microcytic anemias Flashcards

1
Q

definition of microcytic anemia

A
  • MCV < 80
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2
Q

common microcytic anemias

A
  • iron def anemia
  • anemia of chronic disease
  • thalassemia
  • sideroblastic anemia
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3
Q

what is the most common cause of anemia

A
  • iron deficiency anemia
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4
Q

what is the most common cause of iron def anemia

A
  • GI bleeding

- menstrual bleeding

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5
Q

stages of iron def anemia

A
  • depletion of iron stores without anemia
  • anemia with normal RBC size
  • anemia with reduced RBC size
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6
Q

clues in pts hx to think of iron def anemia

A
  • diet
  • PICA
  • phagophagia
  • glossitis
  • mouth soreness
  • angular cheilitis
  • Koionychia
  • dysphagia
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7
Q

where is iron absorbed

A
  • acidic conditions
  • stomach, duodenum, jejunum
  • avg diet has 10-15 mg of iron, only absorb 1.5%
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8
Q

iron requirement in males and non-menstruating females

A
  • 1 mg/d
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9
Q

iron requirements in menstruating females

A
  • 3-4 mg/d
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10
Q

iron requirements in pregnant females

A
  • 2-5 mg/d
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11
Q

what is the role of transferrin

A
  • transports iron
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12
Q

what is the role of ferritin

A
  • stores iron (simple)
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13
Q

what is the role of hemosiderin

A
  • complex iron stores in macrophages

- helpful with insoluble Fe

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14
Q

iron deficiency categories

A
  • deficient intake/ decreased absorption
  • increased requirement
  • blood loss
  • other: hemoglobinuria, idiopathic, Fe sequestration
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15
Q

work up for iron def anemia

A
  • low serum iron, transferrin, ferritin
  • high TIBC
  • usu low retic count
  • low MCV and MCH
  • peripheral smear: hypochromic and microcytic
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16
Q

si/sx of iron def anemia

A
  • easily fatigued
  • conjunctival pallor
  • tachycardia, palpitations
  • DOE
  • pica
  • severe: smooth tongue, brittle nails, koilonychia, chelosis
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17
Q

treatment for iron def anemia

A
  • ferrous sulfate TID- tae with vit C/ OJ to increase absorption
  • try cooking in cast iron skillet
  • parenteral options
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18
Q

why give parenteral options in iron def anemia

A
  • pt cant tolerate PO
  • refractory to PO
  • GI dz that limits absorption
  • continued blood loss
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19
Q

side effect of iron supplementation

A
  • constipation
  • GI upset
  • give colase
  • titrate up to TID to mitigate
20
Q

anemia of chronic disease

A
  • usu MCV < 80 but can also be normocytic
  • problem with iron utilization
  • bone marrow unable to respond to EPO
21
Q

causes of anemia of chronic disease

A
  • inflammation
  • endocrine disorders
  • infection
  • chronic liver dz
  • CT disorders- SLE, RA
  • endocarditis
  • cancers- liquid and solid tumors
  • *IS NOT the same as anemia of CKD
22
Q

what disease states is anemia of chronic disease NOT seen in

A
  • DM
  • COPD
  • CHF
  • HTN
23
Q

etiology of anemia of chronic disease

A
  • “iron is there but vault is locked”
  • lg amount of inflam cytokines released
  • stim hpatocytes to make massive amounts of hepcidin
  • prevents release of iron from macrophages and liver stores
24
Q

lab findings for anemia of chronic disease

A
  • microcytic or normocytic
  • normochromic
  • low retic count
  • normal/ elevated serum ferritin
  • decreased iron
  • decreased-normal TIBC
  • ferritin up or normal
  • increased ESR and CPR
  • bone marrow bx only in difficult cases
25
treatment of anemia of chronic disease
- treat underlying condition - supplemental iron - ok to use EPO - edu pt on risk
26
thalassemia
- defect in alpha or beta globin chains - mild - severe depending on number of genes with mutations - often confused with iron def d/t low MCV
27
alpha thalassemia
- gene deletion -> reduced alpha globin chain synthesis - depends on how many genes deleted (1-4) - common in Asia/ china
28
3 copies of alpha chain
- carrier | - no sx
29
2 copies of alpha chain
- minor | - mild sx
30
1 copy of alpha chain
- HbH disase
31
0 copies of alpha chain
- not compatible with life
32
si/sx of alpha thalassmia
- carriers have no sx - fatigue, weakness - pallor - splenomegaly
33
lab findings for alpha thalassemia
- hypochromic, microcytic anemia - smear: normal, target cells, heinz bodies - get ferritin to r/o iron def - Hgb electrophoresis*
34
treatment for alpha thalassemia carriers
- no treatment - transfuse as needed - can supplement with folic acid and iron - offer genetic counseling
35
treatment for alpha thalassemia disease
- transfusion as needed - consider iron chelation if overloaded splenectomy and SCT in severe cases - off genetic counseling
36
beta thalassemia
- point mutation -> defective beta chains - decreased production of normal Hgb, relative excess alpha - more common in mediterranean - major vs minor disease
37
major beta thalassemia
- homozygois | - two mutations -> no beta globin
38
minor beta thalassemia
- heterozygous | - one mutation -> less beta globin production
39
si/sx of minor beta thalassemia
- most asymptomatic - hypochromic, microcytic - may note target cells, dacrocytes, basophillic stippling
40
si/sx of major beta thalassemia
- severe anemia - pallor, irritability, growth retardation, abd swelling - hypochromic, microcytic - smear: poikilocytosis, target cells, basophilic stippling - RDW- normal - ferritin- normal
41
treatment for major beta thalassemia
- transfusions as needed- esp periods of rapid growth - consider splenectomy and SCT - supplemental folic acid - offer genetic couseling
42
sideroblastic anemia
- make ringed sideroblasts- iron cannot be incorporated - assoc with copper def - results in iron overload
43
causes of sideroblastic anemia
- hereditary or acquired | - drugs: chloramphenicol, linezolid
44
si/sx of sideroblastic anemia
- pale - dizziness, fatigue - hepatosplenomegaly
45
lab findings for sideroblastic anemia
- microcytic, hypochromic - neutropenia if Cu def - liver and kidney abnormalities d/t iron overload - increased serum iron, transferrin, serum ferritin - decreased TIBC - get lead or copper lev if suspected - peripheral smears
46
peripheral smear findings for sideroblastic anemia
- abnormal cell shapes - basophilic stippling - target cells - pappenheimer bodies
47
treatment for sideroblastic anemia
- transfusion and chelation as needed - if INH induced start B6 repletion - if CU def then replete - splenectomy c/i in congenital - doesnt respond to EPO - severe- bone marrow transplant