Clinical approach to anemia online Flashcards
What is polycythemia?
- AKA “erythrocytosis:
- Increase in # of RBC
- Much less common than anemia
2 types of polycythemias?
Primary: “Polycythemia Vera”
- Abnormality of bone marrow categorized as a myeloproliferative syndrome
- Secondary polycythemia occurs in people who smoke or who live at high altitude
Why do patients who smoke or live at high altitude develop polycythemia?
Low blood O2 stimulates EPO leading to increased production of RBCs and hemoglobin concentration
What are the microcytic anemias?
- Iron deficiency: late stages
- Thalassemias
- Lead poisoning
- Sideroblastic anemia
- Anemia of chronic disease: late stages
What are the non megaloblastic MACROcytic anemias?
- Liver disease
- Alcoholism
- Reticulocytosis
How do you tell if anemia is hyperproliferative or a hypoproliferative state?
Reticulocyte count
Why does anemia artificially elevate RBC count?
- Reported as a % of RBCs
- Because anemia is associated with a total reduction in the number of red blood cells, the percentage of reticulocytes may be artificially elevated
How to calculate corrected retic count?
% of reticulocytes x (pt’s hematocrit / 45)
What is a normal RI?
- 0.5% - 2.0%
- RI 2% indicates hyperproliferation
Symptoms of anemia?
Shortness of breath Weakness Fatigue Insomnia Children - growth retardation and failure to thrive
Questions to ask to detect blood loss anemia?
- Have you had dark, tarry stools?
- Do you have any bright red blood in your stool?
- Have you been coughing up blood?
- Do you have blood in your urine?
- Have you been taking NSAIDs or aspirin?
- Do you have heavy or prolonged menses?
What is melena?
- Dark, tarry stools
- Suggest upper GI bleeding
What is hematochezia?
- Bright red blood in your stool
What is hemoptysis?
Coughing up blood
What is Pica?
Craving for items sch as dirt, clay or chalk.
What can lead to malabsorption?
- Gastric bypass
2. Celiac disease
What is Parvovirus B19?
- Virus which replicates in erythroid precursor cells and kills them
- The virus is notorious for causing aplastic anemia in persons with chronic (hemolytic) anemias
What are some signs of hemolysis?
- Darkening of urine
- Yellowing of skin or eyes
- Presence of prosthetic heart valves
What is Koilonychia?
Spooning of nail bed from severe anemia
What is papillary atrophy?
Smooth tongue seen in B12 deficiency anemia
What is scleral icterus and when can it be detected?
- The sclera of eye is yellow because ptn. has jaundice, or icterus.
- As little as 2.5mg/dL of bilirubin
- Typically it becomes evident around 4mg/dL.
What is Hypochromic anemia?
- Cell looks pale because Hgb
- MCH and MCHC decreased in
Usually:
1. Fe deficiency
2. Thalassemia.
What is mchc in macrocytic anemias?
- Normal
- Although Hgb is elevated (MCH is high) the cell itself is also large, so the total concentration of hemoglobin relative to cell volume remains normal
When is RDW high?
- high in iron deficiency anemias and macrocytic anemias.
What are anisocytosis and poikilocytosis?
Evaluate for variations in size (anisocytosis) or shape (poikilocytosis)
What are Acanthocytes?
Have multiple tiny projections seen all over their surface. Seen in liver disease.
What are Burr cells?
Projections are smaller and more evenly spaced than spur cells.
These cells are often present in chronic kidney disease.
What are Bite cells?
- Seen in a G6PD deficiency
- Heinz bodies are seen
What are tear drop cells indicative of?
Myelofibrosis (bone marrow fibrosis)
When are tear drops cells seen?
Liver disease and thalassemia
What can malarial treatment cause?
Symptoms in G6PD deficiency
Who is at risk for infection from encapsulated bacteria?
Sickle cell
When are bite cells seen?
G6PD deficiency
What are microcytic anemias?
- Fe Late
- Lead
- Thalassemia
- Late chronic disease
Which are macrocytic?`
- B12 / folate
- Alcohol
- Reticulocytosis
Normocytic?
- Early Fe
- Early chronic
- Aplastic
- Kidney disease
When is TIBC low?
TIBC tends to be low in anemia of chronic disease because the production of transferrin is decreased in states of chronic inflammation.
