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Foundations III > Anemias > Flashcards

Anemias Flashcards

1
Q

Ratio of Hgb to Hct

A

1:3

Ex. Men: Hgb 14-18, Hct 40-50%

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2
Q

MCV

A

Mean corpuscular volume

-normal is 80-100

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3
Q

MCH

A

Mean corpuscular Hemoglobin

Avg mass of Hgb per RBC”how much color?”

  • Low MCH/MCHC = hypchromic
  • Normal MCH/MCHC = normochromic
  • High MCH/MCHC = hyperchromic
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4
Q

RDW

A

Red cell distribution width

Normal is 11-15%

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5
Q

Causes of increased RBC count

A
  • Dehydration
  • COPD
  • Polycythemia vera
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6
Q

Signs of Anemia

A

Early:

  • pallor
  • tachycardia
  • hypotension
  • orthostatic changes

Late:

  • glossitis
  • chelitis
  • Jaundice (hemolytic anemia, indirect bili)
  • koilonchia
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7
Q

What is the best indicator of iron deficiency anemia

A

low ferritin (<12ng/mL)

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8
Q

Signs of Fe Deficiency Anemia

A
  • Pica
  • Dysphagia (Plummer-Vinson Syndrome)
  • Restless leg syndrome
  • Glossitis
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9
Q

How long do you give ferrous sulfate 325mg in Fe deficiency anemia?

A

give until corrected.

Continue 3-6 months after corrected

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10
Q

Thalassemia

A
  • microcytic (low MCV)
  • hypochromic
  • Normal RDW**
  • HIGH ferritin
  • Target cells*
  • Poikilocytosis

Dx: hemoglobin electrophoresis

Tx: transfusions, avoid iron supplements.

  • Folic acid supplemention
  • Consider removing spleen
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11
Q

What can make MCV falsely big?

A
  1. reticulocytes

2. RBC clumping

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12
Q

What are two characteristic findings on peripheral blood smear for megaloblastic anemias (ex. Folate deficiency, B12 deficiency)

A
  1. Hypersegmented neutrophils

2. Macro-ovalocytes

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13
Q

Macrocytic anemia with reticulocyte elevation

A

-Hemorrhage

or

-Hemolysis

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14
Q

Where is folate absorbed in the small bowel?

A

Jejunum

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15
Q

Folic acid deficiency: causes

A
  • alcoholism
  • hemodialysis
  • anticonvulsants
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16
Q

Folic acid deficiency: clinical features

A
  • anemia sx
  • glossitis
  • NO neurologic abnormalities
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17
Q

What labs will help you tell if folic acid deficiency is the issue?

A

elevated homocysteine

normal methylmalonic acid

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18
Q

B12 Deficiency

A
  • only available in diet
  • MC cause is inability to absorb (needs intrinsic factor [made by parietal cells])

-B12 absorbed in the ileum

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19
Q

Pernicious Anemia

A
  • type of B12 deficiency

- Autoimmune destruction of parietal cells so, absent gastric acid and intrinsic factor

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20
Q

Pernicious anemia: clinical features

A
  • atrophic gastritis –>increased risk for gastric CA

- Neurologic findings (decreased vibration sense, ataxia, parethesias, confusion)

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21
Q

B12 deficiency labs

A

Positive schilling test
or
Antibodies to IF (pernicious anemia)

Elevated methylmalonic acid and homocysteine levels

22
Q

Hemolytic anemia: Labs

A

-Elevated reticulocyte count**

  • Increased unconjugated bilirubin (indirect)
  • Elevated LDH (lactic acid dehydrogenase)
  • Low haptoglobin
23
Q

Hemolytic anemia: peripheral smear

A
  • reticulocytes

- schistocytes

24
Q

Haptoglobin

A

protein produced in the liver that binds to hemoglobin that has been released from lysed RBCs

so, more lysing the less free haptoglobin

25
Q

Hemolytic anemia: clinical features

A
  • anemia sx
  • jaundice
  • gallstones (bilirubin stones)
  • increased risk of infection with salmonella and pneumococcus**

(infection with parvovirus B19 can lead to transient aplastic crisis)

26
Q

Micro versus Macroangiopathic hemolytic anemia

A

Macro - from prosthetic heart valve

Micro - from fibrin strands in the vessels

27
Q

G6PD Deficiency

A
  • X-linked recessive disorder
  • More common in black males and Mediterranean men
  • Fava bean is common trigger**
28
Q

G6PD Deficiency: Labs

A

During episode:

  • Increased reticulocytes
  • Increased serum bilirubin
  • Low G6PD

Peripheral smear:

  • Heinz bodies (denatured hemoglobin)
  • Bite cells
29
Q

G6PD: Tx

A
  • self limited

- Avoid oxidative drugs

30
Q

Hereditary Spherocytosis

A
  • Autosomal dominant
  • Normal MCV, but smaller surface area, dense, globe appearance (no central pallor)
  • Poorly deformable, so get stuck in spleen and get phagocytized by splenic macrophages
  • Chronic hemolysis creates need for increased folate
31
Q

Hereditary Spherocytosis: Dx and Tx

A

clinical manifestion:

  • splenomegaly
  • jaundice

Dx: Osmotic fragility test

Tx: remove the spleen (in adulthood if possible)

-Give PNA vaccine

32
Q

Sickle Cell Disease: General

A
  • Autosomal recessive
  • HbSS (sickle cell disease)
  • HbS + Hb A (sickle cell trait)
33
Q

Sickle cell disease: clinical features

A
  • symptoms start at 4-6 months with change from fetal hemoglobin to adult hemoglobin
  • INCREASED susceptibility to infection

Symptoms precipitated by dehydration, hypoxia, high altitude, intense exercise

34
Q

Sickle cell disease: more clinical features

A
  • chronic hemolysis (bilirubin rises)
  • Vaso-occlusive ischemic tissue injury
  • PAIN CRISIS** (MC feature of disease)
  • osteonecrosis of femoral and humeral heads from bone infarcts
  • Splenic infarcts lead to functional asplenism
  • leg ulcers
35
Q

Sickle cell disease: labs

A
  • Reticulocyte count is elevated**
  • Hgb electrophoresis shows HbS*** (best test to confirm diagnosis)

Peripheral smear:
-Howell-jolly bodies (nuclear remnants usually removed by the spleen)

36
Q

Sickle cell disease: Tx

A

-Hydroxyurea (suppresses bone marrow to decrease incidence of painful crises)

  • PNA vaccine
  • Folate supplementation
37
Q

Autoimmune Hemolytic Anemia: general

A
  • antibodies adhere to surface of RBC

- Complexed antibody and cell are phagocytized leaving –>spherocytes*

38
Q

Autoimmune hemolytic anemia: Labs/peripheral smear

A
  • Polychromasia
  • spherocytosis
  • (+) Coombs test**
39
Q

Incompatible blood transfusion

A
  • Antibodies to ABO/RH blood group antigen

- (+) Coombs test**

40
Q

Treatment for hemolytic anemias

A
  • Folic acid supplementation**

- Splenectomy (to consider)

41
Q

Anemia of Chronic Disease

A
  • normocytic, normochromic
  • normal or increased ferritin
  • Fe and TIBC are low in setting of inflammation
42
Q

Myelodysplastic Syndrome: Tx

A

bone marrow biopsy*

43
Q

Sideroblastic anemia: general

A

Marrow doesn’t use iron for heme synthesis very well

Bone marrow: ringed sideroblasts** (these are produced instead of healthy RBCs)

44
Q

Ringed sideroblasts

A
  • seen in sideroblastic anemia
  • they are erythroblasts with perinuclear iron-engorged mitochondria
  • subtype of myelodysplastic syndrome
45
Q

Sideroblastic anemia: Dx

A

Marked anisocytosis
Marked poikilocytosis
Systemic iron overload**

BMbx: ring sideroblasts

46
Q

Sideroblastic anemia: Tx

A

treat underlying cause

If Congenital sideroblastic anemia…
-Pyridoxine (vitamin B6)

47
Q

What is the most common cause of aplastic anemia?

A

idiopathic

48
Q

Aplastic Anemia: clinical features

A

Pancytopenia**

49
Q

Aplastic Anemia: Tx

A

bone marrow transplant

50
Q

When are helmet cells seen on peripheral smear?

A

hemolytic anemias

Foundations III (34 decks)

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