
22
Q

How to diagnose macrocytic anemia?

A
  • Smear: Macrocytic (High MCV) RBCs, +/- hypersegmented neutrophils, +/- modest neutropenia (low count neutrophils), but . . .
  • –B12
  • Low serum B12, elevated serum methylmalonic acid levels
  • Anti-IF Abs, Schilling test (?), PA accounts for 75%
  • –Folate
  • Serum folate level– can normalize with a single good meal
23
Q

What causes MCV

A
  • Iron deficiency
  • Thalassemia trait
  • Anemia of chronic disease (30-40%)
  • Sideroblastic anemias
24
Q

What causes MCV

A
  • Iron deficiency
  • Thalassemia trait
  • Anemia of chronic disease (30-40%)
  • Sideroblastic anemias
25
Q

How to treat B12/Folate Deficiency?

A

B12 deficiency: B12 1 mg/month IM

26
Q

What can cobalamin/Vitamin B12 deficiency cause?

A

Neurological problems

-Subacute combined degeneration of the dorsal and lateral spinal columns

27
Q

When do you have increased iron requirements?

A
  • Blood loss
  • GI disorder (esophageal varices, hemorrhoids)
  • Extensive and prolonged menstruation
  • Chronic blood donations
  • Rapid growth in body size between 2 and 36 months of age
  • Pregnancy and lactation
28
Q

When do you have an inadequate iron supply?

A
  • Poor nutritional intake in children
  • Malabsorption
  • Gastric bypass surgery for ulcers or obesity
  • Achlorhydria from gastritis or drug therapy
  • Severe malabsorption (for example, celiac disease [nontropical sprue])
29
Q

How to test for iron deficiency?

A
  • Decreased hemoglobin
  • Microcytic MCV
  • Decreased serum iron
  • Increased or normal TIBC (total iron binding capacity)
  • Decreased iron saturation
  • –Serum Fe/TIBC
30
Q

What are Thalassemias?

A
  • Genetic defects in hemoglobin synthesis!
  • –Dec. synthesis of one of the 2 globin chains (alph or beta)
  • –Imbalance of globin chain synthesis leads to depression of hemoglobin production and precipitation of excess globin (toxic)
  • –
31
Q

What are Thalassemias?

A
  • Genetic defects in hemoglobin synthesis!
  • –Dec. synthesis of one of the 2 globin chains (alph or beta)
  • –Imbalance of globin chain synthesis leads to depression of hemoglobin production and precipitation of excess globin (toxic)
  • –“ineffective erythropoiesis”
  • –Ranges in severity from asymptomatic to incompatible with life (hydrous fetalis)
  • –Found in people of African, Asian, and Mediterranean heritage
32
Q

How do you diagnose Thalassemias?

A
  • Smear: microcytic/hypochromic, misshapen RBCs
  • Beta-thal will have an abnormal Hgb electrophoresis (Inc. HbA2, Inc. HbF)
  • The more severe alpha-thal syndromes can have HbH inclusions in RBCs
  • Fe stores are usually elevated
33
Q

How do you treat Thalassemias?

A

Mild: None
Severe: RBC transfusions + Fe chelation, Stem cell transplants

34
Q

What is anemia of chronic disease?

A
  • Normocytic (normal red cell size)

- You NEED a chronic disease (usually inflammatory or infectious)

35
Q

What is the pathogenesis of anemia of chronic disease?

A
  • Cytokines are produced (IFN-gamma, IL-1beta, TNF-alpha,etc.) and cause:
  • –Decreased EPO production
  • –Suppression of erythroid progenitors
  • –Blockade of reticuloendothelial iron release
36
Q

What does anemia of chronic disease look like (lab panel)?

A
  • Microcytic or normocytic anemia
  • Decreased serum iron
  • Decreased serum TIBC (total iron binding capacity)
  • Normal Fe/TIBC percentage
  • Normal or increased ferritin (stores and releases iron in a controlled fashion)
37
Q

What is ferratin?

A

Measures your total body iron stores!

  • If you’re iron deficient, this number will be decreased
  • If you have anemia of chronic disease - your fourteen number will be normal
38
Q

What are sideroblastic anemias?

A
  • Sideroblasts are produced instead of healthy red blood cells
  • Heterogenous grouping of anemias defined by presence of ringed sideroblasts in the BM
39
Q

What are the etiologies of sideroblastic anemias?

A
  • Hereditary (rare), type of porphyria
  • Myelodysplasia
  • EtOH
  • Drugs (INH, Chloramphenicol)
40
Q

Auto-immune conditions can cause. . .

A

hemoglobin and platelets to decrease

41
Q

What should you do after an MCV test if its normal?

A

Bone marrow biopsy to diagnose

-If MCV normal, you need to determine, is there a chronic disease?

42
Q

What should you do if you find anemia?

A

-If MCV is high, could be B12, folate or hemolytic anemia (if you have tons of reticulocytes -> but we always do retriculocyte count first)

43
Q

What are the general principles of anemia?

A
  • It’s a sign, not a sieges
  • Anemias are a dynamic process
  • It’s never normal to be anemic
  • The diagnosis of iron deficiency anemia mandates further work-up

IHO Week 1 (10 decks)

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