normo/normo, macro, & hemolytic anemia Flashcards
what is the etiologic category for normochromic normocytic anemia?
deficient erythropoiesis
what is the DDx for normochromic normocytic anemia?
renal disease, hypothyroidism, aplastic, myelophthisic
what conditions may cause normo/normo anemia due to renal disease?
diabetes, HTN, glomerulonephritis, polycystic kidney disease, recurrent kidney infection
what are the clinical findings for normo/normo anemia due to renal disease?
decrease urine output, increased urine frequency, muscle cramping, HTN
what are the CBC findings for renal disease?
normochromic normocytic anemia
what cells are seen on a PBS for renal disease?
echimocytes
what UA findings are consistent with renal disease?
proteinuria
what other tests would be ordered to confirm renal disease?
kidney function test, renal imaging
what is the proper management for renal disease?
treat underlying disease, refer to nephrologist
what is the mechanism behind hypothyroidism leading to normo/normo anemia?
decrease T3/T4 –> decrease metabolism –> decrease oxygen requirement –> decrease EPO –> decrease RBC
what is the mechanism behind hypothyroidism leading to hypo/micro anemia?
hypothyroidism –> heavy menses –> blood loss –> IDA
what is the mechanism behind hypothyroidism leading to macrocytic anemia?
decrease metabolism –> parietal cells, decrease IF –> decrease stomach acid –> decrease absorption of B12
what are clinical findings seen with hypothyroidism?
sensitivity to cold, weight gain, brain fog, thinning of outer 1/3 of eyebrow
what are the CBC findings with hypothyroidism?
anemia (normo/normo, hypo/micro, macro)
what other tests would be ordered to confirm hypothyroidism?
thyroid panel, iron panel, serum B12/folate
what is the proper management for hypothyroidism?
hormone therapy, refer to endocrinologist
what is panhypoplasia?
decrease is ALL blood lines; RBCs, WBCs, and plts
what is the etiology behind aplastic anemia?
idiopathic, drugs, toxin exposure, radiation therapy, viral
what are clinical findings of aplastic anemia?
increased susceptibility to infections, hemorrhagic difficulties
what are CBC findings consistent with aplastic anemia?
normo/normo anemia, leukopenia with neutropenia (<1500), thrombocytopenia (<70,000)
what other tests could be ordered to confirm aplastic anemia?
reticulocyte count (decreased), bone marrow biopsy
what is the proper management for aplastic anemia?
bone marrow transplant
what is the etiology behind myelophthisic anemia?
carcinoma metastasizing to bone marrow from primary tumor (breast, lung, kidney, prostate, thyroid, adrenal)
myelofibrosis (PCV)
myeloproliferative conditions (multiple myeloma, leukemias, lymphomas)
osteopetrosis
what are clinical findings for myelophthisic anemia?
general s/s of anemia, hepatomegaly, splenomegaly
what are CBC findings in myelophthisic anemia?
normo/normo anemia
what cells would appear on PBS with myelophthisic anemia?
nucleated RBCs (teardrop cells), immature WBCs
what other lab findings are consistent with myelophthisic anemia?
reticulocytosis, polychromatophilia
what etiologic category does macrocytic anemia belong to?
deficient erythropoiesis
what is the DDx for macrocytic anemia?
B12/folate deficiency
what causes macrocytic anemia?
defective DNA synthesis (RNA synthesis continues)
which cell lines are affected in macrocytic anemia?
ALL (anemia, leukopenia, thrombocytopenia)
which cells would appear on a PBS with macrocytic anemia?
hypersegmented neutrophils
how long is B12 stored in the liver?
5-6 years
why is B12 important?
needed for DNA synthesis and myelin synthesis
what conditions could lead to deficiency in intrinsic factor leading to B12 deficiency?
gastrectomy, myxedema, pernicious anemia
what are malabsorption conditions that could lead to B12 deficiency?
celiac disease, crohns disease, SIBO, pancreatitis
why might strict vegans become B12 deficient?
inadequate intake of B12 (B12 is found in meat)
what are hematopoietic clinical findings seen in B12 deficiency?
mild jaundice, “lemon-colored” skin
what are GI clinical findings in B12 deficiency?
glossitis (beefy red tongue), sore tongue, weight loss, anorexia, diffuse abdominal pain
what are neurological clinical findings in B12 deficiency?
loss of vibratory and position sense, ataxia (DWC), spasticity, Babinski sign
what are the CBC findings consistent with B12 deficiency?
macrocytic anemia, increased RDW, mild leukopenia, mild thrombocytopenia
what cells would be seen on a PBS in B12 deficiency anemia?
hypersegmented neutrophils
what are other tests and their findings that would help confirm B12 deficiency anemia?
increased bilirubin, increased LDH, decreased serum B12, auto-antibody test to IF and parietal cells, increased MMA
what is the proper management for B12 deficiency anemia?
eat meats, B12 injections, oral B12
what can taking folic acid without B12 do in patients with a B12 or pernicious anemia?
make signs and symptoms more severe and sudden
why is folate important?
used in synthesis of purines and pyrimidines
what foods contain folate?
vegetables, yeast, liver, mushrooms
where is folate absorbed in the body?
duodenum, jejunum
what is the etiology behind folate deficiency anemia?
deficient dietary intake (elderly, alcoholics)
chronic liver disease
increased requirements (pregnant/lactation)
what are clinical findings consistent with folate deficiency anemia?
general s/s of anemia, GI disturbances, NO neurological deficits
what are the CBC findings consistent with folate deficiency anemia?
macrocytic anemia, increased RDW, mild leukopenia, mild thrombocytopenia
what cells would be found on a PBS with folate deficiency anemia?
hypersegmented neutrophils
what other lab test would confirm folate deficiency anemia?
RBC folate
what is the proper management for folate deficiency anemia?
active folate supplementation
why does increased RBC destruction anemia occur?
shortened RBC lifespan, hemolysis; bone marrow production cannot keep up
what are general clinical findings for increased RBC destruction anemia?
pallor, jaundice, scleral icterus, gallstones
what are the extra labs and their findings for hemolytic anemia?
increased LDH, increased unconjugated bilirubin, increased reticulocyte count, decreased haptoglobin
what etiologic category does intrinsic RBC defects anemia belong to?
increased RBC destruction (hemolytic)
which type of anemia is due to red cell membrane alterations?
hereditary spherocytosis
what is the etiology behind hereditary spherocytosis?
defect in RBC membrane leading to formation of spherocytes which are destroyed by the spleen
what are the CBC findings consistent with hereditary spherocytosis?
mild to moderate anemia, increase in MCHC
which cells would be seen on a PBS in hereditary spherocytosis?
spherocytes
which other test would confirm hereditary spherocytosis?
increased osmotic fragility test
what is the proper management for hereditary spherocytosis?
splenectomy, blood transfusions, folate supplementation, reduce stress
which anemia is caused by disorders of red cell metabolism?
G6PD deficiency
what is the etiology behind G6PD anemia?
x-linked genetic abnormality (MC in males)
what are some possible triggers of G6PD anemia?
drugs, chemicals, infections, stressors, foods (fava beans)
what are clinical findings consistent with G6PD anemia?
difficulty fighting infections, general s/s of anemia
what is the CBC finding in G6PD anemia?
moderate anemia
which cell would be found on a PBS in G6PD anemia?
bite cells
which types of anemia are due to defective hemoglobin synthesis?
sickle cell, thalassemia
is sickle cell anemia homozygous or heterozygous?
homozygous (more severe)
is sickle cell trait homozygous or heterozygous?
heterozygous (excertional sickling)
what is the molecular etiology behind sickle cell anemia?
normal Hb (HbA) has 2 alpha and 2 beta chains
Hb S has valine instead of glutamic acid
deoxygenated Hb S polymerizes and forms long rods = sickle shape
what is the cellular etiology behind sickle cell anemia?
inflexible, prone to getting stuck in small vessels, fragile leading to hemolysis
what is the clinical etiology behind sickle cell anemia?
chronic anemia and crises
vaso-occlusive crisis –> hypoxia –> necrosis –> pain
at what age does HbF fade away and HbA take over?
after 6 months of age
what are the s/s of vaso-occlusive crises
symmetrical painful swelling of hands and feet
increased infection risk
painful crises: bones, joints, abdomen, back, viscera
what are the CBC findings for sickle cell anemia?
moderate to severe anemia, RBC indices usually normal, in crises: leukocytosis and thrombocytosis
what are clinical findings seen in sickle cell anemia?
jaundice, pallor, fatigue
what other tests would confirm sickle cell anemia?
decreased ESR, hemoglobin electrophoresis
which cells would be found on a PBS in sickle cell anemia?
sickle cells
what would be the Hb electrophoresis findings in sickle cell anemia?
80-100% Hb S, no HbA
what would be the Hb electrophoresis findings in sickle cell trait?
20-40% Hb S, 60-80% Hb A
what is the screening test for sickle cell anemia?
SickleDex (tests amount of Hb S)
what is the prognosis for sickle cell anemia?
anemia is lifelong, crises start after 1-2 years, life expectancy is 40-50 years
what does thalassemia do?
impacts the rate of synthesis of HbA; inadequate Hb and imbalanced accumulation of globin chains
what is the morphological type of thalassemia?
hypochromic microcytic
what is the etiologic category of thalassemia?
hemolytic anemia
what is the difference between thalassemia minor and thalassemia major?
the severity of anemia (major is worse than minor)
what is the etiology behind thalassemia minor?
heterozygous; defective rate of production of beta globin chains
what are the clinical findings of thalassemia minor?
general s/s of anemia
what are the CBC findings consistent with thalassemia minor?
mild anemia (>10), decreased MCV, MCH, MCHC, increased RBC count, normal RDW
what cells would be seen on a PBS of thalassemia minor?
hypo/micro RBCS, maybe target cells
what are the Hb electrophoresis findings for thalassemia minor?
increased HbA2, increased HbF, decreased HbA
what is the best confirmatory test for thalassemia minor?
Hb electrophoresis
how do you calculate the Mentzer index?
MCV/RBC count
what would a Mentzer index of greater than 13 be indicative of?
IDA
what would a Mentzer index of less than 13 be indicative of?
Thalassemia minor
what is the proper management for thalassemia minor?
live healthy, avoid stress
what is another name for thalassemia major?
Cooley’s anemia
what is the etiology behind thalassemia major?
homozygous, defective rate of beta globin polypeptide
what are the clinical findings seen in thalassemia major?
jaundice, splenomegaly, hemolytic facies (maxillary hypertrophy, prominent forehead)
what are the CBC findings for thalassemia major?
severe anemia, increased RBC count
which cells would be seen on a PBS for thalassemia major?
target cells
what are the Hb electrophoresis findings for thalassemia major?
little to no HbA, increased HbF (>50%), increased HbA2
why would HbF and HbA2 be increased in thalassemia major?
there is no beta chain
what is the proper management/prognosis for thalassemia major?
regular transfusions, folate supplementation, splenectomy, iron management
why is iron management important with thalassemia major?
an overload of iron causes morbidity and mortality
what is the DDx for intrinsic RBC defects?
hereditary spherocytosis, G6PD deficiency, sickle cell, thalassemia
which etiologic category does extrinsic RBC defects belong to?
hemolytic
what is the DDx for extrinsic RBC defects?
traumatic hemolytic anemia, hemolysis due to infectious agents, anemia due to immunologic abnormalities (isoimmune & autoimmune)
what is another name for traumatic hemolytic anemia?
microangiopathic anemia
what is the etiology behind traumatic hemolytic anemia?
march hemoglobinuria, karate, bongo playing, prosthetic heart valves
what are the CBC findings consistent with traumatic hemolytic anemia?
decrease MCV, increased RDW, anemia
which cells would be found on a PBS of traumatic hemolytic anemia?
schistocytes
what is the etiology behind hemolysis due to infectious agents?
malaria
bacterial toxins (clostridium perfringens, streptococcus, meningococcus)
what are the lab findings for hemolysis due to infectious agents?
hemolytic anemia
what is the etiology behind anemia due to immunologic abnormalities: isoimmune?
transfusion of incompatible blood, hemolytic disease of newborn
what are the 2 possibilities when it comes to incompatible blood?
ABO incompatibility: mom has incompatible blood type with baby
Rh incompatibility: more severe, less common
what are clinical findings in isoimmune abnormalities?
anemic newborn, jaundice
how do you tell the difference between pathological and physiological jaundice?
pathological: 1st 24 hrs after birth
physiological: after 24 hrs after birth
what is the special test to confirm isoimmune abnormalities causing anemia?
coombs’ test (direct antiglobin test)
what is the etiology behind anemia due to immunologic abnormalities: autoimmune?
acquired anemia induced by auto-antibodies binding to RBC membrane
how is anemia due to autoimmune abnormalities defined?
by maximum binding temperature
what antibody is associated with warm tempertature?
IgG
what type of patient would have warm antibody autoimmune hemolytic anemia?
a patient who has other autoimmune conditions
what antibody is associated with cold temperature?
IgM
what type of patient would present with cold antibody autoimmune hemolytic anemia?
elderly, acrocyanosis, or raynaud’s phenomenon
what are risk factors for autoimmune hemolytic anemia?
malignancy (esp lymphomas)
autoimmune disorders (warm, IgG)
medications
prior blood transfusions
what special test is done to confirm autoimmune hemolytic anemia?
direct coombs’
warm: IgG
cold: IgM
