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Blood > Microcytic Anemia 9/27 > Flashcards

Microcytic Anemia 9/27 Flashcards

1
Q

what can cause falsely abnormal MCV? (5)

A
  • cold agglutins
  • hyperglycemia
  • reticulocytosis
  • leukocytosis
  • acute hemolysis
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2
Q

Corrected Reticulocyte count

A

Absolute Reticulocyte count x (pt’s Hgb/normal Hgb)

Hypoproliferation: <2%

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3
Q

To correct for shift Reticulocytes (some released early due to low Hgb ~12), calculate the Reticulocyte production index:

A

(Reticulocyte %/ Reticulocyte maturation time) x (Hgb/15)

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4
Q 
Reticulocyte maturation time for:
Hgb of 15?
Hgb of 12?
Hgb of 8?
Hgb of 5?
A

15: 1 day
12: 1.5 days
8: 2 days
5: 2.5 days

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5
Q

What does RPI less than 2 indicate?

A

Patients bone marrow is not making enough Reticulocytes

RPI over 3 indicates the marrow is responding appropriately to anemia.

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6
Q

What accounts for decreased red cell production? (Reticulocytopenia)

A
  1. Hgb synthesis lesion: iron deficiency, thalassemia, anemia of chronic disease
  2. DNA synthesis lesion: megaloblastic anemia
  3. DNA synth inhibitor drugs
  4. Hematopoetic stem cell lesion: leukemia
  5. Bone marrow infiltration: lymphoma, sarcoidosis, etc
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7
Q

What accounts for increased RBC destruction/loss? (Reticulocytosis)

A
  1. Acute blood loss
  2. Intrinsic Hemolysis: membrane lesion, Hgb lesion, glycolysis abnormality, oxidation lesion (G6PD deficiency)
  3. Extrinsic hemolysis: immune, angiopathic.
  4. Valve dysfunction
  5. Infection
  6. Hypersplenism
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8
Q

Normal RDW, low MCV

A

Thalassemia

Chronic disease

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9
Q

Normal RDW, high MCV

A

Aplastic anemia

Myelodysplasia

Alcohol

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10
Q

Normal RDW and normal MCV

A

Chronic disease (90%)

Hereditary spherocytosis

Acute bleed

Cirrhosis

Uremia

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11
Q

High RDW and low MCV

A

Iron deficiency

S-thalassemia

RBC fragmentation

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12
Q

High RDW and high MCV

A

B12/folate

Autoimmune hemolysis

Cold agglutins

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13
Q

High RDW and normal MCV

A

Early factor deficiency

SS disease

SC disease

Sideroblastic anemia

Myelofibrosis

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14
Q

For microcytic anemia, MCV IS LOW. What do RDW values tell us?

A

High RDW: iron deficiency, S-thalassemia, RBC fragmentation

Low RDW: thalassemia, chronic disease

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15
Q

What is the differential diagnosis of microcytosis (low MCV)?

A

-iron deficiency
-thalassemia
•B: elevated Hgb A2 or F
-anemia of chronic disease
-sideroblastic anemia (rare)
-lead poisoning (rare)
-zinc deficiency

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16
Q

Cause of microcytosis?

A

Reduced Hgb synthesis

Either iron defects OR hemoglobinopathies

17
Q

How to test for iron deficiency? (4)

A
  1. Iron
  2. TIBC
  3. Iron or transferrin saturation
  4. Ferritin
18
Q

What molecule transports iron after absorption?

A

Transferrin

19
Q

What molecule stores iron in the liver and heart?

A

Ferritin (10-20% of absorbed iron)

20
Q

Common reasons for iron loss?

A 
Ulcers
GI bleeds
Liver disease 
IBS
Hemorrhoids
Colon cancer
21
Q

How much iron is lost in females per day?

A

1-3 mg.

Pregnancy: 6 mg/day

22
Q

How can exercise result in iron deficiency?

A
  1. GI tract blood loss
  2. Exercise-induced hemolysis
  3. Increased levels of hepcidin

Also… Bariatric surgery.

23
Q

How do you approach iron deficiency anemia?

A

In older makes, LOOK FOR GI SOURCE

how else can one lose blood? Menstruation, post surgery.

FIND BLEED; STOP BLEEDING

24
Q

What is the go-to iron therapy treatment and dosage?

A

Ferrous sulfate: 325 PO per day.

25
Q

How to treat iron deficiency If ferrous sulfate is not tolerated?

A

Ferrous gluconate

Iron drops

Lower dose + vitamin C/ cranberry juice

26
Q

If unresponsive to oral iron therapy, utilize parenternal iron therapy. What drugs are used? (5)

A
  1. Iron dextran: start w/ 25 mg to test for adverse rxn, then give 975 mg.
  2. Ferric Gluconate: 125mg/hour x 7 sessions
  3. Iron sucrose
  4. Ferumoxytol: 510mg over 17 seconds. Repeat in a week
  5. Ferric carboxymaltose: 750mg. Repeat in one week
27
Q

What is hepcidin and where is it synthesized?

A

Synth in LIVER.

prevents parenchyma iron overload

Reduces quantity of circulating iron by preventing its exit from cells (erythrocytes & macrophages)

28
Q

what molecule does hepcidin work on and how?

A

Hepcidin binds to ferroportin* and induces its internalization and degradation. Keeps iron inside RBCs.

*ferroportin is a transmembrane protein that transports iron from inside the cell to the outside -> bloodstream.

29
Q

What happens with low or no hepcidin?

A

Parenchymal iron overload

30
Q

Iron testing: iron/TIBC/ferritin in iron deficiency?

A

Serum iron: LOW
TIBC: high
ferretin: LOW

31
Q

Iron testing: iron/TIBC/ferritin in anemia of chronic disease?

A

Serum iron: LOW
TIBC: LOW
Ferretin: high

32
Q

When do you get Hgb electrophoresis in evaluating anemia? (3)

A

Family history of hemoglobinopathies/ race

Microcytosis w no or mild anemia

Iron studies not indicative of another process

33
Q

What is the cause of sideroblastic anemia?

A

Elevated iron

Usually acquired disorder: MDS, alcohol, Meds

Can be X-linked

34
Q

Multiple small blue/black spots on RBC indicate basophilic stippling. What does this mean?

A

Pb (LEAD) TOXICITY

or thalassemia

35
Q

What are the clinical manifestations of lead poisoning?

A

Hypochromic microcytosic anemia

Lead inhibits heme production by preventing iron incorporation into protoporphyrin ring

Symptoms: anorexia, abdominal pain, irrationality. RADIAL PALSY

Blood (13 decks)

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