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Clinical Pathology > Anemia Weeks 7-9 > Flashcards

Anemia Weeks 7-9 Flashcards

1
Q

What is the best indicator for anemia?

A

Hemoglobin

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2
Q

What are the normal ranges for:
RBC
Hb
Hct

A

RBC:
Women 3.5-5.5
Males 4.3-5.9
Hb:
Women <11g/dL= anemia
Males <13g/dL= anemia
Hct:
Women 34-47%
Males 40-54%

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3
Q

What is the most important single test in diagnosis of anemia?

A

Peripheral blood smear

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4
Q

What is the normal reticulocyte count range?

A

.5-1.5%

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5
Q

Normal MCV and MCHC values?

A

MCV: 80-100
MCHC: 32-36%

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6
Q

What is the earliest indicator of anemia?

A

RDW (only will go up)
normal= 11-15%

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7
Q

What are the 3 Etiologic classifications of Anemia?

A

Blood loss
Deficiency in Erythropoiesis
Increased break down of RBC

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8
Q

What are the conditions associated with Anemia due to deficient erythropoiesis?

A

IDA
ACD / Iron Reutilization
Sideroblastic / Iron utilization
Thalassemia

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9
Q

What are some causes of Normochromic-Normocytic anemia?

A

Renal disease
Endocrine failure
Aplastic anemia
Myelophthisic anemia

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10
Q

What causes Megloblastic/Macrocytic anemia?

A

B12/Folate deficiencies

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11
Q

What are the morphological types of anemia due to deficient erythropoiesis?

A

Hypo-micro
Normo-normo
Meglo/Macro

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12
Q

What are the two morphological types of anemia due to RBC destruction?
And give some examples of each.

A

Intrinsic / Genetic
-Hereditary Spherocytosis
-G6PD deficiency
-Sickle cell
-Thalassemia
Extrinsic
-Traumatic hemolytic anemia
-infectious agent
-immunologic abnormalities

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13
Q

What lab findings would you expect to see with Acute Posthemorrhagic anemia:
Immediately
Shortly after
Within hours
Several days

A

Immediately= Normal
Shortly after= dilution from fluid> decreased RBC, Hb, Hct (normo-normo)
Within hours= Neutrophilic leukocytosis and thrombocytosis
Several days= Immature WBC, Occasional normoblasts, Polychromatophilia, Slight macrocytosis

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14
Q

What tests can be done if suspected chronic posthemorrhagic anemia?

A

Fecal occult
Endoscopy
Colonoscopy
UA

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15
Q

Where are sites you would expect to find bleeds in chronic posthemorrhagic anemia?

A

GI (Ulcers, GERD, cancers, Crohns, Ulcerative colitis, polyps, hemorrhoids)
Urologic (Bladder or kidney cancers)
Gynecologic (heavy menses, hormonal abnormalities, uterine fibroids, Endometriosis, PCOS, PID, endometrium cancer)

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16
Q

Lab findings for IDA and anemia due to chronic blood loss will look the same of different? What are the similarities and/or what are the differences?

A

Same: Anemia, Ferritin decreased
Different: MCV and MCHC

And of course look at Hx.

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17
Q

Where does absorbtion of iron occur?

A

Duodenum and proximal jejunum

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18
Q

What state/form must iron be in to be absorbed?

A

Fe2+/Ferrous
Bound to heme

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19
Q

Ferric/Fe3+ is from what sources?
Ferrous/Fe2+ is from what sources?

A

Ferric= Plant
Ferrous= animal

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20
Q

Explain the process of eating a fruit, vegetables, or grain and how we then process to use or store iron.

A

Fruits, vegetables, and grains have Ferric/Fe3+
In duodenum Fe3+ is converted to Fe2+
Enterocytes stores ferritin and also converts Fe2+ back to Fe3+ and is pushed into blood vessel bound to transferrin

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21
Q

What form of iron is easier to digest and more readily absorbable?

A

Fe2+/Ferrous from animals bound to heme

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22
Q

What are the components of functional iron?

A

Protoporphyrin + transferrin combines to heme + globin = Hb> RBC

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23
Q

What is Hemosiderin?

A

Clumps of ferritin in macrophages
*needs bone marrow aspiration to check levels because it is too large to get into serum so it will not get picked up on other tests

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24
Q

What groups in the population are at higher risk for IDA?

A

Infants 6 months - 2 years (growth)
Adolescent females (puberty/first menses)
Pregnancy (growth)
Elderly (inadequate diet/decreased HCL)

25
Q

What are the 3 etiologic causes for IDA?

A

Decreased intake for demand
Decreased absorption
Blood loss

26
Q

What are some malabsorption conditions that can lead to IDA due to decreased absorption?

A

Celiac
Chronic diarrhea
Gastrectomy
Gastric bypass
Antacids

27
Q

What are the 3 stages of of the pathophysiology of Anema?

A
  1. Iron depletion
    -State, not anemic, RBC indices normal. Decreased ferritin and decreased hemosiderin
  2. Iron deficient erythropoiesis
    -Increased RDW, Decreased MCV, decreased MCHC, Decreased Serum Iron, Increased Transferrin, Decreased % saturation
  3. Iron deficiency anemia
    -Decreased Hb
    -SSx of anemia present
28
Q

What is Pagophagia?

A

Craving for ice

29
Q

What are some clinical findings for IDA?

A

Pallor
Koilonychia
Cheilosis
Restless leg syndrome

30
Q

When prescribing iron supplements, what is the dose and recommendations on taking it?

A

150-200mg/Day
Does split throughout the day
Ferrous sulphate 325mg 3x/day (other forms of ferrous have different iron content so dosage will vary)
Also can recommend double dose every other day to decrease side effects but it will slow Hb response.
Take in fasted state (30 min prior to meal or 2 hours after)
Vitamin C will help absorption.
Do not take with Calcium, Manganese, Copper or zinc, coffee or tea.
Medications like antacids, proton pump inhibitors and H2 blockers can also inhibit.

31
Q

What are the side effects of Non Heme iron salts?

A

Not serious just uncomfortable.
Epigastric pain, nausea, diarrhea, constipation, darken stool

32
Q

Management response times.

A

Reticulocyte count increase in 7-10 days if effective.
Hb increase about .7-1 g/dL/week and should see in about 2 weeks
Continue treatment for 3-6 months to replenish iron stores

33
Q

B6 is used in what process?

A

Protoporphyrin and iron combining with Heme.

34
Q

Alcoholism causes what kind of anemia?

A

Sideroblastic/ Iron Utilization

35
Q

If you see on an iron panel:
Increased serum Iron
Increased serum Ferritin
Increased % saturation
Transferrin WNL/maybe decreased
What is the most likely diagnosis?

A

Sideroblastic/ Iron Utilization anemia which is and IDA

36
Q

What cell will you find in periphery in Sideroblastic/ Iron Utilization anemia?

A

Sideroblasts

37
Q

Etiology of Sideroblastic/ Iron Utilization anemia can be primary or secondary.
What are the causes for each?

A

Primary= Idiopathic
Secondary= Alcoholism, Drug/toxin induced (lead poisoning), Nutritional deficiency (B6/Pyridoxine)

38
Q

What laboratory findings would you see with Sideroblastic/ Iron Utilization anemia?

A

Sideroblasts in blood smear.
Liver enzymes elevated on chem panel
Low Reticulocytes
Bone marrow examination to confirm for sideroblasts

39
Q

What are some examples of chronic diseases that can lead to ACD

A

Chronic infections
Inflammatory diseases like RA, SLE, long term inflammatory bowel disease.
Malignancies like Lymphoma, Multiple Myeloma, Lung, Liver or breast cancers

40
Q

CBC shows:
Anemia
RDW normal
Increase Ferritin
Decreased Serum Iron
Decreased Transferrin
Decreased %saturation
What is the most likely diagnosis.

A

Anemia of Chronic Disease / Iron reutilization anemia
Hypo-Micro

41
Q

CBC shows:
Anemia
RDW normal
Increase Ferritin
WNL Serum Iron
WNL Transferrin
WNL %saturation
What is the most likely diagnosis.

A

Anemia of Chronic Disease / Iron reutilization anemia
Normo-Normo

42
Q

What would you expect ESR and CRP to be in ACD?

A

elevated

43
Q

Why do we see Normo-Normo ACD?

A

Inflammatory cytokines inhibit erythropoiesis.

44
Q

If Ferritin is low & Transferrin is high, what is the most likely diagnosis?

A

IDA

45
Q

If Serum Iron is high what is the most likely diagnosis?

A

Sideroblastic / IUA

46
Q

If Transferrin is high what is the most likely diagnosis?

A

IDA

47
Q

If % saturation is high what is the most likely diagnosis?

A

Sideroblastic / IUA

48
Q

If you see Alcoholism, what direction would you be going for diagnosis of anemia?

A

Sideroblastic / IUA

49
Q

If someone has a history of Lymphoma and is presenting with anemia, what type are you thinking?

A

ACD / IRUA

50
Q

If someone has a history of Multiple Myeloma and is presenting with anemia, what type are you thinking?

A

ACD / IRUA

51
Q

If someone has a history of liver lung or breast cancer and is presenting with anemia, what type are you thinking?

A

ACD / IRUA

52
Q

If someone has a history of GI or GU cancers and is presenting with anemia, what type are you thinking?

A

IDA

53
Q

Iron panel presents with:
Ferritin- low
Serum iron- low
Transferrin- high
% saturation- low
What is the most likely diagnosis? And why do you find these values?

A

IDA
Decrease in iron pulls from stores decreasing Ferritin. We have established we have low iron so that is why serum iron is low. Because we have low iron circulating we want to have more chances it will be picked up and transported so there is an increase in transferrin. But because we have more transporters and still low serum iron the % saturation is low.

54
Q

Iron panel presents with:
Ferritin- high
Serum iron- high
Transferrin- WNL/Low
% saturation- high
What is the most likely diagnosis? And why do you find these values?

A

IUA has plenty iron present, but the utilization of it lies the problem - we are unable to make heme from it causing the anemia.
Because Iron levels are there we have plenty in stores and plenty in periphery, so ferritin and serum iron are high. No change in iron levels means transporters should be at normal levels or maybe low because we have so much we aren’t needing to worry about getting in places. With normal or even low transferrin and lots of iron available, %saturation is high

55
Q

Iron panel presents with:
Ferritin- high
Serum iron- low
Transferrin- low
% saturation- low
What is the most likely diagnosis? And why do you find these values?

A

IRUA / ACD
Ferritin is an acute phase reactant. And in ACD inflammation is the underlying disease. So with inflammation we have increased acute phase reactants leading to increased ferritin. Due to hypo-mirco anemia the body wants to put iron into storage. This pulls it from the serum decreasing levels. Also to decrease iron going elsewhere the body will decrease transferrin. Serum iron decreases at a faster rate than decreasing transferrin so the % saturation also decreases.

56
Q

If someone presents with pica or pagophagia, what is the most likely diagnosis?

A

IDA

57
Q

What follow up tests would you do with someone with IDA due to blood loss?

A

Fecal occult
If positive do endoscopy or colonoscopy.
UA looking for hematuria
Bone marrow aspiration is the gold standard to diagnose but is invasive.

58
Q

What special test would you do if suspected Sideroblastic / IUA anemia?

A

Peripheral smear looking for Sideroblasts.

59
Q
A

Clinical Pathology (9 decks)

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