Heme Flashcards
How to work up microcytic anemia?
Ferritin, fe, %sat, TIBC
How to work up normocytic anemia?
T.bili/direct bili
LDH
Haptoglobin
How to work up macrocytic anemia?
Megaloblastic vs nonmegaloblastic
If megaloblastic, get b12 folate mma.
Causes of nonmegaloblastic macrocytic anemia?
Liver disease, etoh, drugs (haart, 5fu), metabolic (lesch-nyhan, orotic aciduria).
Neurologic side effects of B12 deficiency?
DCML destroyed – loss of proprioception. Irreversible.
Thalassemia
Problem in globin creation.
Alpha thalassemia (1 missing=asx, 2 missing = mild, 3 missing = severe, 4 missing = hydrops fetalis)
Beta-thalassemia (1 missing mild, 2 missing severe)
How to diagnose thalassemia? How to distinguish between alpha and beta thal?
Hemoglobin electrophoresis. Beta thalassemia has weird hemoglobins (HbA2, HbF). Alpha thalassemia is a diagnosis of exclusion.
How to treat thalassemia minor and thalassemia major?
Minor- no treatment
Major – transfuse, be careful about iron overload. Give desferoxamine.
Causes of sideroblastic anemia
B6 deficiency, cancer, MDS – reversible
Reversible forms: EtoH, lead, low copper.
Sickle Cell anemia diagnosis?
Do a hemoglobin electrophoresis. In a crisis? Look at smear for sickling.
How to treat sickle cell crisis?
IVF, O2, pain control.
If priapism, acute chest, acute brain? Exchange transfusion
G6PD Deficiency
Oxidative stress caused by drugs, fava beans, etc causes rbc lysis.
Cells in G6PD
Heinz bodies leading to bite cells
How to diagnose G6PD deficiency?
Look at G6PD levels 6-8 weeks after event. Can’t check it during hemolysis.
Hereditary spherocytosis
Defect in ankyrin or spectryn, loss of central pallor. Hemolyzed in spleen.
How to treat hereditary spherocytosis
IVIG, splenectomy, folate, iron
How to treat warm hemolysis?
Steroids or eculizumab
PNH
Lack DAF, complement fixation during the night leads to intravascular hemolysis. Cells are CD55 negative. Platelets
Presenting signs of chronic leukemia
Increased white count, smear normal. Patient usually asymptomatic
Presenting signs of acute leukemia
Anemia, bleeding, fevers, bone pain. Younger patients.
AML
Seen in patients in their late 20’s usually. Can go into DIC, have auer rods. Show myeloperoxidate. Treat M3 with ATRA. Otherwise with chemo