Hematology Flashcards
Anemia
Decrease in red blood cells, hemoglobin, or hematocrit
- Characterized by size (MCV) and color (MCH)
Microcytic
Small in size (<80)
Normocytic
Normal in size (80-100)
Macrocytic
Large in size (>100)
Hypochromic
Pale in color
Normochromic
Normal in color
Hyperchromic
Excess color
Serum Iron
How much iron is in circulation
Serum Ferritin
How much iron is in storage
Total iron binding capacity (TIBC)
How many iron binding sites are available for iron to bind to
Peripheral Smear
A visual description of RBCs
Pancytopenia
Combination of anemia, thrombocytopenia, and neutropenia
Bone marrow
Produces RBCs consistent in size and shape unless something is going wrong
Reticulocytes
Immature RBCs and takes about 3 days to mature
Red cell distribution (RDW)
Shows how much RBCs variant size, in comparison to other RBCs and circulation
- < 15% variation in RBC size is considered normal
Iron deficiency anemia
- microcytic and hypochromic anemia
Risk factors:
- Females of childbearing age, children and individuals living in low-middle income countries
Causes:
- Blood loss (generally GI tract GYN), reduced absorption (celiac disease, bariatric surgery) and decreased dietary intake (less common in US)
Presentation:
- symptoms of anemia: fatigue, pica, restless, leg syndrome, headache, exercise intolerance, exertional dyspnea, weakness
Diagnosis:
- Low ferritin (<30), however a normal ferritin does not rule out IDA
Treatment:
- Diet: Increased red meat, organ meat, peas, whole grains, dark leafy greens
- Pharmacotherapy:
- IV vs Oral Iron supplementation
- IV Indicated: Unable to tolerate PO iron, malabsorption, ongoing blood loss
- Oral Iron: Generally all preparations are equally effective
- Can take once a day or every other day
- GI Symptoms are most commonly reported side effects
- Hgb generally normalizes after 6 to 8 weeks of treatment and up to 6 months for iron storage repletion
Iron supplement examples
- Ferric Maltol: 30mg tablet contains 30mg of elemental iron
- Ferrous fumarate: 324mg or 325mg tablet contains 106mg of elemental iron
- Ferrous sulfate: 325mg tablet contains 65mg of elemental iron
Thalassemia
Inherited, micro cystic and hypochromic anemia
- Alpha thalassemia
- Beta thalassemia
Presentation:
- Presentation varies greatly
- Symptoms range from asymptomatic to severe anemia, extramedullary hematopoiesis (sites of erythropoiesis develop outside of the bone marrow), skeletal and growth defects and iron overload.
- Dramatically shortened life expectancy if not treated aggressively, including lifelong transfusion
Diagnosis:
- Diagnostic test is Hgb Electrophoresis/ Genetic testing (globin gene testing)
- Tests that support diagnosis
- Normal serum iron, ferritin, RDW and TIBC (major difference from IDA, which has low ferritin as confirmation for diagnosis)
- Increase in RBCs
- Peripheral smear: Anisocytosis (variation in size), poikilocytosis (variation in shape), and target cells (RBCs that did not delete its nucleus)
Treatment:
- Refer to hematology
- DO NOT supplement with Iron (may cause iron overload)
- Consider reproductive counseling
Anemia of Chronic Disease
- Normocytic and normochromic anemia
- Generally underlying inflammatory disease
- RBCs are hypo-proliferation (die faster than they are produced)
Presentation:
- Suspected ACD in a patient with acute or chronic infectious process, inflammatory disorder, or malignant condition who has Normocytic, norochromic anemia
Diagnosis:
- Characterized by normal to increased iron stores and evidence of an inflammatory disease
Treatment:
- Refer to hematology
- Treat underlying disorder
- Common underlying disorders: Rheumatoid arthritis, or inflammatory bowel disease, also congestive heart failure, COPD, advanced kidney disease, also infection for example HIV, endocarditis and many others.
B12 and Folate Deficiency
Vitamin B12 (Cobalamin): Present in animal derived products
- Risk factors:
- Vegan diet, Strict vegetarian diet, breast feed infant from a vitamin B12 deficient mother, post bariatric surgery, Crohn’s disease, celiac disease, pancreatic insufficiency.
- Meds that impair absorption
- Metformin, neomycin, nitrous oxide, PPIs, H2 Blockers
Folate (Vitamin B9): Present in plant based foods and fortified grains
- Risk factors:
- Increased requirements duet to pregnancy/lactation, decreased intake (substance use disorders, malnutrition, restrictive dieting), chronic excessive alcohol use, residing where cereal/grains are not supplemented with folic acid, goat’s milk as a main source of food in infants toddlers, hemodialysis (give multivitamin to prevent)
Presentation:
- Macrocytic anemia
- Fatigue
- Jaundice
- Neurological symptoms are a later finding
- Most common in Vitamin B12 deficiency
- Most common neuro symptoms: symmetric paresthesias, numbness, gait problems.
Treatment:
- Replacement B12 or Folate therapy
- If anemia is severe or if neuro symptoms present parenteral replacement required.
Sickle Cell Anemia
- Inherited disorder, characterized by the presence of Hemoglobin S (HB s)
- Sickle mutation to RBCs result in hemoglobin that is less soluble than normal
- Persistent vaso-occlusion can lead to acute and chronic pain, tissue ischemia and even infarction
Presentation:
- Symptoms of Sickle cell are not seen at birth, and typically don’t become apparent until after the first few months of life.
- Concentration of HB S rises and the fetal hemoglobin (Hb F) declines
Diagnosis:
- High performance liquid chromatography (HPLC)
- Isoelectric Focusing (IEF)
- Gel Electrophoresis
- Polymerase chain reaction (PCR)
- DNA sequencing
Treatment:
- Co-manage with hematology
- Remain current with age appropriate recommended vaccinations
- Prophylactic Penicillin
- Hydroxyurea for prevention of complications
