Clinical approach to anemia

Question 1

What are the three classifications of anemia?

Answer 1

Morphology: size measured by MCV

Function: measured by reticulocyte count

Mechanism: blood loss, decreased production, increased destruction

Question 2

Low reticulocyte count mean?

Answer 2

RI: <2%

hypoproliferative anemia

• defiency
• anemia of chronic disease
• anemia due to endocrine disorders
• anemia due to bone marrow infiltrates and stem cell disorders

Question 3

High reticulocyte count corresponds to…?

Answer 3

RI > 2%

Hyperproliferative

Caused by:

• acute blood loss
• hereditary hemolytic disease
• acquired anemias: malaria, valvular disease, immune mediated

Question 4

What are the important topics to cover during history?

Answer 4

• any recent bleeding?
  
  • prolonged periods?
  • tarry or dark stools?
  • blood in urine?
  • coughing up blood?
• common symptoms: fatigue, weakness, imsonia, children [growth retardation & failure to thrive]
• nutritional deficiences: iron, b12, folate
• chronic illnesses: cancer, liver disease, infections (TB, osteomyelitis), CKD
• recent actue illness or virus (diarrhea = HUS)

Question 5

Typical findings on PE for anemias?

Answer 5

• scleral icterus: jaundice of eyes — hemolytic via bilirubin
• jaundice — hemolytic
• conjunctival palor
• spooning of nails —- nutritional
• smoothing of tongue: papillary atrophy —- nutritional
• angular stomatis: sores on the mouth —- nutritional
• slapped hand prints on face—- nutritional

Question 6

What are the MCH and MCHC? What are they used to determine?

Answer 6

Mean corpuscular hgb

Mean corpuscular hgb conctration

they are used to determine hyperchromic (too much hgb; darker and deeper red) VS hypochromic (too little hgb; pale cells)

Question 7

IN macrocytic anemias, is the MCHC elevated, low, or normal?

Answer 7

It is normal; even though theres more hgb, volume is in the demonimator and has also increased

Question 8

What does RDW measure?

Answer 8

Red cell distrubution width

Describes the variation of cell size

normal: thalasemia or anemia of chronic disease

increased: hemolytic anemia and macrocytic anemia

Question 9

What are anisocytosis and poikylocytosis?

Answer 9

A: variation in size

B: variation in shape (polygon)

Question 10

Answer 10

liver disease

Acanthocyte (acantho = “spiny”) or spur cell

Question 11

Answer 11

• Echinocyte or burr cell
• chronic kidney disease
• more evenly spaced than spur cells

Question 12

Answer 12

• Bite cell
• deficiency of the enzyme G6PD (glucose-6-phosphate-dehydrogenase)
• Heinz bodies

Question 13

Answer 13

schistocyte via hemolytic anemia

Question 14

Answer 14

Dacrocyte or teardrop cell

myeloma

Question 15

Answer 15

Codocyte or target cell

thalassemia + kidney disease