Anemias Flashcards
Iron difficiency
Microcytic, hypochromic Pregnancy, growth spurts, vegetarian If over 50 with low iron, think colon CA Bone marrow Fe stain is gold standard Dx Chrons and ciliac can cause this
alpha thalassemia
Microcytic, hemolytic
Can get hemochromatosis (iron overload)
Beta thalassemia
Microcytic, hemolytic
Minor-Dx with a2delta2 band
Major- xray crewcut
Sideroblastic anemia
Microcytic
X linked defect in ALAS
Treat with B6
Also ETOH and Pb (basophilic stipling) can cause it
Pb poisoning
Can see lead lines, encephelopathy, abd pain, foot/wrist drop, and microcytic anemia
Macrocytic with megaloblast
Hypersegmented neutrophil
Folate: low folate, high homocysteine, normal methylmalonic acid
Low RBC, WBC, and platelets
B12: low B12, high homocysteine, high methylmalonic acid
Low b12 causes
Poor nutrition/chrons/ileal resection
Pernicious anemia against parietal or intrinsic factor. Higher risk for gastric carcinoma
D. latum fish worm
Has neuro symptoms
Elevated homocysteine and methylmalonic acid
What causes Low folate
Alcoholism and malnutrition can cause this and methotrexate
Nonmegaloblastic macrocytic anemia
Bleeding disorders, liver disease, alcoholism, reticulocytosis
Non-hemolytic normocytic anemia
Anemia of chronic disease
Aplastic anemia
Can also present as microcytic
Anemia of chronic disease
Inflamation–increased hepcidin—decreased macrophage and transferrin to release iron
Labs: low iron, low TIBC, High ferritin
If kidney: treat with EPO if low hematopoiesis
Aplastic anemia
Pancytopenia—petechiae, bleeding, infection, neutropenia
Causes: radiation, viruses, fanconi, ideopathic following hepatitis
Tx: Eliminate cause, BMT, GM-CSF
Intravascular hemolysis
Low haptoglogin, high LDH, hemoglobinuria
Extravascular hemolysis
High LDH, high unconjugated bilirubin
Spherocytosis
RBC become spherical and weak Splenomegaly (Howell jolly bodies if no spleen) \+ Osmotic fragility test Aplastic crisis (Parvo B19) Increase RDW and MCHC
G6PD
More common in African Americans
Low glutathione and NADPH so more oxidative stress
Get heinz bodies with precipitating factors:
Fava beans, sulfonamides, primaquine, anti TB
Sickle cell anemia
Can also show up as crew cut
Valine for glutamic acid
Aplastic crisis (Parvo B19), autosplenectomy, pain, renal papillary necrosis, avascular necrosis of hip, Salmonella osteomelitis
Tx: hydroxyurea (increases HbF)
HbC defect
Lysine for glutamic acid. Like Sickle cell but not as bad
Haptiglobin
Binds hemoglobin in the serum. If RBCs lysed, more binds to RBC and total in serum is decreased.
B symptoms-
Worry about cancers
Fever, night sweats, or weight loss
Jak2 mutation
Too much RBC, WBC, Platelets
Polycythemia vera
Warm antibody
IgG SLE, Lymphoma, CLL Drug induced (PCN and Quinidine) Use prednisone or anti CD20 Ab (rutiximab) Can do spleenectomy
Confirm with direct coombs test
CLL
Relisten to lecture around 40 minutes in
Cold antibody
IgM
Mycoplasma infection, viral, CLL, Lymphoma
Tx: stay warm, treat problem, rituximab
Coombs test/Direct indirect
Testing Ab against RBCs Direct: Ab to RBC Test newborn Indirect: Ab in serum to R Test for mother
TTP
Negative direct coombs
High LDH
Plasma exchange
Thrombocytopenia, microangiopathic hemolytic anemia, neuro, kidney failure, fever
Heinz body
Heinz bodies are formed by damage to the hemoglobin component molecules, usually through oxidant damage, or from an inherited mutation
Liver disease, G6PDH, NADPH, a-thalla
Hypersegmented neutophils
B12, Folate, myodisplastic syndrome
Other causes of megoloblastic anemias
Drugs that impair DNA metabolism
Metabolic disorders (orotic aciduria, lesch nyhan)
Refractory megaloblastic anemia
Di guglielmos syndrome
Causes of folic acid deficiency
Inhibitors of dihydrofolate reductase: methotrexate, pyrimethamine, triamterene, pentamidine, trimethoprim
Alcohol
Rare enzyme deficiencies: dihydrofolate reductase, others
Indirect/Unconjugated bilirubin
Hemolytic anemia
Direct/conjugated bilirubin
Biliary obstruction
Alpha thalassemia trait
Wont show up on hemoglobin electrophoresis
Sickle cell vaccines
Salmonela, S.aureus, H. flu, S. pneumo,, M. pneumo
Give 2 weeks before spleen removal
Target cell
HALT HbC Asplenia Liver disease Thalassemia
Schistocytes
DIC/TTP/HUS, trauma
Bite cell
G6PDH deficiency
Basophilic stippling
TAIL Thalassemia Anemia of chronic disease Iron difficiency Lead poisoing
Acanthocyte spur cell
Liver disease, abetalipoproteinemia
Heinz bodies
Denatured hb seen in a-thalassemia and G6PDH deficiency
leads to bite cells
Howell jolly bodies
Nuclear remnants found in asplenic patients
