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Boards And Beyond > Normocytic Anemia > Flashcards

Normocytic Anemia Flashcards

1
Q

What is anemia

A

Anemia is a decrease in the RBC measurements: RBC count (part of CBC), hemoglobin (concentration in g/dL) and hematocrit (volume % of RBC in the body)

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2
Q

What is the rule of 3

A

Hgb = 3 * RBC count
Hct = 3 * Hgb

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3
Q

What are the clinical features of anemia

A

Vary based on degree of anemia and onset (rapid/slow)
Can be asymptomatic
Weakness
Fatigue
Dyspnoea
Pallor - unhealthy pale appearance (skin of palms and face, also nails and conjunctivae)

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4
Q

Mention the RBC indices

A

Mean corpuscular volume (femolitres)
Mean corpuscular hemoglobin (pg/cell)
Mean corpuscular Hgb concentration (g/dL)

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5
Q

What is the normal MCHC

A

34g

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6
Q

What is the normal MCH

A

27.5 to 33.2 pg/cell

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7
Q

What is the normal MCV

A

80 to 100 fL

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8
Q

What are the blood cell indices

A

Describe mean characteristics of RBCs
Measured by automated blood counters
Used in the evaluation of anemias

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9
Q

What is MCV

A

The average volume of a red cell

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10
Q

What is MCH

A

Average weight of hemoglobin inside of each red cell

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11
Q

What are the classifications of anemia based on MCV

A

Microcytic
Normocytic
Macrocytic

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12
Q

What type of anemia is MCV < 80

A

Microcytic

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13
Q

What is macrocytic anemia

A

MCV > 100

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14
Q

What is normocytic anemia

A

MCV 80-100

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15
Q

Give some examples of microcytic anemias

A

Iron deficiency
Thalassemia
Anemia chronic disease
Sideroblastic anemia
Lead poisoning

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16
Q

Give some examples of normocytic anemia

A

Anemia chronic disease
Hemolysis
Aplastic anemia
Chronic kidney disease

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17
Q

Give some examples of macrocytic anemia

A

Folate/B12 deficiency
Liver disease
Alcohol use
Reticulocytosis

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18
Q

What are retuculocytes

A

Immature red blood cells
Usually about 1-2% of RBC in peripheral blood
In anemia, the bone marrow produces more reticulocytes so the percentage of cells that are reticulocytes should increase in the setting of anemia
When there’s anemia, the kidney produces more EPO. The EPO drives the bone marrow to produce more reticulocytes

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19
Q

Used in anemia to determine if bone marrow response is adequate
Should ride if bone marrow responds normally
Must be corrected for degree of anemia
If < 2% -> Inadequate bone marrow response
What might this be

A

Reticulocyte count

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20
Q

Correct the reticulocyte count for an Hct of 11 and Retic of 8%

A

Corrected RC = 8% * (11/45) = 2%
45 is the normal Hct level

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21
Q

What’s the equation for reticulocyte production index

A

Corrected retic% / Maturation time (varies - increases with decreasing Hb levels)

22
Q

What RPI level is seen in patients with bone marrow failure

A

RPI < 2%

23
Q

Which RPI percentage is a normal marrow response to anemia

A

> 3%

24
Q

Hypochromia in blood smear is characteristic of what condition

A

Iron deficiency

25
Q

Spherocytes in blood smear is characteristic of what condition

A

Spherocytosis

26
Q

Target cells in blood smear is characteristic of what condition

A

Thalassemia

27
Q

Dacrocytes (tear drop cells) in blood smear is characteristic of what condition

A

Marrow fibrosis

28
Q

Acanthocytes in blood smear is characteristic of what condition

A

Liver disease (spiked RBCs)

29
Q

Schistocytes in blood smear is characteristic of what condition

A

Hemolysis

30
Q

What are the two causes of normocytic anemia

A

Decreased red cell production
Increased red cell destruction/loss

31
Q

What feature is characteristic of a decrease red cell production

A

A low reticulocyte count

32
Q

What feature is characteristic of an increased red cell production in normocytic anemias

A

A high reticulocyte count

33
Q

What are some causes of normocytic anemias

A

Anemia or chronic disease
Chronic kidney disease (low EPO)
Hypothyroidism
Bone marrow failure
Aplastic anemia

34
Q

What are some causes of increased red cell destruction leading to a normocytic anemia

A

Acute blood loss
Hemolysis

35
Q

What is the most common cause of normocytic anemia

A

Anemia of chronic disease

36
Q

Which anemia is common in rheumatoid arthritis

A

Anemia of chronic disease

37
Q

Anemia in association with inflammation
Common in rheumatoid arthritis, lymphoma, other chronic conditions
Usually a mild anemia (Hgb > 10g/dL)
Symptoms of anemia rare
Often incidental finding in blood testing
Microcytic in about 25% of cases
Most common normocytic anemia
What condition could this be

A

Anemia of chronic disease

38
Q

Acute blood loss causes ……….. anemia

A

Normocytic

39
Q

Chronic blood loss causes …….. anemia

A

Microcytic

40
Q

Loss of iron in hemoglobin
Leads to iron deficiency
Common with occult GI bleeding
What kind of blood loss could this be

A

Chronic blood loss

41
Q

Loss of red cells
Remaining red cells have a normal MCV
What type of blood loss could this be

A

Acute blood loss

42
Q

Which agents are used to treat chronic kidney disease causing a normocytic anemia

A

EPO stimulating agents
Epoetin or darbepoetin (longer-acting)

43
Q

Used when Hgb < 10g/dL
Goal Hgb: 10 to 11.5g/dL (any higher Hg greater than this increases mortality and myocardial infarction because these drugs can cause or worsen HTN)
Good response to this drug requires iron (iron deficiency -> poor response)
What drug may this be

A

EPO stimulating agents

44
Q

Specific type of bone marrow failure where there are defective stem cells which leads to an acellular or hypo-cellular bone marrow
Pancytopenia
Low WBC, low platelets, low RBC
Low reticular count
Hypo-cellular bone marrow
Absence of infiltrate or fibrosis
What condition may this be

A

Aplastic anemia

45
Q

How is aplastic anemia diagnosed

A

Pancytopenia
Bone marrow biopsy
Acellular or hypocellular bone marrow
Absence of cells/replacement with fat

46
Q

What are some causes of aplastic anemia

A

Most commonly idiopathic
Radiation exposure
Drugs
Toxins (benzene)
Viruses
Inherited (Fanconi anemia which develops in children)

47
Q

What is the mechanism of aplastic anemia

A

Most cases involve autoimmune damage to stem cells even when underlying cause is present
Drugs, chemicals or viruses alter stem cells
Leads to autoimmune destruction
Immunosuppression improves aplastic anemia

48
Q

What are some drugs which could cause aplastic anemia

A

Chemotherapy (anticipated effect)
Antibiotics (chloramphenicol and sulfonamides)
NSAIDs (phenylbutazone and indomethacin)
Anti-seizure drugs (carbamazepine and phenytoin)
Anti-thyroid drugs (methimazole and propylthiouracil)

49
Q

Infects proerythroblasts
Usually causes a decrease in RBCs
Pancytopenia can occur (high risk in immunocompromised patients)
What virus could this be

A

Parvovirus B19

50
Q

What are some viruses which could cause aplastic anemia

A

Parvovirus
Acute viral hepatitis (develops weeks to months after acute hepatitis)
Others: HIV, EBV, CMV

51
Q

Inherited aplastic anemia
Autosomal recessive or x-linked
Usually presents in children less than 16 years old
More than half of patients have physical deformities (short stature, malformed thumbs, hypo or hyperpigmentation, café-au-lair spots
More than 13 genetic abnormalities identified
May involve DNA repair enzymes
What condition might this be

A

Fanconi anemia

52
Q

What is the treatment for aplastic anemia

A

Stop offending agent
Blood and platelet transfusions
Bone marrow stimulation (GM-CSF)
Immunosuppression (antithymocyte globulin - a collection of T cell antibodies, cyclosporine)
Bone marrow transplant

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