Microcytic and Normocytic anemias Flashcards
anemia of chronic disease (ACD) is a result of
underlying systemic dx causing:
release of IL-6 and TNF
increased hepcidin that inhibits iron transport into the intestine
stops iron release in macrophages resulting in decreased RBC production in bone marrow from abnormal iron metabolism.
Decreases EPO production and decreased RBC survival
bone marrow aspiration of anemia of chronic dx
abundant iron in macrophages and no iron in RBC precursors
bone marrow aspiration in iron deficency anemia
absent iron in macrophages and abscent iron in RBCs
TIBC in iron deficiency anemia
TIBC - will be high because there’s more spaces for iron to bind to because there’s more “seats” or iron receptors available because there’s low iron
****most specific test to determine if IDA is there****
TIBC in anemia of chronic dx
normal to low
because there’s no extra transferrin receptors available to bind to iron because of acute phase reactants will cause hepcidin to internalize ferritoportin and transferrin receptors so there’s less receptors available for iron to bind .
ferritin represents what in iron metabolism?
amount of stored iron but also is an acute phase reactant that can be high in anemia of chronic disease and low in iron deficiency anemia.
<15% ferritin is highly suggestive of IDA
test to check for concerns over hemochromatosis
check transferrin level because that will be high. It has the most seats full.
transferrin saturation levels represent
in Fe deficiency anemia
in anemia of chronic dx
in hemochromatosis
the number of seats that are full with iron or receptors bound to iron.
in iron deficiency anemia- there’s low transferrin saturation because low iron.
In anemia of chronic dx, there ls also low to normal because of either less iron available to
In hemochromatosis - there’s high transferrin saturation because there’s a lot of iron bound to these receptors.
alpha and beta thalassemia traits have
normal to increased total iron and ferritin due to high cell turnover. But total iron binding capacity is normal
Thalassemia trait will have a MCV that is ???
MCV<70
Iron deficiency will have
low iron, low ferritin and increased total iron binding capacity and MCV<80 and elevated MCV
hemoglobin analysis in alpha thalassemia trait
no therapy and normal Hgb analysis
chart for thalassemias
Fe deficiency anemia vs. thalassemia chart
What does this peripheral smear show?
See microcytic, hypochromatic RBCs - microcytic anemia includes Fe deficiency, thalassemia, anemia of chronic dx. Likely Fe because high RDW
Chart comparing all the microcytic anemia parameters.
What causes Fe deficiency?
blood loss (Gi or menstral bleeding).
Decreased GI absorption of iron (celiac dx or inflammatory bowel dx, or bariatric surgery)
Can give EPO for anemia if
undergoing chemotherapy and has Hgb <10 and are asympotmatic.
But use cautiously because increases risk for VTE and cardiovascular complications.
Cancer related anemia and management
since anemia could be result of Fe deficiency, chemo induced myelosuppression or increased RBC destruction from tumor induced hemolysis (mAHA or autoimmune)
Best to recheck CBC at next visit as long not symptoatmic and Hgb >10
Chart of common RBC abnormalities seen on peripheral smear
Iron deficiency is defined as
What is the goal iron replacement for pts who are on dialysis or ESRD?
transferrin saturation<20%, ferritin <100 and (<200 in dialysis pts), and needs to be treated prior to starting EPO
Goal is to reach 20-50% transferrin saturation and 200-500 for ferritin
Goal iron replacement for FE defiiciency anemia in CKD and ESRD pt
Goal is to reach 20-50% transferrin saturation and 200-500 for ferritin
target level for EPO is to increase Hemoglobin to
10-11
helps improve physiological parameters and improves quality of life.
>12 adds little benefit and increases mortality and morbidity with stroke, hypertension and vascular access thrombosis.
spherocytes can occur in
autoimmune hemolytic anemia, clostridial sepsis, snake bites, G6PD dehydrogenase deficiency, MAHA and hereditary spherocytosis
if you see spherocytosis, what lab test do you have to order?
direct antiglobulin test (DAT)
helps to differentiate between two conditiosn of hereditary spherocytosis and AIHA
hereditary spherocytosis is seen with:
due to atlered genes for encoding RBC membrane proteins which leads to instability and phagocytosis by spleen.
Autosomal dominant.
See chronic hemolytic anemia, jaundice and splenomegaly and can see increased folate requirement and see bilirubin gallstone formation.
hereditary spherocytosis labs:
how is it diagnosed?
elevated MCV and increased RDW
can show spherocytosis in varying degrees depending on disease severity
Diagnosis is confirmed by flow cytometery with eosin5 maleimide binding or acidified glycerol lysis test.
Treatment of hereditary spherocytosis
folic acid supplmentaion
transfusion for symptomatic anemia
splenectomy for severe cases.
what is transferrin saturation?
iron / TIBC x 100
CKD levels of goal iron replacement
transferrin saturation level >30%
serum ferritin >500 ng/ml
replace with IV or oral iron
transferrin saturation level is (Fe/TIBC x100)
