Clinical Approach to Anemia

Question 1

What is anemia?

Answer 1

It refers to a decrease in the number of red blood cells. It is actually, however, defined as a reduction in oxygen transporting capacity of the blood.

Question 2

What is polycythemia?

Answer 2

It is also known as erythrocytosis. This condition is an increase in the total number of red blood cells.

Question 3

Polycythemia Vera (Primary Polycythemia)

Answer 3

It is a primary abnormality of the bone marrow categorized as a myeloproliferative syndrome.

Question 4

Secondary Polycythemia

Answer 4

This occurs in people who smoke or live at high altitudes

Question 5

What are examples of microcytic anemias?

Answer 5

Iron deficiency (late stages)
Thalassemias
Lead poisoning
Sideroblastic anemia
Anemia of chronic disease (late stages)

Question 6

What are examples of macrocytic anemias?

Answer 6

Megaloblastic

• Folate deficiency
• B12 deficiency

Non-megaloblastic

• Liver disease
• Alcoholism
• Reticulocytosis

Question 7

What are examples of normocytic anemias?

Answer 7

Iron deficiency (early)
Anemia of chronic disease and chronic inflammation
Chronic kidney disease
Aplastic anemia (marrow failure)

Question 8

How does the nature of iron deficiency anemia change over time?

Answer 8

In early iron deficiency anemia, the MCV may be normal, but as the iron levels continue to decline over time, the anemia will often become microcytic.

Question 9

What does a high reticulocyte count in response to anemia mean?

Answer 9

A high reticulocyte count reflects an adequate response of the bone marrow to the anemia.

Question 10

What does a low reticulocyte count in response to anemia mean?

Answer 10

A low reticulocyte count indicates an underproduction or an inadequate response of the bone marrow.

Question 11

Reticulocyte index (RI)

Answer 11

% of reticulocytes x (pt’s hematocrit / 45)

40 for females

Question 12

What is the normal RI?

Answer 12

0.5-2%

Question 13

Absolute reticulocyte count

Answer 13

Measured by flow cytometry

Normally, the ARC should be greater than 25,000-75,000µL

Question 14

What are the 3 general causes of anemia?

Answer 14

Blood loss (acute or chronic)

Decreased production (ie bone marrow failure issues)

Increased destruction (ie hemolytic anemias)

Question 15

What are some common symptoms of anemia?

Answer 15

Shortness of breath
Weakness
Fatigue
Insomnia
Children - growth retardation and failure to thrive

Question 16

How do prosthetic heart valves contribute to hemolysis?

Answer 16

They can cause physical breakage of red blood cells

Question 17

MCH or mean corpuscular hemoglobin

Answer 17

It is the average mass of hemoglobin per red blood cell

MCH = (Hemoglobin x 10) / RBC

Question 18

MCHC or mean corpuscular hemoglobin concentration

Answer 18

It is a measure of the concentration of hemoglobin in a given volume of red blood cells
MCHC = Hemoglobin / Hematocrit

Question 19

Hypochromic Anemias

Answer 19

Anemias in which the red cell looks pale due to decreased Hb. Both MHC and MCHC will be decreased.

Question 20

What are the most common hypo chromic anemias?

Answer 20

The most common hypochromic anemias are iron deficiency and thalassemia.

Question 21

Hyperchromic Anemias

Answer 21

Hyperchromic anemias are anemias in which the red blood cell appears darker and deeper in color on a blood smear.

MCHC is elevated in hyperchromic anemias.

Question 22

What is an example of hyper chromic anemia?

Answer 22

Hereditary Spherocytosis

Question 23

What is the MCHC like in macrocytic anemia?

Answer 23

MCHC is normal in macrocytic anemias. Although the amount of hemoglobin is elevated (MCH is high) the cell itself is also large, so the total concentration of hemoglobin relative to cell volume remains normal.

Question 24

RDW, or red cell distribution width

Answer 24

RDW, or red cell distribution width, is a measure of variation in red cell sizes.

Question 25

When is RDW high?

Answer 25

RDW is high in iron deficiency anemias and macrocytic anemias.

Question 26

With what types of anemia is RDW normal?

Answer 26

RDW is normal in thalassemias and anemias of chronic disorders.

Question 27

Anisocytosis

Answer 27

Anisocytosis refers to a variation in red blood cell size. RDW is a quantitative measure of this.

Question 28

Poikylocytosis

Answer 28

Poikylocytosis refers to a variation in red blood cell shape.

Question 29

Acanthocyte or spur cell.

Answer 29

Have multiple tiny projections seen all over their surface. Seen in liver disease.

Question 30

Echinocyte or burr cell

Answer 30

These cells are often confused with spur cells. The projections on burr cells are smaller and more evenly spaced than spur cells. They also show a small area of central pallor as compared to spur cells. These cells are often present in chronic kidney disease.

Question 31

Bite Cells

Answer 31

Seen in a G6PD deficiency. Red blood cells typically form Heinz bodies, which are small round inclusions in the cell, made up of denatured hemoglobin. As this atypical cell passes through the spleen, it removes the Heinz body and the result is a bite cell.

Question 32

Dacrocyte or teardrop cell

Answer 32

These cells are typically seen in myleofibrosis (bone marrow fibrosis) or infiltration of the bone marrow by a proess like metastatic cancer. These cells take on a teardrop shape because they are forced to squeeze themselves in narrow spaces in a fibrosed bone marrow or marrow crowded with cancer cells.

Question 33

Codocyte or target cell

Answer 33

These cells are named as such because they appear with a central, darker area surrounded by a white ring, giving them the appearance of a bull's eye. These cells are typically seen in liver disease and thalassemia.

Question 34

What disease has a defect related to spectrin?

Answer 34

Hereditary Spherocytosis

Question 35

What disease increases a patient's risk for infection by encapsulated bacteria?

Answer 35

Sickle Cell Anemia

Question 36

What disease may have symptoms develop upon treatment for malaria?

Answer 36

G6PD Deficiency

Question 37

When are hyperhsegmented neutrophils seen?

Answer 37

Megloblastic Anemia

Question 38

When are bite cells seen?

Answer 38

G6PD Deficiency

Question 39

When are shistocytes seen?

Answer 39

Microangiopathic Hemolytic Anemia

Question 40

When are teardrop cells seen?

Answer 40

Bone Marrow Infiltration

Question 41

Pernicious Anemia

Answer 41

Autoimmune condition that results in the atrophy of the parietal cells in the stomach. 1. ) Antibodies that block the cobalamin from binding to IF 2.) Antibodies that bind to the IF and do not allow attachment in the ileum and 3. ) Antibodies directed against the parietal cells themselves.

Question 42

DAT

Answer 42

In the direct test, an animal anti-IgG or anti-C3 is added to the patient's serum. If the patient's red blood cells are coated with an antibody or complement, they will agglutinate.

Question 43

IAT

Answer 43

In the indirect test, the patient's serum is added to a sample of red cells expressing a known set of blood group antigens, followed by the addition anti-human immunoglobulin. If agglutination occurs, this test is positive.