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Normocytic anemia Flashcards

1
Q

Anemia considerations -

A 
Rate of H/H alteration (slow vs fast)
evidence of
- Jaundice, scleral icterus
- Hepatosplenomegaly
- ^-retics
- v-haptoglobin (reclaiming hgb)
-Spherocytes/schistocytes
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2
Q

DDx of normocytic anemia

A 
Anemia of chronic dz
Acute blood loss
Multifactorial anemia
Renal-failure ass/w anemia
Aplastic anemia
Dilutional anemia (in-pt) 
Hemolysis
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3
Q

2nd MC anemia (behind IDA)

A

Anemia of chronic disease

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4
Q

Anemia of chronic disease has what morphology of RBCs?

A

Normochromic, normocytic

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5
Q

Underlying causes of Anemia of chronic disease?

A 
Dilutional anemia (25% due to IVF inpt)
Systemic inflammatory process (SLE, RA, Malig)
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6
Q

Anemia of chronic disease pathophys

A

Inflam process disrupts iron hemostasis
IL-6 stimulates hepcidin release from liver
Decrease iron in BM > Erythropoiesis reduction
+
Systemic inflam destroying RBC’s (v-Survival)

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7
Q

Anemia of chronic disease TXT

A 
UC
Iron replacement
Blood transfusion PRN
EPO if - anemia is symptomatic + Hgb <10g/dL OR
- Cancer w/ active chemo
- CKD (GFR <30mL/min)
- HIV txt w/ evidence of myelosupression
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8
Q

Acute blood loss occult reasons?

A

GI bleed
Retroperitoneal bleed (S/P Cardiac cath)
Post-op bleeding

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9
Q

Acute blood loss RBC morpholoy is initially? But evolves into?

A

Normocytic > microcytic

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10
Q

CKD anemia GFR?

A

<30mL/min

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11
Q

CKD - etiology of the anemia?

A

Decrease EPO > decreased BM production of RBCs

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12
Q

CKD anemia management

A

EPO bld measurement - not req (PRN)
TXT - synthetic EPO stimulating agents when
-1. GFR <30mL/m AND -2. hgb <10g/dL

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13
Q

CKD anemia TXT goal

A

Hgb - 11g/dL

HCT - 33%

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14
Q

Primary Aplastic anemia is?

A

IgG autoantibody against BM stem cells

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15
Q

Secondary Aplastic anemia is due to?

A

Inheritied/acquired

  • Chemo/Rad
  • Rx
  • Infections
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16
Q

Pancytopenia BM D/O

A 
Aplastic anemia
MDS
Acute leukemia
Myelofibrosis
Infiltrative D/O (lymphoma, myeloma, carcinoma)
Megaloblastic anemia
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17
Q

Pancytopenia Non-Clonal (Non-BM) D/O

A

Hypersplenism

SLE

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18
Q

Aplastic anemia clinical features

A

Hallmark is Pancytopenia (+hypocellular BM)
Anemia - weak, fatigue, pallor (Usually very severe)
Neutropenia - high risk of infection
Thrombocytopenia - bleeading

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19
Q

Aplastic anemia population age group

A

Bimodal
15-25yo
AND
>60yo

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20
Q

Aplastic anemia TXT

A

BM transplant - younger and/or better fx status
Immunosupression - Older patients (graft vs Host dz)
Case by case however

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21
Q

Hemolytic anemia general attributes

A

Continuous or intermittent

Intrinsic or Extrinsic

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22
Q

Intrinsic Hemolytic anemia is due to?

A

Defect in the RBC itself (usually hereditary)

  • membrane defect = hereditary spherocytosis
  • oxidation vulnerability = G6PD
  • hemoglobinpathy = SCA or Thalassemia
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23
Q

Extrinsic Hemolytic anemia is due to?

A

Immune - (autoimmune, lymphoproliferative, Rx toxicity)
Microangiopathic - TTP, HUS, valve hemolysis
Infection - plasmodium, clostridium, borrelia
Burns

24
Q

Hemolytic anemia smear findings

A

Schistocytosis (req’d for hemolysis to be Dx)

25
Q

Hemolytic anemia labs

A

Indirect bili - INC - esp if intravascular hemolysis
Hemoglobinuria - INC - telltale intravascualr hemolysis
LDH - INC - released from lysed RBCs
Retic - INC - (however, Low-NL if + BM D/O)
Haptoglobin - DEC - binds free Hgb as RBCs lyse

26
Q

MC intrinsic hemolytic anemia?

A

Hereditary Spherocytosis

27
Q

Hereditary Spherocytosis is due to?

A

ABNL spectrin or actin (proteins that provide membrane structure) thus become trapped in spleen and rupture. (Chronic hemolysis)

28
Q

Hereditary Spherocytosis have RBCs that cannot?

A

Pass through small fenestrations of the spleen due to lack of plaibility (Increased fragility)

29
Q

Hereditary Spherocytosis RBCs appear on smear?

A

Normocytic anemia - Round RBCs, lack concavity, central pallor

30
Q

Hereditary Spherocytosis pop predisposition?

A

Autosomal dominant D/O

MC Dx in childhoos (can be adult)

31
Q

Important Hereditary Spherocytosis Labs

A 
MCHC is increased (rounded shape increases surface area and allows more room for Hgb)
Reticulocytosis
Spherocytosis
Negative Coombs test = (not autoimmune)
Increased osmotic fragility test
32
Q

Hereditary Spherocytosis TXT

A

Supportive
pRBCs if Hgb <7g/dL
Folic acid supplement (required for Erythropoiesis)
Splenectomy (rare - eliminates hemolysis site)

33
Q

MC enzymatic RBC D/O?

A

G6PD deficit

34
Q

G6PD deficit causes?

A

Hemolysis if RBCs are exposed to oxidative stress.

35
Q

G6PD deficit genetic predisposition?

A

X-linked recessive

Southeast asia, Mediterranean, African American

36
Q

G6PD deficit pathophy

A

NL G6PD acts on glutathione in a reduced state which protects Hgb from oxidative denaturation

37
Q

Oxidative stress is?

A

bodys inability to detoxify oxygen free radicals > thus they attack biological molecules (DNA, lipids, Proteins)

38
Q

Oxidative stress and a pt w/ G6PD deficit causes

A

Episodic hemolysis in relation to the insult

39
Q

Oxidized stress onto Hgb causes what to happen?

A

Denatures into Heinz Bodies (inclusion w/in RBCs)

40
Q

Rx that induce oxidative stress?

A

Antimalarials - (Primaquine, Dapsone)

Sulfonamides - (Sulfonamethoxazole)

41
Q

G6PD deficit clinical course?

A

Pt is perfectly healthy unless exposed to oxidative stress

  • Rx
  • Dehydration
  • Hypoxia
42
Q

G6PD deficit labs to focus on

A 
Retics - INC
Indirect bilirubin - INC
LDH - INC
Haptoglobin - DEC
Blood smear - Heinz bodies (denatured hgb)
43
Q

SCA genetic predispostion

A

Autosomal recessive D/O
African American
Usually Dx 1st yr life (Hgb F stops revealing Hgb S)

44
Q

SCA mutation is?

A

Point mutation in Beta chain at 6th position resulting in the formation of Hgb-S > sickling RBCs

45
Q

ABNL hgb shape causes?

A

Chronic hemolytix Anemia

Acute painful episodes due to vaso-occlusion

46
Q

Acute vaso-occlusions w/ SCA occur when?

A

Spontaneously OR Oxidative stress (Inf, Dehydrated, hypoxia)

47
Q

Vaso-occlusions are a risk factor for?

48
Q

Acute manisfestations of vaso-occlusions

A 
Bacterial Sepsis/meningitis
Recurrent Pain - dactylitis, MSK, Abd pain
Stroke
Splenic sequestration
Aplastic crisis
Priapism
Hematuria (including papillary necrosis)
49
Q

Chronic manifestations of vaso-occlusions

A 
Anemia
Jaundice
Splenomegaly
Fx asplenia
\+ others
50
Q

SCA features?

A

Chronic hemolysis
Smear = Sickles and Howell-Jolly bodies (nuclear remnants - usually removed by spleen)
Fx hyposplenism/Asplenia

51
Q

SCA Dx is confirmed how?

A

Hgb electrophoresis

52
Q

SCA TXT

A

Hydroxyurea - INC Hgb F (if >2 acute painful crises/yr)
Pneumococcal Vaccine - encapsulated bugs - asplenia
Transfusion therapy - Hgb <7.0g/dL
IVF - NS or LR
Pain - ( 1-3 APAP, 4-7 NSAIDS, 8-10, (hydro)-morphine

53
Q

Autoimmune hemolytic anemia (AIHA) is?

A

acquired autoantibodies to RBCs membranes

54
Q

AIHA important features

A

Episodic hemolysis trigger w/ physiologic stress
Rapid onset anemia - possibly life threatening
+ Coombs DAT (checks for antihuman antibodies)

55
Q

Purpose of a Coombs direct antiglobulin test

A

Checks for antihuman antibodies in the blood

56
Q

Microangiopathic Hemolytic anemia (MAHA) is?

A

group of D/O w/ intravascular hemolysis due to RBC fragmentation

57
Q

Hallmark S/S of MAHA is?

A

Schistocytes

Heme (8 decks)

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