Anemia Short Case Flashcards
What is the definition of anemia?
- Low H/H or RBC count compared to NL age & gender controls
- More than 2 STD below mean
What are the H/H levels for females to be considered anemic?
Hgb < 12 or Hct < 36
What are the H/H levels for males to be considered anemic?
Hgb < 13.5 or Hct < 41
What is the lab value on a CBC that represents the average size (volume) of the patient’s RBCs?
MCV
What is the lab value on a CBC that represents the average hemoglobin content in a RBC?
MCH
Low = low hemoglobin content per cell - on peripheral blood smear would show up as hypochromia
What is the lab value on a CBC that is a measure of the variation in RBC size?
RDW
Low = RBC are all around the same size
High = a lot of variation in RBC size
Anemia is never normal. What are some questions you should be asking yourself?
- Is the patient bleeding?
- Is their bone marrow suppressed?
- Is the patient iron deficient?
- Are they B12 or Folic deficient?
- Do they have chronic dz or recurrent infxn?
There are numerous S/S of anemia. What are a few?
- Fatigue, weakness
- Palpitations, Tachycardia
- Dyspnea
- Dizziness, Syncope
- Bleeding
- Angina
- Tachypnea
What are some clues of anemia from the HPI?
- Melena, Abd pain, NSAID/OAC usage, Hx ulcers
- Menstrual history
- Pica
- Diet
- Gastric bypass, parasthesias, gait problems, memory issues
- EtOH abuse - Moonshine, lead paint/pipe exposure
- FHx blood disorders - G6PD, sickle cell, thalessemia
- Jaundice, New meds, Transfusions, infxn
- Hx of prolonged bleeding, epistaxis, bleeding gums, easy bruising
What is one of the main things to check for on PE?
Stool for occult blood!
What are some other things to look out for on PE?
- Pallor of skin, conjunctiva
- Jaundice
- Petechiae/ecchymoses
- Wt loss
- Glossitis, angular stomatitis
- Tachy, new murmur
- Orthostatic hypotension
- Splenomegaly
- Sx scars
- LAD
- Dec. vibratory sense, impaired proprioception
When anemia is detected on the CBC what do you look at next?
MCV
Low < 80 (microcytic RBCs present)
NL 80 - 100 (normocytic)
High > 100 (macrocytic)
What DDx are you thinking of if a patient has microcytic anemia?
- IDA
- Thalassemia
- Sideroblastic (lead toxicity)
- Copper deficiency
- Zinc poisoning
What is the most common cause of anemia worldwide?
IDA
If a patient has IDA what should be high up on your DDx for cause?
Need to r/o:
-
GI bleeding!
- PUD
- CA
- NSAID use
- Also consider menstrual losses
S/S of IDA?
- Pallor, easily fatigued
- Irritability, anorexia
- Tachy, tachypnea on exertion
- Pica
- Severe deficiency: Hct <25% - cheilosis, smooth tongue, brittle nails, formation of esophageal webs (Plummer-Vinson syndrome)
What would you expect to see on IDA labs?
- Dec ferritin
- Inc TIBC (indirect way to measure transferrin sat)
- Dec serum Iron concentration
How many protein chains is Hgb made up of?
4
2 alpha
2 Beta
What is an inherited disorder with abnormal hemoglobin production in either the alpha or B chains of Hgb?
Thalassemia
T/F: A patient with Thalassemia could be anywhere along the spectrum: silent carrier to profound anemia
True
Thalassemia Labs: What should you look for on peripheral smear?
- Target cells
- Basophilic stippling
- Poikilocytes
What would you see on Thalassemia Labs? What would you use to Dx?
Serum iron, Ferritin levels and RBCs usually NL to Elevated
Dx: hemoglobin electrophoresis
What is your DDx if a patient has normocytic anemia?
- Acute blood loss
- Anemia of chronic dz (AOCD)/Anemia of inflammation
- Chronic renal insufficiency
- Hemolysis
- Bone marrow suppression (may be macrocytic)
- Endocrine dysfunction (hypothyroid, hypopituitary)
What conditions could possibly cause AOCD?
- CKD
- DM
- Chronic autoimmune disorders
- Many more
What is the pathophys of AOCD?
- Underlying medical condition creates ongoing state of inflammation
- Cytokine release
- Dec RBC production
- Dec RBC survival
- Dec EPO production
- Dec iron absorption
- Anemia
What would you see on AOCD Labs?
- Normochromic, normocytic, mild anemia Hgb 10-11
- Dec serum iron
- TIBC NL to low
- Serum ferritin NL to high (acute phase reactant)
- ESR and/or CRP
In what type of anemias do you see decreased RBC survival and increased cell lysis?
Hemolytic Anemias
What are some hereditary causes of hemolytic anemia?
- G6PD
- Sickle cell
- Hereditary spherocytosis
- Thalassemia
What are trauma/immune attack causes of hemolytic anemia?
- TTP
- HUS
- DIC
- Valvular hemolysis
- Infxn
- Burns
- Hypersplenism
What would you expect to see on hemolytic anemia labs?
- Inc reticulocyte count (> 2)
- Falling Hgb
- Inc Indirect bilirubin
- Inc LDH (LDH in RBCs - if lysed = released)
- Dec Haptoglobin
- Could see schistocytes on peripheral smear
What is on your DDx if a patient has macrocytic anemia?
- Alcoholism
- Folate deficiency
- Vit B12 deficiency
- Myelodysplastic syndromes (MDS)
- Liver dz
- Reticulocytosis
- (Inc MCV is a NL characteristic of reticulocytes, therefore conditions that cause this will be assoc with Inc MCV)
- Drug-induced anemia
- AML
What is Myelodysplastic Syndrome?
- Group of malignant hematopoietic stem cell disorders with dysplastic (have abnl cell morphology) and ineffective blood cell production
- Risk of transformation to acute leukemia
How does Myelodysplastic Syndrome arise?
- Can arise de novo
- Or after exposure to chemo, environmental toxins, radiation
WBC might also be helpful in determining the cause of anemia. What would be on your DDx if WBCs are LOW?
- Aplastic anemia (pancytopenia)
- Bone marrow suppression
- Vit B12 deficiency
- Hypersplenism
What would be on your DDx if WBCs were HIGH in an anemic patient?
- INfxn
- INflammation
- Hemotologic malignancy
