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Heme/Onc > Lecture 2: Microcytic Anemias > Flashcards

Lecture 2: Microcytic Anemias Flashcards

1
Q

Definition of anemia

A

reduction in the volume of RBCs (Hct) or concentration (Hgb) when compared to similar values from a reference population

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2
Q

What are the 3 major causes of anemia and what do each include?

A

(1) Bone marrow underproduction- nutritional deficiency, drugs, HIV, Leukemia, Metastatic cancer, MDs, Aplastic anemia
(2) Blood loss- GI bleeding, excessive menstrual bleeds, retroperitoneal, excessive blood donation
(3) RBC destruction- intrinsic or extrinsic disorders

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3
Q

What is the “differential” when ordering a CBC with a differential and then a reticulocyte count?

A

WBC differential- the peripheral blood smear tells you this

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4
Q

What is the importance of the Retic and MCV counts?

A

They can help guide towards the cause of the anemia

  • low retic suggests hypoproductive anemia
  • elevated retic suggest RBC destruction
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5
Q

Normal RBC is about what size?

A

Same size as a small lymphocyte nucleus

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6
Q

What are the 3 types of anemia? Give some examples of each.

A
  • Microcytic (MCV 100 cu microns)
    ~ megaloblastic anemia, hemolysis with
    reticulocytosis, chemo, hypothyroidism, MDs
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7
Q

Microcytic Anemias: DDx (5)

A

(1) Iron deficiency Anemia
(2) Thalassemia trait
(3) Lead poisoning
(4) Sideroblastic anemia
(5) Anemia of chronic disease

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8
Q

What is the most common anemia in the US?

A

Iron deficiency anemia

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9
Q

What does a decrease in iron lead to?

A

Decreased RBCs and Small RBCs

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10
Q

T/F The body has no way to eliminate excess iron.

A

TRUE; lost ~1.5 mg/day

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11
Q

What are the normal body stores for iron homeostasis?

A

~2-3 gm

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12
Q

When you get an iron lab, what are the values you obtain? (5)

A

(1) Serum Iron (Iron)
(2) Transferrin
(3) TIBC
(4) Percent Saturation
(5) Ferritin

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13
Q

What will iron labs look like in iron deficiency anemia?

A
  • low ferritin, Fe, and % sat

- high TF, TIBC

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14
Q

What is the most frequent cause of iron deficiency anemia?

A

Chronic blood loss

  • Menstrual bleeding in college aged females
  • NSAIDS (leads to ulcer disease)
  • have to identify cause in males and post menopausal women
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15
Q

What is another etiology of IDA that is not chronic blood loss?

A

Dietary Fe++ deficiency

  • pregnancy and lactation
  • adolescent growth spurt
  • celiac sprue or PPIs (GI malabsorption)
  • Gastric bypass (bypass duodenum AND decreased gastric acid)
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16
Q

What are clinical symptoms of IDA? (5)

A

(1) MOST asymptomatic
(2) “Tired”, “weakness”, “fatigue”, “cold”
(3) Decreased exercise tolerance
(4) Pica
(5) GI bleeding (melena, hematochezia, hematemesis), GU bleeding (hematuria)

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17
Q

What is Pica?

A

Appetite for non-food items

- chalk, clay, dirt, paper, ice, etc

18
Q

what are the physical exam findings for IDA?

A

(1) Skin pallor- conjuctiva and oral mucosa too
(2) Signs of increased CO- tachycardia, systolic murmur (“flow murmur”)
(3) Objective evidence of blood loss- melena, BRBPR, (+) stool occult blood
(4) Glossitis, cheilosis, koilonychia

19
Q

What will labs look like in IDA?

A
  • low MCV
  • High RDW
  • Low ferritin
  • High TIBC
  • Anisiocytosis and poikilocytosis on the blood smear
  • cigar shaped RBCs and elliptocytes when severe
20
Q

What is the first priority in management of IDA? What will you do to determine this?

A

Evaluate for blood loss- correct underlying cause if possible

  • H&P (stool occult blood- pelvic exam)
  • Upper endoscopy (esophageal/gastric disease)
  • Colonoscopy (cancer, IBS)
  • Urinalysis (renal/bladder bleeding)
  • Radiologic imaging (malignancy)
21
Q

What is the second priority in IDA management? How will you do this?

A 
Replenish Iron
- Oral (ferrous sulfate)
      ~ GI side effects common
- I.V. 
     ~ only for patients unable to tolerate oral iron
22
Q

Oral iron

A
  • Ferrous sulfate 325 mg po titrated to TID
  • Best absorbed on an empty stomach, best tolerated with food
  • Will turn stool dark color
  • Vit C helps with absorption
  • Tea can inhibit absorption
  • ferritin, retic count, CBC should all go up
23
Q

How long should you continue iron therapy after CBC normalizes?

A

3-6 months

24
Q

When does Retic count respond? Hgb and Hct?

A

days; 8 weeks

25
Q

What is Thalassemia?

A

Spectrum of diseases characterized by reduced or absent production of one or more globin chains
- The severity depends on how many of the globin chains are affected

26
Q

What is the major Hgb in adults? What does it consist of?

A

Hemoglobin A; tetramer consisting of one pair alpha and one pair beta globin chains

27
Q

At what age does fetal Hgb decrease?

A

6 months

28
Q

The majority of adult patients have which type of thalassemia?

A

alpha or beta thalassemia MINOR

  • asymptomatic
  • Dx: presence of microcytic, hypochomic red cells with or without minor degrees of anemia
29
Q

What is alpha or beta MAJOR

A

Alpha: incompatible with extra-uterine life
Beta: life-long transfusion-dependent anemia

30
Q

In what regions are Thalassemias most common?

A

Alpha: Middle East and western Asia, Southeast Asia, Africa
Beta: Mediterranean region, Africa, and Southeast Asia

31
Q

T/F The severity of the clinical picture does not depend on how many of the globin chains are affected.

A

FALSE, DOES depend. Beta is worse than alpha

32
Q

Alpha thalassemia

A

Abnormal production of alpha-globin chains resulting in a relative excess of beta-globin chains

33
Q

Gene deletions 1-4 in Alpha thalassemia

A

(1) Alpha thalassemia trait- silent carrier
(2) Alpha thalassemia trait- mild anemia (cis and trans deletion)
(3) Hemoglobin H disease- More marked anemia
(4) Hydrops fetalis- death in utero

34
Q

Alpha Thalassemia Minima (Silent Carrier): lab vaules/smear

A
  • Asymptomatic
  • CBC, Hgb electrophoresis and smear usually normal
  • Slight microcytosis (MCV) may be present
  • NO TREATMENT
35
Q

Alpha Thalassemia Trait (cis and trans deletion): lab values/smear

A 
- Peripheral smear:
     ~hypochromia
     ~microcytosis
     ~target cell
- MCV <80
- Hgb ~10-12 g/dL
- Hgb electrophoresis normal
- NO TREATMENT
36
Q

Hemoglobin H Disease: lab values/smear

A 
- Peripheral smear
     ~hypochromia
     ~microcytosis
     ~target cells
- MCV <80
- Hgb ~7-9 g/dL
- Hgb electrophoresis shows 10-20% HgbH
- May require intermittent transfusions
37
Q

Beta thalassemia

A

Underproduction of beta chains

  • inherited defect in beta-globin chain synthesis
  • alpha-globins form precipitates that damage red cell membranes
38
Q

Regarding beta thalassemia: depeding on number of globin chains affected, leads to:

A
  • intravascular hemolysis

- premature destruction of erythroid precursors results in intramedullary death and ineffective erythropoiesis

39
Q

Lead Poisoning

A

Causes impaired heme synthesis

  • Abdominal pain, behavioral problems, poor school performance
  • Basophilic stippling of RBCs
  • Dx: lead levels
  • Tx: Elimination of lead source/ chelation therapy
40
Q

Sideroblastic anemia

A

Rare disorder of hematopoietic stem cells and defective heme synthesis
- causes chronic anemia

Heme/Onc (7 decks)

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