Hematology from PANCE Pearls Flashcards
What are the 3 reasons anemia happens
Blood Loss
Increased RBC destruction
Decreased RBC production
Sx of Anemia
Palpitations, tachycardia, high output HF, SOB, Tachypnea, Chest Pain, pallor, purpura, headache, hepatosplenomegaly
What is workup for Anemia
CBC with RBC indices (Hgb, HCT, MCV, MCH, RDW, RBC count)
Peripheral Blood Smear
Bone marrow biopsy is gold standard (not done in most pts)
What does a reticulocyte count tell you
What if its elevated vs. decreased
Body’s response to anemia
Increased: Brisk bone marrow response to hemolysis or blood loss
Decreased: Deficient production of RBC
What are the 3 categories under Macrocytic Anemia
B12 Deficiency
Folate Deficiency
Alcohol Abuse/Liver Disease/Hypothyroidism
What are 2 causes of B12 deficiency
Malabsorption (Pernicious, Alcohol, Crohn's) Decreased Intake (Vegans)
Sx of B12 deficiency
Anemia
Pallor, Glossitis, Stomatitis
NEUROLOGIC SX: Peripheral neuropathy, ataxia, weakness, vibratory, sensory)
Dx of B12 deficiency
Peripheral smear: Large MCV, hypersegmented neutrophils
Decreased B12
Increase in serum homocysteine and increased methylmalonic acid
Tx of B12 deficiency
IM B12
Where is folate absorbed
Jejunum
What are reasons for Folate Deficiency
Malabsorption, pregnancy, hemolysis
Sx of Folate Deficiency
Anemia, Pallor
NO neurologic sx
Dx of Folate Deficiency
Increasd MCV, Hypersegmented neutrophils, decreased Folate, normal B12
Tx of Folate Deficiency
Folic Acid AND B12
What are the 3 most common forms of Microcytic Anemia
Iron Deficiency
Alpha/Beta Thalaseemia
Anemia of Chronic Disease
What is the most common cause of iron deficiency anemia
Bleeding
Sx of Iron Deficiency Anemia
Anemia sx (fatigue, pallor) Pagophagia (ice craving), pica, angular cheilitis, koilonychia (nail spooning)
Dx of Iron Deficiency Anemia
Decreased serum Fe Decreased Ferritin Increased TIBC Increased RDW Decreased RBC count Decreased MCV
Tx for Iron Deficiency Anemia
Iron Replacement
What is Thalassemia
Decreased production of globin chains
What should clue you into Thalassemia regarding lab values
Microcytic anemia with normal or increased serum Fe or no response to Fe treatment
What is Alpha Thalassemia
Decreased alpha-globin chain production
What is a silent carrier in Alpha Thalassemia
3 normal genes, clinically normal
What is an Alpha-T minor alpha Thalassemia trait
2 normal genes
No sx with mild anemia
What is alpha-T intermedia (Hgb H disease
Sx seen
1 normal gene
Severe anemia
See Heinz Bodies
Pallor, Hepatosplenomegaly, Microcytic Hemolytic Anemia
What is Alpha-Thalassemia Major (Hydrops Fetalis)
No functioning alpha genes
Associated with stillbirth or death soon after from high output failure
Dx of Alpha Thalessemia
Peripheral Smear: Target cells, Tear drop cells
HgB Electrophoresis: Normal HgbRatios
Tx of Alpha Thalessemia
No tx for mild
Moderate: Folate, avoid oxidative stress (Sulfa drugs)
Severe: Blood Transfusion, Iron Cheleating Agents, Bone Marrow Transplant is definitive
What is Beta Thalassemia
Decreased production of beta globin chains
What is Beta-Thalassemia trait (minor)
1 defective gene
Asymptomatic or mild anemia
What is Beta-Thalassemia Intermedia
Mild form
What is Beta-Thalassemia Major (Cooley’s Anemia)
Sx
Both beta genes are mutated
Results in erythroid hyperplasia and extra medullary hematopoiesis
Hepatosplenomegaly, severe hemolytic anemia (jaundice, dyspnea, pallor), osteopenia, frontal bossing, iron overload, gallstones
Dx of Beta-Thalassemia
Peripheral Smear: Target Cells
Microcytosis and normal/increased serum iron with increased RBC
Hgb electrophoresis: Increased HgbA2 or Increased HgbF
Tx of Beta-Thalassemia
Trait: none needed
Major/Severe: Transfusions, Chelating agents, Bone Marrow Transplant
What is Lead Poisoning Anemia (Plumbism)
Acquired sideroblastic anemia
Sx of Lead Poisoning Anemia
Abdominal pain with constipation neurologic sx (ataxia, fatigue, learning disabilities, coma, shock)
Dx of Lead Poisoning Anemia
Peripheral Smear: Microcytic hypochromatic anemia with basophilic stippling and ringed sideroblasts in bone marrow
Increased serum lead and increased serum Fe
Tx of Lead Poisoning Anemia
Remove source of lad
Chelation therapy if severe
What is Anemia of Chronic Disease
Chronic inflammatory conditions
D of Anemia of Chronic Disease
Increased Ferritin
Decreased TIBC
Decreased Serum Fe
Tx of Anemia of Chronic Disease
Tx underlying disease
Erythropoietin-alpha if renal disease
