Anemias Popcorn Flashcards by Garima Khanal

2 types of microcytic anemia

iron def

thalassemias

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causes of microcytic anemia

mestrual bleeding

GI blood loss

decreased Fe absorption (celiac, H pylori)

increased Fe requirement (preggo)

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main sx of microcytic anemia

PICA

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dx of microcytic anemia caused by Fe deficiency

MCV <80

Dec. MC.MCHC (hypocrhomic)

Increased RDW

Decreased Ferritin & serum Fe

Increased TIBC

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bone marrow bx shows what in iron def anemia

absence of Fe stores (TF)

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iron def anemia tx

ferrous sulfate until anemia corrected

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how long do you continue ferrous sulfate post iron def anemia correction?

3-6 mos

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what do you use Blood TF for in IDA? (iron def. anemia)

only use to replace Hgb

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1 deletion of alpha in Thal

silent

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2 alpha deletions Thalassemia

mild microcytic

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3 alpha deletions Thal

hemolytic anemia (HgbH dz)

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4 alpha deletions Thal

hydrops fetalis

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minor Beta Thal CPx

asx

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major (cooley’s anemia) = severe dysfunction of both B globin chains

fatal

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Dx of Thalasseia

Low MCV & MCH

Nml RDW

Inc. Ferritin

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peripheral smear of Thal

target cells

nucleated RBC

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what detects type of hemoglobin in Thal?

hemoglobin electrophoresis

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Thal tx

Blood transfusion is severe: iron chelation

DO NOT GIVE FE SUPP.

folic acid

splencectomy

Hematopoietic cell transplatation

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macrocytic anemia is separated into what 2 categories

megaloblastic

non-megaloblastic

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megaloblastic anemias

B12 def

folate def

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avg daily requirement of folate in regular women vs pregnant women

regular: 200
preggo: 400-800

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absorption of folate vs B12

folate: jejeunum

B12: ileum

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are there neuro abnormalities in folate def?

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folate def anemia during pregnancy can cause what

neural tube defects

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daily requirement of B12

1-2ug

causes of B12 def anemia

partial/complete gastrectomy ileal dz or resection bacterial overgrowth or intestinal parasites

pernicious anemia can lead to what?

atrophic gastritis which increases the risk of gastric CA

CPx of B12 anemia

NEURO: - decreased vibratory/position sense - ataxia - paresthesias - confusion/dementia

pathology of pernicious anemia

immune mediated

how can you get false MCV \>100?

increased RBCs or RBC clumping mimicking larger RBCs

folate def labs

serum folate level \<150 Inc. Homocysteine normal methylmalonic acid

B12 def/pernicious anemia labs

leukopenia, thrombocytopenia dec. B12 increased homocysteine & methylmalonic acid

Peripheral smear of both Folate def & B12 def anemia

hypersegmented neutrophils \>5 nuclear lobes macroovalocytes

test for pernicious anemia

positive schilling test a-bodies to IF

folate def tx

replace: 5mg in pts with malabsorption

what do you want to rule out with folate def anemia?

B12 def

pernicious anemia tx

parenteral vit B12: 1000mg IM daily for 1 wk wkly injections for 1 month monthly injections for life

B12 def tex

PO replacement

why shouldnt you treat B12 def with folic acid alone?

can mask progressive worsening of Pernicious anemia that can cause neuro damage

classifications of hemolytic anemia

acute vs chronic acquired or inherited

types of intravascular hemolytic anemias

macroangiopathic (prosthetic heart valve) G6PD def paroxysmal nocturnal hemoglobinemia

CPx of hemolytic anemia in general

pallor SOB **jaundice** **gallstones (billirubin stones)**

G6PD def anemia cause

x-llinked oxidative drugs/infections

G6pd Cpx

episodic hemolysis = healthy, no splenomegaly

G6PD labs

Increased reticulocytes Increased indirect Bilirubin Dec. G6PD levels

G6PD Peripheral smear

bite cells & heinz bodies

G6PD tx

episodes = self limited avoid oxidative drugs

hereditary spherocytosis

aut DOMINANT

hereditary Spherocytosis CPx

asx **mild jaundice** **scleral icterus** splenomegaly

what happens in chronic hemolysis due to H. spherocytosis?

creates need for increased folaye if intake is not adequate --\> megaloblastic anemia develops (folate def)

dx for H. Spherocytosis

osmotic fragility test: RBS increases hemolysis on exposrure to hypotonic sfluids

H. Spherocytosis tx

splenectomy ## Footnote **give pneumovax in adulthood**

CPx sickle cell

develops in childhood: 4-6 mos delayed growth & development increased infections

what 4 things worsen sickle cell sx?

1. dehydration 2. hypoxia 3. intense exercise 4. high altitude

chronic hemolysis in sickle cell can result in what emergency

aplastic crisis: sudden drop in Hb & bilirubin rises

vaso-occlusive ischemic tissue injury results in what emergency (seen in Sickle cell)

pain crisis: MC featue of this dz

sickle cell pain crisis tx

analgesics & fluids

what consists of a pain crisis in sick cell?

osteonecrosis of femoral and humeral heads (bone infarcts) CVA, MI splenic infarcts: functional asplenism leg ulcers

sickle cell dz labs

Hgb: 5-11 normochromic, normocytic increased reticulocytes

best test to confirm sickle cell

Hgb electrophoresis reveals Hbs

peripheral smear of sickle cell

sickled RBCs, nucleated RBCs, target cells, howell-Jolly bodies thrombocytosis

Peripheral smear of Autoimmune hemolytic anemia (AIHA)

polychromasia, spherocytosis, nucleated RBCs

autoimmune hemolytic anemia lab test

positive direct coombs test

sickle cell tx

RBC tranfusions pneumovax & folate supp **HYDROXY UREA (**chemo) for painful crises BM transplant

what helps with hemolysis in general?

Corticosteroids

describe anemia of chronic dz

normocytic, normochromic Can be microcytic as well

anemia of chronic dz labs

normla MCV normal or Increased Ferritin Dec. Iron & TIBC IF inflammation DX OF EXCLUSION

what may benefit anemia of chronic dz?

EPO

causes of sideroblastic anemia

MDS chronic alcoholism lead poisoning meds chronic infections or inflammation malignancy

sideroblastic anemia labs

low/nml/high MCV moderate anemia: Hct = 20-50% nml or increased Ferritin aniso & poikilo **_systemic Fe overload_**

siderblastic anemia dx

BM biopsy

WHat does the BM biopsy for sideroblastic anemia show?

erythroid hyperplasia rringed sideroblasts blue stained iron stippled RBCs

sideroblastic anemia tx

Fe overload: phlebotomy, chelation Pyroxiden Vit B6 for congenital

causes of aplastic anemia

drugs viral ionizing radiation

CPx of aplastic anemia

weakness infections bleeding

aplastic anemia labs

pancytopenia: thrombocytopenia, anemia, leukopenia

dx test for aplastic anemia

BM bx

what does BM bx for aplastic anemia show?

normoblasts granulocytes megakaryocytes

aplastic anemia tx

BM transplant