Hematology 6% Flashcards
Erythrocyte lineage
Stem cell-> proerythroblast->normoblast (nucleus)->reticulocyte (bluish cells)->RBC
Inc’d retic count (BM working properly)
etio: blood loss - GI, vaginal, hemorrhage inc'd destruction Extrinsic - DIC, hemolysis Intrinsic - membrane protein - hereditary spherocytosis Metabolic enzyme - G6PD Globinopathies - SS, Hb
Dec’d Retic count
Dec'd prodxn dec EPO - chronic renal dz Dec Fe - iron def anemia dec globin - thalassemia dec DNA - megaloblastic anemia BM failure - aplastic anemia - DO WELL with bm tx
Microcytic (MCV<80)
iron def anemia
anemia of inflamm (MCV 78,79,80)
Thalassemia
Sideroblatic anemia
Macrocytic MCV >100
Vit B12/folate (MCV 110) myelodysplasia etoh liver dz liver dz blood loss hypothyroid inc retic hemolysis, blood loss
Normocytic MCV 80-100
renal failure
hypothyroid (98-103)
anemia of inflamm (81,82,83)
aplastic anemia
Iron study - normal
Iron 50-160, transferrin sat 20-45%, TIC 22-420 Ferritin >20 (station wagon 1/3 full)
Iron def anemia -
now school bus very empty
iron <15%, high TIBC (more seats), low ferritin (low iron=low ferritin)
Anemia of inflamm
liver secretes hepicidn, inc’d ferroportin in macrophages - internalize feroprtin so that iron can’t get out of macrophages
low iron, low to normal transferrin sat, low TIBC cuz high ferrtin just inaccessible
Hemochormatosis
screening test - transferrin saturation is most specific - high iron high ferritin low TIBC (occupied)
Most sensitive assay for IDA -
ratio soluble transferrin/log ferritin
>2=IDA
<1 anemia of inflammation
Chronic alcoholism
inc’d carbohydrate free transferrin level
Celiac sprue
oily stools, itch skin lesions (dermatitis herpetiformis - tx with dapsone) - TTG+, IDA
R/O IDA
ferritin >100
Paroxysmal nocturnal hematuria PNH
C3 dep on RBC, C4 deposits, C6-9 party->hemolysis - pt wakes up with coca cola urine -> also with abd pain -> thrombus in ODD places (splenic thrombosis) - dx with Flow cytometry CD55/59
Tx: BM tx
slso give meningiococcal vaccine
Anemia of inflammation (chronic dz)
RBC can’t use iron from reticuloendotheial stores (Macrophages etc) due to hepcidin release (traps iron in macrophages) in chronic inflamm states like Rheum arthrtisi, LE, TB etc (iron filled macros in BM)
Pagophagia
eating ice in IDA
Hg 10, MCV 85, TIBC low, TF sat 22% ferritin low 120 - BM shows?
dec sideroblasts and inc iron filled macrophages
70 M or post meno F with Hg9.5, MCV 70, low ferritin - wtd?
GI w/u
Young - EGD
Old - colonoscopy
25yo F Hg 9, MCV 63 Ferritin low RDW 17 - hypochromic microcytosis, target cells, pencil/cigar cells dx?
Menstrual loss or preg with inc need
Tx - PO iron (IV only with renal failure)
When to check retic count during IDA tx
5 days
60yo F DM,RI p.w fatigue, Hg 9, occult neg, EPO 10 (n) started on epo, 4 wks alater Hg only 9.2 wtd?
start iron supp - too low to make cells
Hg 10.5, MCV 80, peripheral smear normal - uniform size cells RDW 14
inc plasma volume
Hg 10.5m MCV 75, hypochormic microcytic cells RDW 17%
IDA