Anemias Flashcards
MCV < 82
N or Increased ferritin
N or Increased SI
N or Decreased TIBC
Decreased production of globin chains, but normal structure, that leads to an imbalance
What type of anemia?
Hereditary Thalassemia
Microcytic/Hypochromic
Decreased Hgb production
Increased ferritin and SI
Decreased TIBC, Retics, Hgb, RBCs.
Due to a block in the protoporphyrin ring pathway leading to Iron overload.
Mild-Severe anemia
Basophilic Stippling & PHBs
What anemia am I?
Sideroblastic Anemia
N or Increased Iron stores
Decreased SI and TIBC
Blood shows mild microcytic or normocytic anemia.
Due to having storage iron, but can’t release it for Hgb or RBC production.
Seen in malignant disease and RA.
What anemia am I?
Anemia of Chronic disease (ACD)
Homozygous
Slightly decreased Hgb
N to increased RBCs
No NRBCs
Micro/hypo RBCs
Target cells
Possible ovalocytes
Basophilic Stippling
No PHBs
NORMAL IRON TESTS
Increased A2 on electrophoresis
Beta Thala minor
Heterozygous
Slightly decreased Hgb
Mild in most cases
Basophilic stippling
Targets
Normal Hgb electrophoresis
Bart’s blood in cord.
Due to a deletion of 1-2 alpha genes.
What am I?
Alpha Thala minor/trait
Homozygous
DECREASED Hgb and RBC
Severe diagnosis
Increased # of NRBCs
Aniso/Poik
Basophilic Stippling, HJBs, Schistos, PHBs.
Increased: ferritin, SI, bilirubin, and Hgb F
Decreased TIBC, OF test, and Hgb A.
BM hypercellular
Hepatosplenomegaly and splenectomy after 4 and transfusion dependence.
What am I?
Beta Thala major (Cooley’s)
Which type of SA has increased basophilic stippling?
Lead poisoning
How can you differentiate IDA based on cell morph?
No basophilic stippling or PHBs.
Normal electrophoresis, maybe a decrease in Hb A2.
Decreased Iron stores, usually the first thing effected.
Tests used in order to differentiate micro/hypo anemias?
Iron Studies
Hgb Electrophoresis
Basophilic Stippling
PHBs
Macrocytic RBCs (>98 MCV)
Normochromic
Mild-Severe anemia
Increased SI, bilirubin, and super increased LDH.
Decreased to N: RBCs, Hgb, Hct
Increased MCH
Normal MCHC
Megakaryocytes abnormal resulting in thrombocytopenia.
Oval macrocytes, HJBs, Cabot rings possible, Hyper-seg Neuts, Giant PLTs, Teardrops,
RBCs are fragile, causing increased LDH.
M:E Ratio decreased
Megaloblastic anemia
Types of megaloblastic anemia?
Vitamin B-12 deficiency
Folate Deficiency
Pernicious Anemia
B-12 & folate deficiency (together).
Tests to differentiate megaloblastic anemias in order?
Vitamin B-12 and Folate
Antibody Tests
Retic Count
Liver tests
What is the schilling test and what is it used to determine?
A test for vitamin b-12 deficiency.
Establishes the exact cause of the deficiency.
Steps in Schilling test?
B-12
MMA test
IF blocking antibody
Parietal Cell Antibody test
Gastrin Test
When to proceed to the next step in diagnosis of pernicious anemia?
B-12 ( <300pg/mL)
leads to
Methylmalonic Acid test
(> 0.4 umol/L) leads to
Intrinsic factor blocking antibody
(Positive- PA) Negative leads to
Parietal cell antibody test (Positive=PA) Negative leads to
Gastrin test (< 100 pg/mL not PA) ( > 100 pg/mL PA, indirect confirmation)
Malabsorption causes of B-12 deficiency?
Gastrectomy
Blind loop syndrome (bacteria use up)
H. pylori infections
Drugs that cause B-12 deficiency?
Alcohol
Nitrous Oxide
Antitubercular drugs
Increase need B-12 deficiency causes?
Pregnancy/Lactation
Growth
Malabsorption of folic acid causes?
Ileitis/Crohn’s
Blind loop syndrome
Gluten-sensitivity
Childhood celiac disease
Folic acid deficiency due to increased requirement?
Pregnancy
Infancy
Hematologic diseases (Sickle cell anemia).
Drugs that cause folate deficiency?
Methotrexate (Chemo)
Alcohol
Oral contraceptives
Long-term Anticoagulant drugs (block vitamin K), Antiseizure meds.
Megaloblastic anemia treatment?
Vitamin therapy for B-12 and folate deficiency.
Intramuscular injections for pernicious anemia.
No DNA synth impairment
Round macrocytes
No hyper-seg neuts
Leukos and PLTs normal
No jaundice, glossitis, or neuropathy
Due to: Chronic liver disease, Alcoholism, Stim erythropoiesis (newborns).
INCREASED Retics, including stress retics
What am I?
Non-megaloblastic Anemia
Normocytic RBCs
Intrinsic
Increased retics
Abnormal RBC membrane or Hgb structure.
Deficient enzyme
Abnormal RBC destruction tests
Hereditary Hemolytic Anemia
Membrane defects?
H Spherocytosis
HS post-splenectomy
H Ovalocytosis
H Stomatocytosis
H Acanthocytosis
Increased permeability to Na W/ loss of membrane.
True macrocytic RBCs
MCHC > 36%
DAT ( - )
OF Increased
H Spherocytosis
Spherocytes
MCHC > 36%
HJBs, PHBs, Hgb rises
Increased PLTs
HS Post-Splenectomy
> 25% of ovalocytes have polarized cholesterol on the ends.
Normal OF test
H Ovalocytosis
Altered membrane lipids
Abetalipoproteinemia
Normal OF test
Many spur cells
H Acanthocytosis
Hemoglobin Defects?
Hgb SS Disease
Hgb SA trait
Hgb SC disease
Hgb CC disease
Hgb CA trait
What is the membrane defect in Hgb?
Amino acid substitution of valine
Hemoglobin Defect W/:
Mild anemia
Targets, C-crystals
Decreased OF
Hgb CC disease
Hemoglobin Double heterozygous defect
Mod Anemia
Targets, SC crystals, occasional sickles and C crystals.
Decreased OF
Hgb SC disease
Heterozygous Hgb defect
Not anemic
Targets, No C crystals
Hgb CA trait
Involved in Vaso-occlusive disease
SCP ( + )
Severe Anemia
NRBCs, targets, sickle cells, HJBs, PHBs, basophilic stippling
Decreased OF
Hypercellular BM
Decreased M:E
Hgb SS disease
Heterozygous
No anemia
Targets, no sickles
SCP (+)
Hgb defect
Hgb SA trait
HMP Pathway defect
Decreased NADPH
HBs, Schistos, Spheros
X-linked
G6PD deficiency
EMB pathway defect
Decreased ATP
Anemia W/ echinocytes
Pk deficiency
Extrinsic defects
Increased retics
Abnormal RBC destruction tests
Reduced RBC Lifespan
Acquired Hemolytic Anemia
Causes of acquired hemolytic anemia?
Antibodies
Trauma (Mechanical, Microangiopathic)
Infectious or physical agents
Antibody defect
Unknown 1st cause
CLL or drugs 2nd cause
Spheros
MCHC > 36%
DAT (+)
Increased OF test
Warm Autoantibodies
Warm Auto-Immune Hemolytic Anemia (WAIHA)
Unknown 1st cause
2nd cause due to mycoplasma RBC agglutination
Raynaud’s
Cold Autoantibodies
Cold Auto-Immune Hemolytic Anemia (CAIHA)
Severe Anemia
INCREASED NRBCs and Bilirubin
HDN-Rh
Not anemic
Spheros
Increased Bilirubin
HDN-ABO
Mechanical-Valves Schistocytes
MAHAs-DIC/HUS-Schistocytes
Marked Hemoglobinuria- Schistocytes
Trauma caused Hemolytic Anemia
Schistocytes and Spherocytes
Infectious toxin in Hemolytic Anemia
Clostridia toxins
Infectious Agent in Hemolytic Anemia
Schistocytes
Spherocytes
Parasitic
Malarial parasites
A physical agent, causing schistocytes and spherocytes in hemolytic anemia?
Thermal burns
Pancytopenia or imparied cell production anemia
Decreased retics
Normal RBC destruction test
BM failure Hemolytic Anemia
BM failure HA
Immature neuts
NRBCs
Leukoerythroblastic picture
BM transplant
Marrow injury
1st cause is idiopathic
2nd cause Benezene, RADs, viral, chloramphenicol, pesticides.
Congenital- Fanconi’s
Blood: Pancytopenia, No polychromasia or NRBCs
Normal bilirubin
Hypocellular BM
Increased Fat and decreased cells
Aplastic Anemia
Aplastic anemia has what ratio in the BM?
3:1
What is not used in aplastic anemia?
Iron
Tests to differentiate Hemolytic Anemias in order?
Retic Count
RBC destruction tests (Bilirubin, LD, etc).
OF test, Hgb electrophoresis and/or DAT
BM Exam