Anemias Flashcards
What are reticulocytes?
Fat, juicy immature RBCs
What can cause hemoglobin to be falsely reduced on CBC?
Reduced by dilution (i.e. pregnancy, administration of IV fluids)
What circumstances can cause increased hemoglobin?
Environments and conditions producing hypoxia (high altitudes, smokers, COPD etc.)
What do reticulocytes indicate on CBC?
Proxy of bone marrow function
What polymorphonuclear cells (PMN’s) are present longer in the blood?
Monocytes, work similarly to neutrophils
What WBC are involved in allergic responses?
Basophils and Eosinophils
What is the most present WBC in the CBC?
Neutrophils
Are patients with anemia usually symptomatic?
No, most often asymptomatic
What is elevated MCV
RBCs larger than normal (macrocytic)
What is decreased MCV
RBCs smaller than normal (microcytic)
What is anisocytosis?
Variance in RBC size (some large, some small etc)
What are schistocytes?
Fragmented RBC’s (look like helmet’s on smear)
What is hyperchromia?
Loss of central pallor, spherocytes (usually seen in hereditary spherocytosis)
What are Howell-Jolly Bodies?
Nuclear Remnants
What causes basophilic stippling (precipitation of ribosomes)?
Lead/heavy metal poisoning, thalassemias, ETOH abuse
What is the number one cause of anemia?
Iron deficiency anemia
What are some symptoms of iron deficiency anemia?
Pica
Brittle Bones
Spoon shaped nails
Cheilosis
Smooth tongue
Esophageal webs
What is the appropriate response increase in Hgb with iron supplementation in someone with iron deficiency anemia?
1mg/dL over 1 month
What are more bioavailable, and better absorbed sources of iron
Heme iron in animal food sources (beef, lamb, pork, poultry, eggs, and fish)
What is the threshold for a blood transfusion?
Hgb of less than 7
If you have a patient >50 years with unexplained or new anemia you must rule out what disease process?
Colon cancer
What is a common extrinsic cause of hemolytic anemia?
Often autoimmune
How is hemolytic anemia characterized?
Elevated reticulocyte count with stable or falling Hgb/Hct
What causes glucose-6-phosphate dehydrogenase deficiency (G6PD)?
Infection, certain foods (fava beans), certain medications
What Hgb substitution occurs in sickle cell?
Hgb S which sickle under stress
What is used to treat pain in sickle cell anemia crisis?
Analegesics, fluids, O2, and rest
What is used to prevent sickle cell anemia crisises?
Hydroxyurea (increases Hgb F production)
What are the three main causes of Vitamin B12 deficiency?
Pernicious anemia (lack of intrinsic factor needed for absorption)
Dietary insufficiency (vegans and some vegetarians)
Malabsorption (many causes, surgery etc.)
What three body systems are impacted by B12 Deficiency?
Heme, Psych, and Neuro
What labs can be useful to detect early disease in B12 deficiency?
Homocysteine or methylmelonic acid (MMA)
What are some causes of folate deficiency?
Nutritional deficiency (anorexia, ETOH abuse, celiac)
Poor absorption
Pregnancy
Hemolytic anemia
Medications (TMP-SMX, phenytoin, sulfasalazine)
What is the treatment of folate deficiency?
Folic acid supplementation (5-15mg per day PO)
What is the primary cause of polycythemia vera?
JAK2 mutation
What are characteristic symptoms of polycythemia vera?
Plethora (ruddy complexion, red complexion)
Redness of extremities
Engorged retinal veins
Generalized pruritis after bathing
What is the most indicative symptom of polycythemia vera?
Puritis after bathing/showering
What are the causes of macrocytic anemias?
ETOH induced anemia
B12 deficiency anemia
Folate deficiency anemia
Hemolytic anemias
What is folate needed for?
DNA synthesis during erythropoiesis
What is another name for B12?
Cobalamin
What type of anemia is B12 deficiency anemia?
Macrocytic anemia
What type of macrocytic anemia will have neurologic findings?
B12 deficiency anemia because in normal circumstances, B12 helps to maintain the myelin sheath
What are the causes of normocytic anemias?
Blood loss (acute)
Anemia of chronic disease
Hemolytic
Aplastic anemia
In normocytic anemia, with reduced oxygen-carrying ability of blood what symptoms will be present?
Increased heart rate
Dyspnea
Fatigue
What causes sequestration crisis?
In children, the spleen and liver can sequester large amount of the sickled cells and cause significant anemia
What disease process is caused by a mutation where valine substitutes for glutamic acid on the beta chain?
Sickle Cell Anemia
Basophilic stippling seen on blood smear indicates what?
Lead Poisoning
What are the labs in iron deficiency?
Increased TIBC
Decreased Iron
Decreased Ferritin
What are the labs in chronic disease anemia?
Decreased iron
Increased Ferritin
Decreased TIBC
What is needed for the definitive diagnosis of sideroblastic anemia?
Bone marrow evaluation
Will show ringed sideroblasts on Prussian blue staining
