MTB Flashcards
IDA Lab values
Low Ferritin <10mg/dL - can be falsely elevated as an acute phase reactant
Low Reticulocyte count
High TIBC
High RDW and Platelet count
RDW - newer RBCs are smaller and Fe deficient
Sideroblastic Anemia
Causes
Microcytic - Iron trapping in mitochondria
ALA synthase or B6 problem
Drugs: Chloramphenicol, INH, alcohol
Sideroblastic Labs
High Ferritin
Very high - Transferrin
Low TIBC
Anemia of Chronic Dz Labs
Normal or High serum Ferritin
Low serum Iron
Low TIBC
Low reticulocyte count
When does the body switch from fetal Hb to Adult Hb?
6 months
Cooley Anemia
Beta thal major
Thalassemia Dx
Varies with type: Beta thal - increased HbF and HbA Beta thal major - Hb low (3-4) Alpha thal - normal HbF and A2 Target cells and Normal RDW
Reticulocyte count in Microcytic
Low except Alpha thal 3 gene deletion has High
Reticulocyte count
Production problems
Blood loss and hemolysis - increased
Microcytic anemia Tx
Severe - Packed RBCs -Transfuse when: 1.Symptomatic SOB, HypoTN, tachy, syncope, chest pain 2. Hct very low in elderly or heart disease pt Very low = 25-30
1 Unit PRBCs raises Hct by?
3 points per unit - 1 mg/1mL of Iron
Most Accurate test for Microcytic Anemias
IDA: BM Bx
Sideroblastic: Prussian blue for ringed sideroblasts
B12 Deficiency
Increased MMA
B12 level can be normal/normal low so if highly suspect, do MMA level
Macrocytes in B12 and Folate deficiency
Oval
Macrocytes in hemolysis, liver dz, myelodysplasia
Round
B12/Folate deficiency heme pattern
Reduced reticulocyte count
BM hypercellular
High LDH, Billirubin (Unconjugated), Iron level
Increased homocysteine
Pernicious anemia test
Confirm with anti-intrinsic factor and anti-parietal cell abs
Electrolyte change seen with B12/folate replacement
Hypokalemia - cells in marrow produced so rapidly that marrow packages up all K, lowering serum level
Caution in heart pts and digoxin pts
K is a cofactor for B12
Myelodysplastic syndrome
High MCV, low retic
BM Bx
Pelgar Huet polymorphs - bilobed
Hemolytic Anemia Labs
Sudden drop in Hct
Low Haptoglobin
Haptoglobin
Intravascular hemolysis
transports RBC Hb from vascular space to spleen, liver, RES
Indirect BR
Bound to Albumin
Should not filter thru glomerulus
Hemosiderin
metabolic product of Hb
present in urine if hemolysis - severe and lasts for days
What does dark urine indicate
Hemosiderin (Hb) in urine
Renal Failure, ATN