Normocytic Anemias Flashcards
Inflammatory anemia (ACD) is common in what population of patients?
hospitalized patients
What is the cause of anemia of chronic disease?
increased inflammatory cytokines result in increased hepcidin and reduced EPO
What is the classic iron study profile for anemia of chronic disease?
- increased ferritin
- decreased serum iron
- decreased TIBC
- transferrin saturation can increase or decrease
What is the main treatment for anemia of chronic disease?
- treat underlying cause
What is the medical treatment for anemia of chronic kidney disease?
- ESAs (Recombinant human EPO) is first line treatment
- iron, vitaminB12, folate PRN
- renal transplant last choice
In anemia of chronic kidney disease, EPO should be elevated in proportion to what?
to the anemia
What is the goal Hgb with medical treatment for anemia of chronic kidney disease?
10
With acute blood loss anemia how low does it take for equilibration to occur?
6 hours
*use vital signs and clinical judgement to determine transfusion needs acutely
How long should it take for the reticulocyte to respond to acute blood loss anemia if the marrow is normal?
4-5 days
What are the 4 specific hemolysis labs?
- bilirubin ( indirect > direct)
- lactate dehydrogenase (LDH)
- Haptoglobin
- Direct Coombs test (Direct antiglobulin test)
What antibodies mediate a “warm” vs “cold” AIHA?
warm = IgG mediated cold = IgM mediated
How is a “warm” AIHA diagnosed? (2 components)
- Positive direct Coombs test (C3 and/or IgG)
- spherocytes/ microspherocytes on smear
How is “cold” AIHA diagnosed? (2 components)
- Positive cold agglutinins (+C3, -IgG)
- agglutinated RBCs (clumps) on smear
Mycoplasma pneumoniae is associated with what type of AIHA?
“Cold” AIHA
How is microangiopathic hemolytic anemia (MAHA) diagnosed?
- 3 or more schistocytes per HPF on peripheral smear
What is the cause of meylophthisic anemia?
- bone marrow replacement/infiltration by fibrosis or tumor
Tear drop cells on peripheral blood smear is pathognomonic for what type of anemia?
- myelophthisic anemia
What is the hallmark sign of aplastic anemia?
- pancytopenia
How is aplastic anemia diagnosed?
- bone marrow biopsy shows aplasia of all 3 lineages
How is aplastic anemia treated?
ATG/cyclosporine if >40; HSCT if <40
Anemia only, with preserved WBC/Plts, is consistent with what bone marrow failure syndrme?
Pure red cell aplasia
What are the 3 common etiologies of pure red cell aplasia?
- viral
- autoimmune
- thymoma
In a patient who presents with acute blood loss anemia which of the following should you NOT use to determine if transfusion is needed acutely?
a. vital signs
b. clinical judgement
c. hemoglobin
d. all of them can be used
c. hemoglobin
* IT TAKES 6 HOURS FOR EQUILIBRATION TO OCCUR CANT USE Hgb*
On peripheral blood smear you see numerous schistocytes and the patient also presents with thrombocytopenia. What is the diagnoses?
a. warm AIHA
b. cold AIHA
c. acute blood loss anemia
d. MAHA
d. MAHA
* microangiopathic hemolytic anemia*
How can you differentiate between the following 2 bone marrow failure syndromes: aplastic anemia and pure red cell aplasia?
- aplastic anemia = pancytopenia
- pure red cell aplasia = anemia ONLY, normal WBC/Plts
