Anemias Flashcards
What is the MC anemia worldwide?
Iron Deficincy Anemia (microcytic anemia)
Chronic blood loss is the MCC of what?
IDA in adults
What is the MC source of chronic blood loss?
Menstrual loss
What are 2 clinical features of microcytic IDA?
- Pica- ice chips
- Koilonchia (spoon nails)
What is the most reliable test to diagnose microcytic IDA?
Serum Ferritin (low)
What is the gold standard test to diagnose microcytic IDA but rarely done?
Bone marrow biopsy
Tx for microcytic IDA?
Oral iron replacement (ferrous sulfate)
- a trial should be given to menstruating females.
Beta-Thalassemia Major predominantly in what population?
Mediterranean population
What are 2 clinical manifestations of microcytic Beta-Thalassemia Major?
- Severe anemia (microcytic hypochromic)
- Skull x-ray demonstrates “crew-cut” fuzzy appearance
What lab test would you find to be elevated in a pt with microcytic Beta-Thalassemia Major?
Hgb Electrophoresis: Hgb F and Hgb A2
What cells would be seen in a peripheral smear in a pt with microcytic Beta-Thalassemia Major?
Target cells
- Dacrocytes (teardrop cells)
What is a general characteristic of normocytic Aplastic Anemia?
Massive bone marrow failure - results in pancytopenia
What procedure is done to provide a definitive diagnosis of normocytic Aplastic Anemia?
Bone marrow bx
Vitamin B12 is bound to what?
An intrinsic factor so it can be absorbed by the terminal ileum
MCC of macrocytic Vitamin B12 Deficiency Anemia?
Pernicious anemia
- lack intrinsic factor
- MCC in western hemisphere
What disease causes microcytic Vitamin B12 Deficiency Anemia?
Crohn Disease
What clinical feature is present in microcytic Vitamin B12 Deficiency Anemia and not in Folate Deficiencies?
Neuropathy
What causes hemolytic Sickle Cell Anemia?
- Autosomal recessive disorder (requires 2 genes from 2 carries)
- under hypoxic conditions the hbg molecule polymerize causing RBC to sickle
Hemolytic sickle Cell Anemia is MC in what descent?
African descent (1 in 12)
A pt with hemolytic Sickle Cell Anemia can experience aplastic crises, how is that provoked?
- Provoked by a viral infection (human parvovirus B19)
Normocytic Aplastic crises reduced the ability of what?
- Reduces the ability of bone marrow to compensate
What is the MC clinical manifestation secondary to vaso-occlusion in pts with hemolytic Sickle Cell Anemia?
Painful crises involving the bones
- osseous infarction leading to severe pain.
- last up to 1 wk
What is the FIRST manifestation secondary to vaso-occlusion in pts with hemolytic Sickle Cell Anemia?
Hand-foot syndrome (dactylitis)
Hand-foot syndrome (dactylitis) is what?
Painful swelling of the dorsal aspect of hands and feet, results from avascular necrosis of metacarpal and metatarsal bones.
What diagnostic tests are used to dx a pt with hemolytic Sickle Cell Anemia?
- CBC showing anemia (MC finding)
- Peripheral smear showing sickle-shaped RBCs
- Hgb Electrophoresis- required to diagnose
What is a tx for hemolytic Sickle Cell Anemia?
- Hydroxyurea
What is hemolytic Hereditary Spherocytosis?
Autosomal dominant inheritance, loss of RBC membrane surface area (loss of biconcave) w/o decreased RBC volume which forces the spherical shape.
Diagnostic test and tx for hemolytic Hereditary Spherocytosis?
- Splenectomy - tx of choice
- RBC osmotic fragility - test the ability of RBCs to swell
- Direct Coombs test - will be negative
What are some general characteristics of hemolytic G6PD Deficiency?
- An X-linked recessive disorder that primarily affects men
- Protects against malaria
What is known to precipitant hemolytic G6PD Deficiency?
- Antibiotics: Sulfonamides and Nitrofurantoin
- Fava beans
What is some diagnostic test for hemolytic G6PD Deficiency?
- Deficient NADPH formation of G6PD levels
- Measurement of G6PD levels is diagnostic
What are some general characteristics of Autoimmune Hemolica Anemia?
RBC destruction
What are the clinical features of Autoimmune Hemolica Anemia: WARM AIHA?
- Leads to extravascular hemolysis, the primary site of RBC entrapment is in the spleen
- More common than cold
What are the clinical features of Autoimmune Hemolica Anemia: COLD AIHA?
Produces complement activation and intravascular hemolysis, the primary site of RBC sequestration is the liver
What diagnostic test is done for Autoimmune Hemolica Anemia: WARM and COLD AIHA?
Direct Coombs test = positive
Tx for Autoimmune Hemolica Anemia: WARM AIHA?
Glucocorticoids
Tx for Autoimmune Hemolica Anemia: COLD AIHA?
Avoid exposure to the cold - helps prevent attacks of hemolysis and subsequent anemia
Hemolytic Sickle cell anemia may cause Priapism what is the tx?
Terbutaline - helps w/ vasocontriction
What test do you order if MCV is >100?
B12, folate, and review RDW
What test do you order if MCV is <80?
Iron studies and review RDW
A lead line along the epicondyle dic seen on an XR is d/t what?
Sideroblastic anemia
