Anemias Flashcards
Iron Deficiency
Reason: low iron
Symptoms: anemia, Pica (ice chewing), Angular cheilits ( corner mouth sores), Restless legs
Etiologies: GI losses, elsewhere bleeding, menstration, malabsoprtion, decreased intake
LABS: Down: MCV, Retics, ferritin (acute phase could look normal), Iron, Transferrin saturation
increase: TIBC, sTfR, Pencil looking cells
Microcytic
Iron treatment
PO: need to be with acid to change into active form
IV: for people with low compliance or immediate need or low compliance
Thalassemia
Reason: inherited mutaion in ⍺ or β heme chain
Symptoms: Microcytic anemia, hypochromic with cell that look like targets
Eitologies: Hb electro or genetic testing the best
Labs: MCV disporpotionally low, target looking cells, Hb electro - ⍺ β shows up different
microcyctic
Alpha Thalassemia
Gene
1. silent 3/4 - no change
2. a-/a- (alpha Th), aa/– (minor Th) - minor 10-14 Hbg no transf
3. -a/– hemo H disease - inter 6-10Hgb maybe need transf
4. –/– - death
Beta Thalassemia
GENE:
1. minor b/b+, b/bo - minor 10-14
2. inter b+/b+,b+/bo - inter 10-6
3. major bo/bo - major 6-3
b+ great variablity but bo is just absent
Thalassemia Treatment
RBC transfusion, Iron chelation, Hydroxyuera, gene therapy
Siderblastic anemia
Reason: can incorporate iron into Hb
Symptoms: Erythroblasts (pre-RBC) with iron in the mitochondria
Etiologies: Genetic or acquired, MDS, Copper def, lead poisoning
Labs: blue stained RBC that show the iron around the mitochondria
microcyctic
Megaloblastic anemia
Reason: B12 defi, folate def (uncommon)
Symptoms: RBC large bc they didnt divied bc of DNA systhesis probelms
Etiologies:
Labs: MCV > 100, hypersegmented neutrophils ( many lobes not just 3)
Macrocyctic
Importance of B12 and Folate
Cofactors in DNA synthesis to help methylation
B12 absorption - take up in stomach and procced all the way to Small Intes - 50% liver 50% other tissues
B12 deficiency Causes and Signs
- Strict veganism
- Lack of intrinsic factors (percoius anemia), Gastrectomy, H. pylori, proton pumps, H2 blockers
- Absporption
- Congenital causes
Signs: Macrocyctic anemia, Hypersegmented nuetro, High methymelonic acid
symptoms: Neuropathy(
Pernicious anemia
Reason: B12 deficiency
Symptoms: Low B12, Parietal antibodies, Intrisic factors
Etiologies: autoimmune disease agaisnt stomach cells, loss of gastric glands, loss of gastic acid and intrinsic factors
Labs:
Population: above 60 and women>men
Folic acid deficiency
Reasons:
1. low diet intake
2. drugs ( folate antagonis, methotrexate)
3. jejunum malabsportion - crohn;’s celiac
4. increased demand, Preg and hemolytic anemias
Signs:
1. Macrosystic anemia
2. Hypersemented nuetrophils
3. **NORMAL METHYMELONIC ACID
symptoms: NO NEUROPATHY
What are other causes of Macrocytosis
- retics bigger than RBC
- alcholism/liver
- COPD
- Hyperthyroidism
- Drugs - Chemo, Sulfa, Triamterene, Anticonvulsants, Valporic acid
Myelodysplastic Syndrome
Reason: mutations in myeloid precursers
Symptoms: Cytopenias, MCV >100
Etiologies: Ineffective hematopoiesis in marrow, lots of cells but malformed
Labs:
Risk factors - age, Benzene exposure, chemotherapy
Macrocytic
Normocyctic Anemia
Reason: Diease/ inflamation
Symptoms: Decreased RBC, Hepcidin (reduction in plasma iron, so iron builds up even though enought just BM cant use non-plasma, Cant respond to EPO, low EPO
Etiologies: Age, Chronic infections, HIV, maliganacy, Diabetes, RA
Labs: ESR and CRP | Ferritin up, Hepcidin up, Iron down, TIBC low or normal, Transferrin down, sTfR normal (simlar to iron def but some changes)
Renal Failure Anemia
Normocyctic like
EPO problems
All dialysis need EPO replacements
Sequestration Anemia
Splenomegaly:
1. thalassemia major
2. Cirrohosis with portal HTN
3. Gaucher disease
4. Malignancies
Normocytic anemia
Blood loss Anemia
low CBC and RBC, increase reticues only if given enough time to build up
Hemolytic Anemia Genralized
Hemolysis (death of RBC cells outside of marrow), Extravascular (outside of vascular like spleen), Intravascular ( circulation/blood vessels)
can be aquired or born with
What to look for: Fatigue, pale, jaundice, dark urine, gallstones, Big spleen, family history
IN ALL HEMOLOTIC EVENTS - increased bilirubin, lactate dehydrogenase, RPI >3
Caveats: Bilirubin up is in various liver disorders, bili and LDH elevated in EPO inefficency
Intravascular vs Extravascular Hemolysis
same for reti, LDH and Bili
blood in urine is up for Intravascular but Haptoglobin is undetectable
Intra: Reticulocytes do not increase for days and peak in 1 week
Congenital/Hereditary disorder lead to which Hemolysis?
Extravascular hemolysis (mostly spleen, sometimes liver)
Autosomal dominate
Suffers from Anemia, Jaundice, splenomegaly and pigemnted gallstones
3 abnormalities
1. Spherocytosis - MOST COMMON
2. Elliptocytosis
3. Stomatocytosis
Decteable by Peripheral smear
Hereditary Spherocytosis
Reason: Extavasular hemolysis (RBC death)
Symptoms: anemia, jaundice, fatigue, pigmented gallstones
Etiologies: Def membrane (spectrin, ankyrin or band 3), this causes sphere shape and target of phagocytosis
Labs:
Crisis:
1. Hemolytic crisis - common in children
2. Aplastic crisis - viral infection B19
3. Megoblastic - increase folate demands, preg child elderly
Hemolytic
Herditary elliptocytosis
Meditarranean or african ancestry
alpha or beta gene defects
Hemolytic
Congeital/ Hereditary RBC G6PD
ketchup
Race: black or mediterranean
X-linked men
Oxidized stress can make heiz bodies (dotes in rbc)
spleen pit cells make bite cells (someone bit RBC)
Hemolytic
