EXAM #3: COMMON HEMATOLOGIC PRESENTATIONS Flashcards
Why is angina a common symptom of anemia in patients with pre-existing CAD?
Decreased oxygen delivery to the heart b/c of decreased oxygen in the blood
What is the definition of anemia in males and feamles?
- Males= Hb less than 13.5
- Females= Hb less than 12.5
What are the common causes of a microcytic anemia?
1) Fe++ deficiency
2) ACD
3) Sideroblastic anemia
4) Thalassemia
How does iron deficiency lead to microcytic anemia?
Hb= heme + globin
- Decreased iron
- Decreased heme
- Decreased Hb
- ->Microcytic anemia
What is the most common cause of Fe++ deficiency in infants?
Breast-feeding
What is the most common cause of Fe++ deficiency in children?
Poor diet
What is the most common cause of Fe++ deficiency in Adults?
PUD vs. hookworm
What is the most common cause of Fe++ deficiency in Elderly?
Colon polyps/carcinoma
What lab values are characteristic of Fe++ deficiency anemia?
- Decreased ferritin
- Increased TBIC
- Decreased serum Fe++
- Decreased %saturation
- Increased FEP
How does increased Hepcidin production in ACD lead to microcytic anemia?
1) Hepcidin sequesters Fe++ in storage sites
2) Decreased available Fe++
3) Decreased heme
4) Decreased Hb
–>Microcytic anemia
What are the lab findings in ACD?
- Increased Ferretin
- Decreased TIBC
- Decreased serum Fe++
- Decreased %saturation
- Increased FEP
Explain the etiology of sideroblastic anemia leading to microcytic anemia.
Sideroblastic anemia= congenital defect in ALA Synthease, the rate limiting step of heme synthesis
1) Decreased protoporphyrin
2) Decreased heme
3) Decreased Hb
–>Microcytic anemia
When protoporphyrin is deficient, where is Fe++ trapped? What does this lead to?
Mitochondria –> “Ringer sideroblasts”
What are the acquired causes of sideroblastic anemia?
Alcoholism
Pb poisoning
Vitamin B6 deficiency
B6 is the cofactor for ALA synthase
What are the lab findings in sideroblastic anemia?
- Increased ferretin
- Decreased TBIC
- Increased serum Fe++
- Increased %saturation
Outline the etiology of microcytic anemia in Thalassemia.
Decreased synthesis of globin chains=
- Decreased Hb
–>Microcytic anemia
What is the hallmark PBS finding of Beta-Thalassemia?
Target cells
What is the approach to treating stable Fe++ deficiency anemia in the elderly?
Oral Fe++ therapy with 325 mg of Ferrous Sulfate and 500 units Vitamin C
What are the most common causes of macrocytic anemia?
Folate/ B12 deficiency
How do Folate and B12 deficiency lead to macrocytic anemia?
Both are necessary for DNA precursors; leads to cell enlargement without division
What type of neutrophil is associated with Folate and B12 deficiency?
Hypersegmented i.e. greater than 5 lobes
Folate deficiency picmonic.
See picmonic.
B12 deficiency picmonic.
See picmonic.
What are the lab findings associated with folate deficiency?
1) Decreased folate
2) Increased homocysteine
3) Normal MMA
What does increased homocysteine increase the risk for?
Thrombosis
What are the lab findings associated with B12 deficiency?
1) Decreased B12
2) Increased serum homocystine
3) Increased MMA
How is B12 deficiency treated?
1) Parenteranl injection
2) Oral supplementation
How do you correct a RC count?
RC x Hct/45
What does a corrected RC count greater than 3 represent?
Good marrow response
What does a corrected RC count less than 3 represent?
Poor marrow response
What are the clinical findings associated with extravascular hemolysis?
1) Splenomegaly
2) Jaundice
3) Bilirubin gallstones
What are the clinical findings associated with intravascular hemolysis?
1) Hemoglobinuria
2) Hemoglobinemia
3) Hemosidinuria
What is the inheritance pattern of G6PD?
X-linked recessive
Outline the etiology of G6PD.
- Decreased G6PD
- Decreased NADPH
- Decreased reduced glutathione
- Oxidative injury
What are the PBS findings associated with G6PD?
Heinz bodies
Bite cells
What type of anemia is seen with G6PD?
Normocytic
What type of hemolysis is associated with G6PD?
Predominantly intravascular
Note that this is different from the case presentation from class
What is the most common source of a PE?
DVT
What is a “D-dimer?”
Fibrin solubility product
Aside from DVTs, what else can cause a PE?
1) Amniotic fluid embolus
2) Fat embolus
3) Hypercoaguable state
4) Cancer
What is the etiology of PV?
Polycythemia Vera= neoplastic proliferation of myeloid cells, esp. RBC
What mutation is associated with PV?
JAK2
What are the symptoms of PV?
Hyperviscosity Syndrome:
1) Itching with bathing
2) Headache
3) Blurred vision
What is a serious complication of PV?
Budd Chiari Syndrome
What is treatment for PV?
1) Phlebotomy
2) ASA
3) Hydroxyurea
How is PV distinguished from reactive polycythemia?
- PV= decreased EPO, SaO2 normal
- Reactive= low SaO2, increased EPO
What are the SaO2 and EPO findings associated with RCC?
Normal SaO2 and high EPO
What are the lab findings in PV?
1) High WBC
2) ALL myeloid cells are increased, more so of the 1 lineage affected
What is the full differential for a patient with macrocytic anemia not attributable to folate or B12 deficiency?
1) Hypothyroidism
2) Liver Disease
3) Alcoholism
4) Myelodysplastic Syndrome
