OnlineMedEd: Hematology Oncology - "Anemia Approach" Flashcards
Review the symptomatology of Hgb by ranges.
- Greater than 13: normal
- 10 - 13: usually asymptomatic
- 8 - 9: malaise, fatigue with moderate exertion (like the athlete who can’t run what they used to)
- 6 - 7: DOE, presyncope
- 4 - 5: MI, high-output cardiac failure
However, the symptoms depend on (1) how fast you got there and (2) comorbidity.
Give the formula for delivery of O2.
DLO2 = CO x Hgb x SpO2%
Pallor of the anterior rim of the eyelid usually appears at Hgb less than _____________.
8
Give Dustyn’s workup for anemia.
1) Order a CBC when person has s/s of anemia (e.g., fatigue, DOE, malaise, presyncope)
2) Look at the MCV
- Microcytic: usually production
- Normocytic: usually destruction
- Macrocytic: usually production
3) Look at the reticulocyte count
- Less than 2% = production anemia
- More than 2% = destruction anemia
If the reticulocyte count is greater than ____%, then it is likely a destruction anemia. Less than this is indicative of production anemias.
2
When you see a microcytic anemia, you should order _____________.
iron labs: ferritin, serum Fe, TIBC, and % sat
Once you see an elevated MCV, then you should look for ______________.
hypersegmented neutrophils (greater than 5 is megaloblastic macrocytic anemia)
The hypersegmented neutrophils is either ______________.
folate deficiency or B12 deficiency
_______________ is elevated in B12 deficiency but not in folate deficiency.
Methylmalonic acid
Normocytic anemias are usually one of three things: _________________.
hemolysis, hemorrhage, or anemia of chronic disease
When you see a normocytic anemia, look for ________________.
the LDH (high in hemolysis), haptoglobin (low in hemolysis), and total bilirubin (high in hemolysis)
If the above labs are normal, then it is likely hemorrhage or anemia of chronic disease.
