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Skin, Lymph, Blood > Dr. Pence - Anemia Clinical Diagnosis And Management > Flashcards

Dr. Pence - Anemia Clinical Diagnosis And Management Flashcards

1
Q

Anemia : is what and can happen due to what

A

Low RBC mass

  1. TH : low
  2. ERP : low (chronic kidney disease)
  3. Testosterone : lower
  4. Fe+3 : low
  5. VIT B12 : low
  6. Folate : low
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2
Q

Anemia Sx

A
  • fatigue
    -Dyspnea
  • pre-syncopal sx
  • pale conjunctiva
  • Pale skin
  • lines on nails
    (Can be sleep deprivation)
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3
Q

In the cross that Dr. Pence has what is in leach space (X)

A

TOP : Hgb
BOTTOM : Hct
LEFT : WBCs
RIGHT : Plt

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4
Q

Hct normal
Hgb normal
Reticulocyte count Index

A

Hct : 37%-54%
Hgb : 12-16 F, 14-18M
R county Index : > 2 means BM is responding to an anemia

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5
Q

Normocytic MCV

A

78-98fL

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6
Q

RDW is what and normal range

A

Variation in size of RBC
12%-15%
High variation is more in anemia (esp, in Fe+3 deficiency)

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7
Q

LDH

A

Lactate Dehydrogenase
= high inside blood and tissue
= high level if tissue damage or hemolysis

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8
Q

Indirect (unconjugated bilirubin)

A

Breakdown product of RBC

High is hemolysis

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9
Q

Haptoglobin

A

Plasma protein binding to free hemoglobin

= LOW if there is hemolysis

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10
Q

Iron Studies what it means :
Ferritin
Transferrin
Total Iron Binding Capacity

A

Ferritin : Fe storage , best way to measure amount of iron in blood
Transferrin : iron transporting protein (high during anemia = TIBC) = to confirm Fe+3 deficiency anemia
= low in Anemia of chronic disease

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11
Q

When can Ferritin be high

A
  • high Fe*
  • inflammation *
  • autoimmune *
  • infection *
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12
Q

Anemia + low reticulocyte count

What do I do now

A

Check MCV

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13
Q

Anemia and Reticulocyte count is high

What do I do now

A

Reason through if it is blood loss or consumption issue

  • LDH, Haptoglobin, Bilirubin = hemolysis
  • find bleed
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14
Q

EX of high reticulocyte count anemia

A
  • chronic bleeding

-

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15
Q

EX of low MCV anemia

A
  • Fe+3 deficiency (IDA)
  • Thalassemia
  • SC
  • Sideroblastic
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16
Q

EX of normal MVC anemia

A
  • renal disease
  • BLOOD LOSS
  • ANEMIA or CHRONIC DISEASE (ACD)
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17
Q

EX of anemia with high MCV

A
  • Folate deficiency (megaloblastic)
  • B12 deficiency (megaloblastic)
  • Hypothyroidism
  • EtOH
  • MDS (macrocytic only)
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18
Q 
CASE 1 : male 68yo, 3mo of easy fatigabilty, dyspnea on exertion
Fingernails tear, looks skinnier, drinking pain used on car , nails are curled and lines
PE : pale and conjunctiva pallor bilaterally, inflammation on corner of mouth 
- low Hgb
- low Hct
- normal WBCs and Plt 
- low reticular count
-MCV LOW
- high RDW
- low ferritin, and high Transferrin 
- Transferrin saturation % = LOW
= what is it and what do you do
A

= Fe+3 deficiency (IDA)
due to the high transferrin = high Total Iron Binding Capacity
Low T sat = stored/capacity
= find out reason, change in bowel habits, blood in stool, vomit blood, diet….

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19
Q

Male 68yo with IDA has blood in stool what do you do

A

Colonoscopy and colon cancer

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20
Q 
35yo male fatigued started 60month before
Wrist hand and knee swollen bilaterally = morning stiffness 
Takes NSAIDS don’t help 
- low Hct
- low Hgb
- normal WBC and Plt
 -low reticulocytes
- MCV NORMAL
- RDW : N
- Fe+3 LOW
- Ferritin HGIH
- Transferrin Low
- Trasnferrin Sat LOW
A

Anemia of Chronic Disease (ACD) (malignancy, infection, autoimmune like RA)

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21
Q

How does inflammation increases Ferritin

A

Inflammation :

  1. Decreased absorption of Fe
  2. Decreases EPT production
  3. Increases HEPCIDIN : increases Ferritin and lowers Transferrin/Ferroportin
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22
Q

How to TX ACD

A
  • TREAT cause of the anemia
    (Don’t give Fe+3 supplements without knowing cause of problem)
    ** if there is CKD or malignancy = give Erythrocytes Stimulating Factor (ESF) , can give thrombosis however improves anemia
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23
Q

Blood transfusion should be given to

Only for rotations

A

Hgb less then 7 or 8 if pt has acute coronary syndrome or problems

24
Q 
35yo males epigastric pain 3months ago onset, 3 episodes of coffee ground emesis (past 24hrs), OTC antacids help, NSADS taken regularly for various injuries, ABD distention 
- Tachy, hypotension, cool extremities = not good HYPOVOEMIC SHOCK
- pallor 
- VERY low hgb (6)
-low Hct 
- normal WBC, plt
- retic count normal, RI low 
MCV : normal
A

UGIB and in hemorrhagic shock

  • normal retic count - since it’s acute bleeding
  • RI is usually high in acute bleeding so its low here because : BM has not been able to start making more
25
Q

Normocytic anemia + normal reticulocyte count when there is hypovolemic shock is now

A

Hemorrhagic shock

Uncompensated blood loss —> BM has not had time to compensate

26
Q

What can happen from anemia from acute blood loss

A

Renal failure
MI
Hypovolemia

27
Q

TX hemorrhagic shock

A
  1. Apply pressure and compression when you can
  2. Give blood and fluid (2 IVs), O- blood
  3. Surgery and suture up the bleed
28
Q

If someone is visibly bleeding and there Hgb is normal what do you do

A

Give them blood and fluids still

29
Q

who makes Anti-D AB

A

Someone who is Rh-

30
Q

What to do if mom is Rh- and fetus is Rh+

A

Give Rhogam to mom (it is a drug antibody against the Anti-D AB)

31
Q

4yo AA right leg pain in hip, trauma moved states to higher elevation

  • SOB when playing,
  • FH of blood in urine, and anemia
  • tachy, and HTN, 91% O2 sat
  • crackles in left base lung
  • LUQ tenderness and fullness
  • low Hgb and low hct
  • WBC and plt low
  • MCV low
  • RDW HIGH
  • Retic count is low , RI low
A

He has SC
And osteonectrosis in hip femoral hip
Usually a SC crisis has a high Retic count however it can be low also
= give opioids
= transfusions to reduce HgS less then 30 (high alloimmunization + FE iron overload)

32
Q

3 common presenting sx of SC

A
  1. Microvascular occlusion
  2. Tissue damage
  3. Chronic Hemolysis
  4. Stroke
  5. Thrombosis
  6. Acute Chest Syndrome : fat thrombus from the necrosis of a bone (pulmonary infiltrate on CXR, hypoxemia, SOB, fever) pneumonia **
  7. Kidney/spleen problems
33
Q

Acute Chest Syndrome how to TX

A

= give pneumonia medication (in case)

=transfusion and O2 given

34
Q

Kidney problems in SC

A
  1. Polyuria (can’t concentrate urine)
  2. Hematuria (even SC trait can have it)
  3. Vasocclusion of small vessels
35
Q

Osteomyelitis is what

A

Fever and hip pain (infection in the dead bone)

36
Q

Spleen problems in SC

A

Hypovolemia
Splenomegaly
Autosplenectomy (splenic infarcts)

37
Q

No spleen casuals what common things

A

Encapsulated infections

Dots in the RBCs

38
Q

How to TX SC crisis

A
  1. Start O2 and exercises (blow in from a tube as much as you can to expand the lung)-center spirometer
  2. Control pain : opioids, NSAIDS, Tylenol (to help breathing, oxygenation, hostle behavior)
  3. Check in on them often (like after 4hrs)
39
Q

What can cause SC crisis

A

Cold weather and high elevation

40
Q

Hydroxyurea

A

Upregulate HgF
Downregulate HgS
= for SC patients
= can cause FE overload

41
Q

Exchange transfusion in SC

A

Take out there old blood put in new blood

- prevents iron overload

42
Q

Stem cell transplant in SC

A

Only for under 16yo
Can be curative
With 10% mortality rate

43
Q 
25yo female with 1 week fatigue, weakness, dizziness, red spots all over the shoulder where she has her purse , gingival bleeding, 
- she had a UTI and was TX with ABs
- pale and tired, conjunctival pallor, petechiae 
- low Hct
- low Hgb
- low WBCs
- Low plt
- MVC HIGH
- Retic count low, RI low 
- normal RDW
- BM only fat 
-
A

Panocytopenia **

Aplastic Anemia

44
Q

What can cause AA

A

Drugs
Virus
Radiation/benzene
Fanconi anemia

45
Q

AA TX

A

Transfusion support and Growth factor support

= if nothing then stem cell transplant (young respond to this more

46
Q

B12 foods

A

Dairy, cheese, fish, meats, fortified food

Deficiency happens over years

47
Q

Other name for B12

A

Cobalamin

48
Q

B12 deficiency can happen from

A 
Diet
Gastrectomy 
Crohn’s disease
Gastric bypass
Pernicious anemia
49
Q

B12 deficiency confirmed by

A

HGIH Methylmalonci acid and Homocysteine

Low B12 vitamins

50
Q

Folate Deficiency confirmed how

A

High homocysteine only

51
Q

Other name for Folate

A

VIT B9, folic acid

Takes some months

52
Q

Folate deficiency can happen from

A 
Diet
Crohns 
celiac 
Pregnancy 
Mx like Methotrexate (SLE,RA)
53
Q

Folate in absorption is where

A

Jujunnium and lillium

54
Q

Low MCV

Normal RDW

A

ACD

55
Q

Normal MCV

Normal RDW

A

ACD

56
Q

HIGH MCV

Normal RDW

A

Chemo, Anti-viral medication, alcohol in excess,

APLASTIC ANEMIA

57
Q

Low MCV

HIGH RDW

A

IDA

Skin, Lymph, Blood (9 decks)

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