Heme Exam 1 Flashcards
Anemia detected on CBC.
MCV is low (<80fL) so you order some iron studies:
- Low Fe
- Normal-low TIBC
- Normal-high ferritin
Ddx?
Anemia of chronic disease: infection, inflammation, or malignancy
Anemia detected on CBC.
MCV is low (<80fL) so you order some iron studies:
- Low Fe
- High TIBC
- Low ferritin
Dx?
Iron deficiency.
-now go determine the cause mr. PA
Anemia detected on CBC.
MCV is low (<80fL) so you order some iron studies:
- Normal-high Fe
- Any TIBC
- Normal - high ferritin
Ddx? … wait you’ll need to know more. Upon further investigation:
Either..
- Iron overload is present
- Siderocytes on peripheral smear
- Sideroblasts on bone marrow
Dx?
Sideroblastic anemia.
- must then figure out cause
Anemia detected on CBC.
MCV is low (<80fL) so you order some iron studies:
- Normal-high Fe
- Any TIBC
- Normal - high ferritin
Ddx? … wait you’ll need to know more. Upon further investigation:
Either..
- Tear drop red cells
- Target cells
- Splenomegly
- Positive family history of _____ (would give away)
Ddx?
Alpha or beta thalassemia:
- next you would perform hemoblobin electrophoresis
Anemia detected on CBC.
MCV is high (>100fL) so you order some Serum B12 and folate levels, as well as some MMA and homocysteine levels (if needed)
- Low B12
- Elevated MMA
- Elevated Homocysteine
Dx?
B12 deficiency
*determine cause
Anemia detected on CBC.
MCV is high (>100fL) so you order some Serum B12 and folate levels, as well as some MMA and homocysteine levels (if needed)
- Low Folate
- Normal MMA (methylmalonate)
- Elevated Homocysteine
Dx?
Folate Defiency
*determine cause
Anemia detected on CBC.
MCV is high (>100fL) so you order some Serum B12 and folate levels. They’re normal.
Either..
- Dysplastic features present
- Cytopenias present
Dx?
Myelodysplastic disorder
Anemia detected on CBC.
MCV is high (>100fL) so you order some Serum B12 and folate levels. They’re normal.
No dysplastic features or cytopenias present.
Ddx?
Increased reticulocytes
Liver dz
Hypothyroidism
Drugs
Labs indicative of hemolysis
- reticulocytosis (if not explained by accelerated RBC production)
- lactate hydrogenase: elevated
- haptoglobin: decreased
- indirect hyperbilirubinemia
Hereditary Spherocytosis/Eliptocytosis: helpful labs
- PBS (both)
- osmotic fragility test (HS)
Autoimmune hemolytic anemia: causes
- half cases = idiopathic
- lupus
- chronic lymphocytic anemia
- lymphomas
Autoimmune hemolytic anemia: tx
-First line: prednisone
-Splenectomy (refractory or recurrent)
-Plasmapheresis (rapid, severe hemolysis)
Other tx:
-monoclonal antibodies (rituximab)
-immunosuppressant agents (cyclophosphamide, vincristine, mycophenalate)
-IvIg
Cold agglutinin dz: lab findings
- mild anemia/reticulocytosis
- room temp PBS: RBC agglutination
- DAT: + for complement agglutination only
- Serum cold agglutinin titre
- Monoclonal IgM fond on serum electrophoresis
Cold agglutinin dz: tx
- Rituximab*
- Prednisone/splenectomy = INEFFECTIVE
- may need cytotoxic agents or immunosuppressants
Microangiopathic hemolytic anemia: causes
- thombotic thrombocytopenic purpura
- hemolytic uremic syndrome
- pre-eclampsia/eclampsia
- malignant HTN
- mechanical heart valve
