Common anemias

Question 1

How do we classify anemia?

Answer 1

anemia is classified based on how the red blood cells look, i.e. the size of the cell
low MCV: microcytic anemia
normal MCV: normocytic anemia
elevated MCV: macrocytic anemia

Question 2

What causes microcytic anemia, i.e. low MCV level?

Answer 2

iron deficiency

Question 3

What causes normocytic anemia?

RBCs are of regular size but ABSOLUTE number is low

Answer 3

blood loss
HEMOLYTIC anemia
aplastic anemia
anemia of CHRONIC disease

Question 4

What do we expect the lab data of a person with hemolytic anemia to be like?

Answer 4

Hgb and hematocrit LOW

MCV NORMAL

Question 5

What are the different types of hemolytic anemia (normocytic anemia)?

Answer 5

1- Spherocytosis [inflexible RBCs which become trapped and destroyed by spleen]
Tx: spleen-ectomy; blood transfusion; EPO; folic acid

2- Sickle cell anemia [pain and vast-occlusive stroke]
Tx: blood transfusions; hydroxy-urea; pain management; avoidance of precipitants [cold, infection]

Question 6

What information does reticulocyte count provide?

Answer 6

Reticulocyte count is an indicator of the bone marrow’s ability to produce RBCs

High reticulocyte count indicates acute blood loss [sickle cell; G6P def; autoimmune hemolytic anemia]

Low reticulocyte count indicates anemia of chronic disease

Question 7

What are the differentials of anemia of chronic disease [NORMOCYTIC ANEMIA]?

Answer 7

Low serum iron level
Normal to high ferritin (iron stores) level
Low TIBC
Erythropoietin deficiency

Question 8

Define total iron binding capacity

Answer 8

It is the blood’s ability to attach itself to iron and transport it around the body

During iron deficiency, TIBC will be high
if you have too much iron in blood, your TIBC will be low to normal

Question 9

What does a high or a low ferritin indicate?

Answer 9

Ferritin is an acute phase reactant that can be falsely elevated during infection and inflammation

Ferritin is not a direct reflection of iron stores

in people with chronic inflammation, CKD or CHF, high ferritin levels exist but with LOW iron levels

Question 10

What are the differentials of microcytic anemia?

Answer 10

Low Hgb or Hct
Low MCV
Low serum iron
Low ferritin MOST DEFINING CHARACTERISTIC 
High TIBC