anemia types Flashcards
Iron deficency anemia
Microcytic , hypochromic anemia:
low MCV, low MCH
most common cause of anemia
Fe+ loss exceeds storage
causes:
chronic blood loss, inadeq iron intake, impaired absorption
signs and symptoms: smooth tongue brittle or spoon nails known koilonychia , PICA
Iron deficiency anemia labs
low HH and RBC
low MCV
low MCHC
low ferritin < 12
* most sensitive and specific
low serum Fe+ level < 50
low transferrin saturation < 20%
High TIBC > 450
treatment iron deficiency anemia
identify the cause
pharm: ferrous sulfate 300-325 PO tid
Three months of therapy
take on an empty stomach
avoid antacids or milk
add vit c
Venefer intravenous
use if gi intolerance or malabsorbtion
Nonpharm:
Food high in iron,raisins, green veg, red meat, citrus
GI Referral:
EGD/colonoscopy
pilcam
tagged RBCs
vitamin B 12 ( cobalamin ) deficiency
macrocytic anemia with low B12,
unable to absorb enough B12 from food
causes;
vegan diet
pernicious anemia
post gastrectomy
Poor malabsorption:
ileal resection
celiac disease
severe chronic pancreatitis
alcoholism
chron’s disease
B 12 clinical findings
neurological:paresthesia
memory loss
Increased homocysteine:
CV problems
Glossitis
vague GI symptoms:
anorexia or diarrhea
B 12 deficiency diagnosis
Labs:
High CMV and low HH and B 12
Suspect PA;
gastric biopsy and endoscopy
high risk for gastric ca
intrinsic factor immunoglobulin G antibody
type 1 and 2
check homocysteine
elevated levels l
increase chances of MI stroke and dementia
Vitamin B 12 deficiency treatment
Pernicious anemia:
Lifelong b 12 replacement
Anemia caused by poor digestion and absorption:
vit B 12 1000mcg sq IM x 7 days then weekly x 4 weeks
then monthly maintance
concider oral option
elevated homocystiene:
cover folate and b 12 replacements
check folic acid levels
anemia of chronic disease
mild to moderate, microcytic, or normocytic
second most common anemia
etiology:
decreased erythrocyte lifespan
inflammation
organ failure
advanced age
anemia of chronic disease labs
low HH
< 10 hgb rare
normocytic /normochromic
normal to high ferritin
low iron and transferrin
normal RDW
anemia of chronic disease
diagnosis and treatment
Labs:
Anemia work up , ESR and CRP
Signs and symptoms:
based on underlying disease and severity
treatment plan
manage underlying disease process
erythropoietin ( Procrit)
transfusion
consult:
GI and hematology
hemolytic anemia
RBC survival is reduced
intravascular causes: (self-limiting)
membrane and glycolytic defects
oxidation vulnerability
hemoglobinopathies
extravascular causes: RBCs are destroyed in the liver and spleen
immune issues
microangiopathic
infection
hypersplenism
burns
hemolytic anemia diagnosis and treatment
low HH
low Haptoglobin
elevated retic
elevated LDH
elevated total bilirubin
hemoglobinuria
urine hemosiderin
schistocytes
sickle cell anemia
carry only one copy of the gene
disease carries two copies of the gene
mutation in beta globin
hemoglobin S
Hbs: polymerizes reversibly, leading to
stiffen RBC membrane
increase viscosity
dehydration leads to a sickle shape
sickled cells lose pliability
sticky membranes
microvascular occlusion
RBC destruction
sickle cell crisis
infection
fever
excessive exercise
abrupt changes in temp
hypoxia
hypertonic dyes
sickle cell crisis sign and symptoms
pain and low HH elevated retic count ACS ICU level of care
acute pain is the hallmark
low HH, elevated retic
granulocytosis
tissue ischemia
end organ damage
acute chest pain syndrome:
chest pain, tachypnea , fever, cough
pulmonary crisis
splenic sequestration
sickle cell treatmetn
treat cause
hydration
systemic pain control
opiates
antihystamine= zyrtec
antibiotics
nitrous oxide
02
THALASSEMIA
microcytic hypochromic anemia
cause:
inherited
disorders
alpha and beta globin biosynthesis
diminished Hgb production
Epidemiology:
common in Mediterranean
Asia , Africa, middle east
Types:
alpha: Asia
beta: Africa
alpha thalassemia
most common asians
alpha thalassemia 2 straight
asymptomatic
alpha thalassemia one straight
resembles beta thalassemia minor
alphas thalassemia 1 + alpha thalassemia 2
HbH disease
intermedia disease
homozygous state for alpha thalassemia
total deletion of alpha
futile
beta thalassemia
beta thalassemia trait/mino;
asymptomatic pts
beta thalassemia intermedia;
milder symptoms can survive without transfusion
beta thalassemia major:
life-threatening transfusion dependant
heterozygotes :
beta thalassemia trait
thalassemia diagnosis
diagnosed in childhood
anemia and microcytosis
signs and symptoms:
hepatosplenomegaly
chipmunk face
path: long bone and vertebral fx
electrophoreis showing elvelated levels
thalassemia treatment
no treatment for alpha and beta minor
Hgb H disease:
folic acid
avoid medicinal iron and oxidative drugs
Severe thalassemia:
routing blood transfusion
folic acid
iron chelation therapy
Splenectomy = vaccinate pts
allogenic stem cell transplant
seek hemo consult
sideroblastic anemia
bone marrow produces sideroblasts rather than healthy RBCs
available iron is unable to be incorporated in hemoglobin
known family hx or clinical feature
x linked is the most common feature autosomal recessive 1/2 cases are female
male will be effected with female carries one gene on chromosome will be ineffective
acquire causes:
myelodysplastic syndrome (AML)
medications
Excessive ETOH
copper deficiency
sideroblastic anemia treatment
look at the signs and symptoms: pallor , fatigue , dizziness , hepatosplenomegaly , heart disease, kidney failure
bone marrow bx
treat
removal toxin
thiamine or folic acid
keep an eye on the iron
avoid spleen ectomy **
aplastic anemia
marrow is damaged by infection, inflammation, or cancer
massive hemorrhage is unusual
could be CNS involvement
acquired causes: toxins, radiation chemo , medication, infection , pregnancy
inherited causes ; Fanconi anemia , dyskeratosis
consider as leading for young adult with pancytopenia
complication: massive hemorrhage
aplastic anemia diagnosis
low ret count
pancytopenia
bleeding
petechiae
do bone marrow bx fatty bone marrow is found **on test
