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HemOnc Week 1 > ICL 4.1: Anemia Workup & Classification > Flashcards

ICL 4.1: Anemia Workup & Classification Flashcards

1
Q

what is anemia?

A

decreased ability to carry oxygen due to low RBC count or low Hb concentration

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2
Q

what are the signs of anemia?

A
  • pallor
  • hemolytic: jaundice, brown urine, gallstones, ecchymosis
  • iron deficiency: koilonychias, angular cheilitis
  • B12 deficiency: gait disturbance
  • lead poisoning: lead line
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3
Q

what are symptoms of anemia?

A
  • dyspnea
  • fatigue
  • dizziness
  • tachycardia
  • leg cramps
  • restless legs
  • dementia
  • paresthesia

symptoms depend on how quickly the anemia develops and the cardiac reserve of the patient

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4
Q

how do you classify anemia?

A
  1. by etiology
    - loss of blood
    - increased destruction
    - decreased production
  2. by morphology
    - microcytic
    - normocytic
    - macrocytic
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5
Q

what is considered low Hb for men and women?

A

<13.5 g/dL for men

<12 g/dL for women

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6
Q

what is MCH?

A

mean corpuscle hemoglobin

Hb content in an RBC

low in IDA and thalassemia

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7
Q

what is MCHC?

A

mean corpuscular hemoglobin concentration

Hb concentration per RBC

low in IDA

high in spherocytosis

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8
Q

what is RDW?

A

variance in RBC size

high in IDA, MDS, hemoglobinopathies

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9
Q

what’s the bone marrow response to anemia?

A

increased reticulocytes in peripheral blood

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10
Q

what is reticulocyte index? what’s the formula?

A

correct for early bone marrow release

tells you if the bone marrow is responding properly to anemia

RI = corrected reticulocyte count/fudge factor

> 3-8: good response

< 3: poor response

ex. 7 g/dL Hb, 21 Hct with reticulocyte count 10%

corrected reticulocyte 10 x (21/45) = 4.6

reticulocyte index = 4.6/2.1 = 2.19

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11
Q

what is the corrected reticulocyte count?

A

% reticulocytes x (pt. Hct/normal Hct (45))

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12
Q

what does a reticulocyte look like on a blood smear?

A

special stain will show you the RNA that’s still in the reticulocyte

looks like a bunch of purple dots in the cell

this RNA wouldn’t be present in a mature RBC

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13
Q

what are Howell-Jolly bodies?

A

DNA

looks like one purple dot on an RBC
spleen

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14
Q

when do you see Howell-Jolly bodies?

A

when a person has had a splenectomy because the spleen is no longer clearing them out

can also see them in hemolytic anemias and megaloblastic anemias

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15
Q

when are Papenhelmer bodies seen?

A

iron deficiencies

hemolytic anemia

thalassemia

splenectomy

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16
Q

what do Pappenheimer bodies look like on a blood smear?

A

they look like just a couple little dots clumped together on the side of the RBC

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17
Q

what is basophilic stippling? when do you see it?

A

it’s RNA; pathological precipitation of ribosomes!

seen in thalassemia and lead poisoning

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18
Q

what does basophilic stippling look like on a blood smear?

A

like an RBC heavily covered in blue polka dots

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19
Q

what are Heinz bodies?

A

denatured hemoglobin

you need a special stain to see them!

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20
Q

when do you get Heinz bodies?

A

unstable hemoglobin

thalassemia

enzyme deficiencies like G6PD deficiency**

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21
Q

what do Heinz bodies look like on a blood smear?

A

just a few randomly scattered bigger polka dots in the RBC

22
Q

what does Hemoglobin H look like on a blood smear and what is it?

A

denatured hemoglobin

looks like a uniformly covered RBC covered in polka dots but not super heavily covered

23
Q

when are target cells present?

A

if macrocytic = liver disease

if normocytic = HbC disease

if microcytic = thalassemia

24
Q

what are schistocytes? when do you get them?

A

RBC fragments, randomly shaped

seen in hemolytic anemias or mechanical destruction like with a heart valve

25
Q

what are acanthocytes?

A

super spiky looking RBCs

usually seen in liver disease,

26
Q

when are tear drop RBCs seen?

A

thalassemia

bone marrow has lots of fibrous stroma so the RBC is pushed out of the bone marrow and is tear drop shaped

27
Q

what are echinocytes? when are they seen?

A

wavy sorta spiky looking RBCs

seen in pyruvate kinase deficiency

28
Q

what are spherocytes? when are they seen?

A

solid, sphere shaped RBC

seen in immune hemolytic anemia and transfusion reaction

29
Q

what are the types of RBC hemolysis?

A

intrinsic: problem with the RBC structure
extrinsic: antibodies of mechanical destruction

30
Q

what causes decreased RBC production?

A
  1. lack of necessary building block (Fe, B12)
  2. lack of room to grow in bone marrow (due to malignancy)
  3. suppression of growth factors/cytokines from infections of drugs
31
Q

what RBC features is used when we classify anemias by morphology?

A

RBC size

32
Q

what causes microcytic anemias?

A
  • lead poisoning

- pregnancy

33
Q

what are the types of macrocytic anemia?

A
  1. megaloblastic

2. non-megaloblastic

34
Q

what causes megaloblastic macrocytic anemia?

A

problems with RBC formation

  • B12 deficiency
  • folate deficiency
35
Q

what causes non-megaloblastic macrocytic anemia?

A
  • chronic alcohol use
  • reticulocytosis
  • liver disease
  • hypothyroidism
36
Q

what is B12 used for?

A
  1. homocysteine to methionine reaction

2. methylmalonylCoA to succinylCoA reaction

37
Q

what does B12 deficiency cause?

A

decreased DNA synthesis

more megaloblasts in BM

hypersegmented neutrophils in peripheral blood

38
Q

how do we absorb vitamin B12?

A

steps:
1. diet

  1. stomach: intrinsic factor
  2. terminal ileum absorption
  3. liver storage (supply lasts years)
39
Q

what causes B12 deficiency?

A
  1. GI problems
  2. poor diet
  3. increased needs like pregnancy or hyperthyroidism
  4. stomach problems like loss of intrinsic factor or gastrectomy
  5. S.I. problems like bacterial overgrowth (blind loop syndrome) or fish tapeworm
  6. terminal ileum problems (loss of absorption) like crohn’s disease
40
Q

how can you try to compensate for B12 deficiency?

A

give folate

but folate can’t compensate for neurological problems so make sure you’re giving both B12 and folate

41
Q

compare RDW in IDA vs. thalassemia?

A

IDA: high

thalassemia: normal/low

42
Q

compare RBC count in IDA vs. thalassemia?

A

IDA: low

thalassemia: increased

43
Q

compare blood smear for IDA vs. thalassemia?

A

IDA: elliptocytes

thalassemia: basophilic stippling and target cells

44
Q

how do you differentiate IDA vs. ACD?

A

TIBC and % saturation

increased in IDA

normal/decreased in ACD

45
Q

where does fe absorption happen?

A

duodenum

46
Q

if you have a normocytic anemia, what lab test will tel us if the bone marrow is responding appropriately?

A

reticulocyte count

47
Q

what CBC parameter will help us differentiate between IDA and thalassemia?

A

RDW and RBC count

48
Q

how can you use ferritin to distinguish IDA from ACD?

A

low in IDA

normal/high in ACD

BUT normal/increased ferritin does not rule out IDA

49
Q

what CBC results do you usually see in hemolytic anemias?

A
  • normal MCV
  • elevated bilirubin
  • elevated LDH
  • decreased free haptoglobin
  • hemoglo binemia/hemoglobinuria
  • increased reticulocytes
  • nucleated RBCs
50
Q

what causes intrinsic hemolytic anemia?

A
  1. membrane issues (HS, PNH)
  2. enzyme issues (G6PD deficiency)
  3. Hb issues (HbSS)
51
Q

what causes extrinsic hemolytic anemias?

A
  1. antibodies
  2. mechanical (heart valves)
  3. microangiopathic
52
Q

what types of antibodies can be found in autoimmune hemolytic anemias?

A
  1. warm autoimmune
  2. cold agglutinins
  3. cold hemolysins

HemOnc Week 1 (32 decks)

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