Hematology Case Day Flashcards
Normal Number for Iron
50
Normal number for TIBC
200-350
Normal number for Ferratin
10-200
What is PICA?
Strange craving to chew on things common in iron deficiency anemia
(Pagophagia – chewing on ice)
Pertinent past medical and surgery examples given for diagnosis of anemia
IBD – Decreased B12 reabsorption
Gastric Bypass
What does Hepcidin do
Decreases the transport of Iron
Important anemia signs to look for on physical exam
Vital Sign Changes Pallor Splenomegaly Neurologic Signs Guiac Check in Rectal Exam
Three crucial initial anemia labs
Reticulocyte Count
MCV
Peripheral Smear
How to calculate absolute reticulocyte count (ABR)
(% retic count) * (RBC count)
MCV= ______/________
Hct / RBC
Low Retic. Count. Low MCV – Heme Defect – Name them
Iron Deficiency
Anemia of inflammation
Congenital Sideroblastic Anemia
Lead poisoning
Low Retic Count, Low MCV – Globin Defect – Name them
Thalassemias
What do you see on a peripheral smear with Iron Deficiency
Poikilocytosis
Thrombocytosis
What do you see on a peripheral smear with Thalassemias
Target RBCs
What do you see on a peripheral smear with Lead Poisoning
Basophillic stippling
What do you see on a peripheral smear with Anemia of Inflammation
Toxic Granulation in neutrophils
Iron Deficiency. Serum Iron, TIBC, Ferratin?
Iron – Low
TIBC – High
Ferritin – Low
Anemia of Inflammation. Serum Iron, TIBC, Ferratin?
Iron – Low
TIBC – Low
Ferratin – Normal/High
Thalassemia. Serum Iron, TIBC, Ferratin?
Iron – Normal
TIBC – Normal
Ferratin – Normal/High
Def. megaloblastois if MCV is over
115
Cause of megaloblastosis? non-megaloblastic anemias w/ low retic and high mcv?
Mega – DNA synth problem
Non-mega – Cholesterol membrane defects
Two meds that may cause megaloblastic anemias
Hydroxyurea
Methotrexate
What is seen in peripheral smears in B12/Folate Deficiency?
HYPERSEGMNETED NEUTROPHILS
Leukopenia
Thrombocytopenia
What is seen in peripheral smears in MDS?
Pelger-Huet Anomaly of PMNs
Basophilic Stippling
Varying RBC Shapes
What is a Pelger-Huet anomaly of PMNs?
Bilobed Neutrophil
What might a low retic. count with a normal MCV mean
Primary BM failure (aplastic anemia, BM infiltration)
Secondary BM failure (Low EPI, Meds, Parvo, HIV)
Describe the peripheral smear of a patient with marrow infiltration
Leukoerythroblastic (not enough room in the marrow to finish maturing, so imature RBCs and WBCs are released into the blood)
Describe the peripheral smear of an aplastic anemia patient
Leukopenia and thrombocytopenia
Describe the peripheral smear of a secondary marrow failure patient
Normal
Anemia with a high reticulocyte count means,,,
Shortened RBC survival (Hemolysis or Blood Loss)
General lab findings commonly seen in hemolytic anemia
High Retic, LCH, Bilirubin
Low Haptoglobin
Urine hemosiderin
What is haptoglobin?
Its the guy that carries Iron back to the marrow
If you do a Coombs test on a hemolytic anemia, what antibodies do you use?
IgG – Warm
IgM – Col
What peripheral smear finding is associated with autoimmune hemolysis?
spherocytosis
Common causes of mechanical hemolysis
TTP/HUS (Microangiopathic Hemolytic Anemia)
Prosthetic Valve Hemolysis
Hereditary conditions associated with non-immune hemolysis?
Hemoglobinopathies (Sickle Cell) Enzyme defects (G6PD) Membrane Defects (hereditary spherocytosis)
Spur cell anemia is found in…
Liver Failure
Infection related hemolysis is foudn in…
malaria and babesiosis
Difference between a B12 and a folate deficiency
B12 has neuro symptoms and folate does not
Test for hereditary spherocytosis
Osmotic Fragility Test
