Heme Flashcards
microcytic anemia (↓ MCV) ↓Serum Fe ↓Transferrin ↓Ferritin ↑TIBC ↑RDW
Iron deficiency
Iron deficiency tx
ferrous sulfate 325 mg QD with vit C
microcytic, hypochromic ↑Serum Fe ↑Serum Lead ↓TIBC ↑Ferritin
Lead Poisoning Anemia
microcytic ↓Serum iron ↓TIBC ↑Ferritin ↑Transferrin
anemia of chronic inflammation
African American Normocytic ↓Hb ↓Hematocrit ↑Reticulocytes ±Howell-jolly bodies Hb electrophoresis: HbS
sickle cell
sickle cell tx
pain control: IV hydration & oxygen, NSAIDs, opioids
Hydroxyurea: ↑RBC water & ↓RBC sickling and ↑HbF Folic Acid
±RBC transfusion: severe only
microcytic ↓MCV ↑ or nrml RBC ↑Serum Fe & ferritin ↓Hb Target cells Heinz bodies
α-Thalassemia
α-Thalassemia tx
Mild: no treatment
Moderate: folate, avoid
oxidative stress, AVOID Fe supplementation
Severe: weekly blood transfusions, Vit C, folate, Iron chelation, Splenectomy, bone marrow transplant
Mediterranean ↓MCV ↑ or nrml RBC ↑Serum Fe and ferritin ↓Hb Target cells frontal bossing hepatosplenomegaly
β-Thalassemia
β-Thalassemia tx
Minor: No med care, genetic counseling
Major: Perodic blood transfusions, Vit C, folate, avoid excess Fe intake, Iron chelating agents, splenectom
How do you dx pernicious anemia?
schilling test
What are the hemolytic anemias with enzyme disorders?
G6PD deficiency
Pyruvate kinase deficiency
What are hemolytic anemias with erythrocyte membrane
disorders?
Hereditary Spherocytosis
Hereditary Pyropoikilocytosis
Hereditary Elliptocytosis
AIHA
What are indications for splenectomy?
splenomegaly, hypersplenism, gallstones, jaundice, growth, transfusion
dependence
What are the microcytic anemias?
Fe deficency
Anemia of Chronic Inflammation
Lead posioning
What are the normocytic anemias with decreased
reticulocytes?
accute hemorrhage anemia of chronic inflammation renal dx liver dx marrow infiltration myelodysplastic syndrome
What are the normocytic anemias with increased
reticulocytes?
hemolyitc anemia
post-hemorrhagic anemia
What are sx of leukopenia/neutropenia?
fever, sx of infections
What are sx of thrombocytopenia?
purpura, petechiae, prolonged bleeding, excessive bruising
What are the general signs of anemia?
fatigue, dyspnea, syncope, pallor, postural hypotension, CHF
What are the macrocytic anemias?
vit B12
Folate
What is pancytopenia?
all 3 cell lines decreased
What is thrombocytopenia?
low platelet count
How do you treat
acquired
neutropenia?
G-CSF
How do you treat
acute myeloid
leukemia?
chemo
How do you treat
anemia of chronic
inflammation?
Eradicate underlying disease
IV Fe
How do you treat
Aplastic anemia?
HSCT
How do you treat autoimmune neutropenia (AIN)?
observation
How do you treat
Autoimune Hemolytic
Anemia (AIHA)?
Warm: Stabilize, Glucocorticoids 1-2
mg/kg QD, Splenectomy or,
Rituximab
Cold: avoid cold, Rituximab,
plasmapheresis
How do you treat
BMF?
HSCT curative but not always
indicated
How do you treat
chronic lymphocytic
leukemia (CLL)?
watch & wait, if sx present treat with
Rituximab
How do you treat
chronic myeloid
leukemia (CML)?
imatinib
How do you treat
DIC?
Treat underlying cause Hydration
RBC transfusion
If bleeding:
platelets, FFP, cryoprecipitate
How do you treat
dimond-blackfan
anemia?
supportive care with RBC
transfusions
How do you treat
Fanconi anemia?
support with transfusion or HSCT
How do you treat Fe
deficiency?
Ferrous sulfate 325 mg po QD witth
vit C
How do you treat
folate deficiency?
Folic acid 1 mg po QD
How do you treat
G6PD deficency?
Self limited
Avoid offending food/drugs
Hydrate
How do you treat
Hemolytic Uremic
Syndrome (HUS)?
Supportive tx: observation, IV fluids
Severe: plasmapheresis, dialysis as
needed
ABX will WORSEN condition
How do you treat
hemophilia A
DDAVP/stimate
How do you treat
hemophilia B?
factor IX infusion
How do you treat
hereditary
spherocytosis (HS)?
Splenectomy & folic acid to help
not cure
How do you treat
hodgekins lymphoma?
Involved field radiotherapy,
chemotherapy
How do you treat
inherited
thrombophillia?
LMW heparin IV Vondaoarinux,
UFH Warfarin (oral once ontrolled)
plus vit K
How do you treat ITP?
Children: observation,shore course steroids, ±IVIG or anti-D Adults: corticosteroids, IVIG, anti-D, platelet transfusion if <30K Chronic: splenectomy, Rituximab, immunosuppressant agents
How do you treat
lymphoblastic
leukemia (ALL)?
chemo
How do you treat
pyruvate kinase
deficiency?
Splenectomy
How do you treat
severe congenital
neutropenia?
G-CSF
How do you treat
sickle cell?
Pain control: IV hydration & oxygen, NSAIDs, opioids Hydroxyurea: ↑RBC water & ↓RBC sickling & ↑HbF Folic Acid
How do you treat TTP?
Plasmapheresis: remove Ab daily 1.5 L plasma vol exchange Immunosuppression: corticosteroids, ±splenectomy if refractory to tx Platelet transfusion CONTRAINDICATED unless likethreatening bleeding
How do you treat vit B
deficiency?
IM B12 (100 mcg daily then weekly
then monthly)
Orabl B12 1mg QD (mild)
Folic acid for first several months
How do you treat von willebrand
disease?
DDAVP/stimate
How do you treat α-Thalassemia?
Mild: no treatment
Moderate: folate, avoid oxidative stress, AVOID Fe supplementation
Severe: weekly blood transfusions, Vit C, folate, Iron chelation, Splenectomy, bone marrow
transplant
How do you treat β-Thalassemia?
Minor: No med care, genetic counseling
Major: Perodic blood transfusions, Vit C, folate, avoid excess Fe intake, Iron chelating agents,
splenectomy
