Hematology #1 Flashcards
MCC of anemia worldwide
Iron deficiency anemia
What is the most common cause of iron deficiency anemia in the US
What is the most common cause of iron deficiency anemia in the world
- Chronic blood loss: menstruation, Colon cancer, Hookworms
- Diet (worldwide)
Risk factors for iron deficiency anemia
- Increased metabolic requirements: children, pregnant, lactating women
- Cow milk ingestion in young children: infants given cow’s milk < 1 year of age
Symptoms of iron deficiency anemia
- Fatigue, weakness, exercise intolerance, dyspnea
- Pasophagia (craving for ice)
- Pica (craving for non-food substances)
- Koilonychia (spooning of nails)
- Angular cheilitis (inflammation of both corners of mouth)
- Glossitis (smooth tongue)
What do iron studies in iron deficiency anemia show?
- Decreased ferritin
- Increased TIBC (transferrin)
- Decreased transferrin saturation
- Decreased serum iron
What gives a definitive diagnosis for iron deficiency anemia?
Bone marrow biopsy: absent iron stores
What is ferritin?
Ferritin stores iron in the blood
What is transferrin?
Transporters of iron in the blood (ferry)
-TIBC is the binding capacity of transferrin, so if they are increased, there is low iron in the blood
Treatment for iron deficiency anemia
-Iron replacement
What are some tips you should give patients when telling them how to take their iron replacement?
-Take iron with vitamin C (ascorbic acid), with water or orange juice and take on an empty stomach
What is the main cause of lead poisoning anemia in the US
-ingestion or inhalation of environmental lead (paint chips or lead dust)
Symptoms of lead poisoning anemia
- Neurologic symptoms: ataxia, fatigue, learning disabilities, wrist or foot drop
- Intermittent abdominal pain, vomiting, loss of appetite
Diagnostic for lead poisoning anemia
-Serum lead level > 10 mcg/dL on venous sampling most accurate
What does a peripheral smear for lead poisoning anemia?
Microcytic hypochromic anemia with basophilic stippling
-Ringed sideroblasts in the bone marrow
Treatment for lead poisoning anemia
- Removal of the source of lead (most important treatment)
- If 45-69 mcg/dL: Succimer (oral) or Calcium disodium (if oral no tolerated)
What is thalassemia?
Decreased production of globin chains
When should you consider thalassemia?
If microcytic anemia with normal serum Fe or no response to Fe treatment
Explain the absorption of B12
B12 is released by acidity of the stomach and combines with intrinsic factor where it is absorbed mainly in distal ileum
B12 deficiency causes ________. It is needed to convert ______ to methionine for DNA synthesis.
- Abnormal synthesis of DNA
- Homocysteine
Etiologies of B12 deficiency anemia
- Pernicious anemia (lack of intrinsic factor)
- Crohn Disease
- Chronic alcohol use
- H2 blockers and PPIs
- Metformin
- Vegan diet