Normocytic And Microcytic Anemia Flashcards
What are the causes of normocytic anemias?
Primary bone marrow dysfunction Anemias secondary to underlying disease Increased RBC loss or destruction Decreased RBC production Over expansion of blood volume( dilutional anemia)- pregnancy, over hydration
What is sickle cell disease?
Genetic disorder resulting from the presence of a mutated form of hemoglobin ( hemoglobin S)
More common in blacks
Diagnosed by hemoglobin electrophoresis
What are the features of sickle cell disease?
Pain- vaso occlusive pain crisis Bone pain Splenic sequestration More prone to infections Growth retardation, delayed sexual maturation
Normocytic anemia algorithm
Presence of normocytic anemia
Review patient history
Obtain reticulocyte count and peripheral smear
What is a high reticulocyte count indicative?
Lab testing for hemolysis: bilirubin,LDH
If positive- consider enzyme defects, autoimmune disorders
If negative-consider blood loss or mixed disorder
If cause unknown refer to hematologist
What is a low reticulocyte count indicative of?
Medical disease suspected- lab testing for renal,liver , thyroid disease
Underlying inflammation- consider iron studies
Abnormal smear- consider bone marrow disorder(leukemia)
If cause unknown refer to hematologist
What are the causes of microcytic anemia?
Blood loss anemias
Thalassemia
Lead poisoning
Iron deficiency anemia
What are the tests for iron studies?
Serum iron
% saturation (transferrin sat)
Total iron binding capacity (TIBC)
Ferritin level
What is the pattern of iron studies in iron deficiency?
Low serum iron, % saturation
High TIBC
Low ferritin
What is the pattern of iron studies in anemia of chronic disease or inflammation?
Low serum iron and % saturation
Normal or low TIBC
High ferritin
What is the microcytic anemia algorithm?
Presence of microcytic anemia
Check serum ferritin
Low serum ferritin- iron deficiency anemia
Normal or elevated- check for inflammation
Inflammation present-consider anemia of chronic disease
No inflammation- consider thalassemia
What are the causes of iron deficiency anemia?
Inadequate dietary iron
Impaired iron absorption
Bleeding
Loss of body iron in the urine
What are the signs and symptoms of iron deficiency anemia?
Fatigue Leg cramps Craving ice (Pica) Cold intolerance Altered behavior
How to diagnose and treat iron deficiency anemia?
Diagnosed by low serum iron and ferritin levels with an elevated TIBC
Treated with iron supplementation, treat underlying cause: bleeding
What are thalassemia?
Genetic disorder characterized by a deficiency in globin chains
