week 12-anemia Flashcards
1
Q
anemia definition
A
lower than normal level of healthy red blood cells or hemoglobin
2
Q
anemia is characterized by (3)
A
ow hemoglobin, low hematocrit, low RBC count on the complete blood count (CBC)
3
Q
anemia in adult males hemoglobin and hematocrit values
A
Anemia in adult males: hemoglobin <130 g/L (13 g/dL); hematocrit <41%
4
Q
anemia in adult females hemoglobin and hematocrit values
A
Anemia in nonpregnant adult females: hemoglobin <120 g/L (12 g/dL); hematocrit <36%
5
Q
RBC count
A
The number of RBCs per volume of blood
6
Q
hemoglobin
A
Amount of oxygen-carrying protein in the blood
7
Q
hematocrit
A
Percentage of a given volume of whole blood occupied by packed RBCs
8
Q
mean corpuscular volume MCV
A
Measurement of average size of RBCs
9
Q
what has a larger MCV than RBCs
A
the reticulocytes are larger than mature RBCs
10
Q
mean corpuscular hemoglobin
A
Amount of oxygen-carrying Hb inside RBCs
11
Q
mean corpuscular hemoglobin concentration (MCHC)
A
Average concentration of Hb inside RBCs (i.e., ratio of MCH to MCV)
12
Q
red cell distribution width (RDW)
A
Measurement of variance in RBC size
13
Q
WBC count
A
The number of WBCs per volume of blood
14
Q
WBC differential
A
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
15
Q
platelet count
A
Number of platelets per volume of blood
16
Q
mean platelet volume MPV
A
Measurement of average platelet size
17
Q
reticulocytes
A
Immature RBCs that contain no nucleus but have residual RNA
18
Q
symptoms of anemia
A
Symptoms in chronic anemia are due to decreased oxygen delivery to the body’s tissues:
* Fatigue
* Tachycardia
* Palpitations
* Dyspnea on exertion
19
Q
what pallor spots have the highest LR for anemia
A
conjunctival rim pallor (LR+ 16.7)
palmar crease pallor (LR+ 7.9)
palmar pallor (LR+ 5.6)
20
Q
what is the most important clinical sign for anemia but is not always evident until the hemoglobin drops quite low
A
Pallor is the most important clinical sign, but it is not usually visible unless hemoglobin falls to 80 g/L (8 g/dL)
21
Q
are physical exams good to rule out anemia?
A
- No physical sign rules out anemia
- What does this mean?
- Even without physical exam signs, order a complete blood count if your patient has symptoms that suggest anemia
- Order a complete blood count if you observe conjunctival rim or palmar crease pallor
22
Q
2 causes of anemia
A
reticulocytopenia
OR
reticulocytosis
23
Q
reticulocytopenia
A
decreased RBC production
24
Q
reticulocytosis
A
increased RBC destruction (hemolysis) or accelerated RBC loss
25
things that cause decreased RBC production (reticulocytopenia)
* Hemoglobin synthesis lesion: iron deficiency, thalassemia, anemia of chronic disease, hypoerythropoietinemia
* DNA synthesis lesion: megaloblastic anemia, folic acid deficiency, DNA synthesis inhibitor medications
* Hematopoietic stem cell lesion: aplastic anemia, leukemia
* Bone marrow infiltration: carcinoma, lymphoma, fibrosis, sarcoidosis, Gaucher disease, others
* Immune-mediated inhibition: aplastic anemia, pure RBC aplasia
26
things that cause increased RBC destruction or accelerated RBC loss (reticulocytoisis)
Acute blood loss
* Hemolysis (intrinsic)
* Membrane lesion: hereditary spherocytosis, elliptocytosis
* Hemoglobin lesion: sickle cell, unstable hemoglobin
* Glycolysis lesion: pyruvate kinase deficiency
* Oxidation lesion: glucose-6-phosphate
dehydrogenase deficiency
* Hemolysis (extrinsic)
* Immune: warm antibody, cold antibody
* Microangiopathic: disseminated intravascular
coagulation, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, mechanical cardiac valve, paravalvular leak
* Infection: Clostridium perfringens, malaria
* Hypersplenism
27
3 steps to a general approach to anemia
1. Exclude acute blood loss
2. Determine the general mechanism for anemia
* Distinguish RBC underproduction from hemolysis
3. Determine the specific cause of RBC underproduction or hemolysis
28
symptoms of acute blood loss
* Hematemesis (vomit blood)
* Melena (dark tar stool)
* Hematochezia or rectal
bleeding
* Hematuria (blood in urine)
* Menorrhagia or vaginal
bleeding
* Hemoptysis (cough up blood)
29
signs of acute blood loss
* Hypotension
* Tachycardia
* Large ecchymoses (bruises)
30
what is a normal reticulocyte count
0.5-1.5%
31
what causes a low reticulocyte count
in RBC underproduction anemia
32
what causes a high reticulocyte count
in hemolysis or when bone marrow responds normally to blood loss
33
reticulocyte production index
Corrects the reticulocyte count for the degree of anemia and for the
prolonged peripheral maturation of reticulocytes that occurs in anemia
34
reticulocyte production index calculation
* RPI = reticulocyte count % x (Hct/45) / Maturation
* Maturation represents the maturation time of RBCs in days at various levels of anemia
* Maturation = 1.0 for Hct ≥40%; Maturation = 1.5 for Hct 30-39.9%; Maturation = 2.0 for Hct 20-29.9%; Maturation = 2.5 for Hct <20%
35
what is a normal reticulocyte production index
1
36
in patients with anemia an RPI <2 indicates
hypo proliferative anemia
(RBC underproduction anemia)
37
in patients with anemia an RPI >2 indicates
hyperproliferative anemia (hemolysis or when
bone marrow responds normally to blood loss)
38
RPI >2 or <2
<2 = hypo proliferative anemia
>2= hyper proliferative anemia
39
what is the normal range of MCV
80-100 fL
40
macrocytic anemia vs microcytic anemia
macro= * Average RBC is larger than normal
micro= * Average RBC is smaller than normal
41
2 subcategories of microcytic anemia
* Subcategorized as megaloblastic (due to impaired DNA synthesis) or non-megaloblastic (normal DNA synthesis)
42
macrotyic anemia has an MCV of
>100 fL
43
microcytic anemia has a MCV of
<80 fL
44
normocytic, microcytic, and microcytic anemia MCV values
normo= 80-100
macro= >100 fL
micro= <80 fL
45
types of normocytic anemia
* Anemia of chronic disease/inflammation
* Anemia of renal/kidney disease
and Mild form of most
acquired microcytic or macrocytic etiologies of anemia (i.e. early stages)
46
anemias of chronic disease/ inflammation can be 2 types of sizes
normocytic or microcytic
47
examples of microcytic anemia
* Iron deficiency
* Thalassemia
* Anemia of chronic
disease/inflammation
48
macrocytic (megaloblastic) and (non-megaloblastic anemias)
megaloblastic;
* Vitamin B12 deficiency
* Folate deficiency
non:
* Aplastic anemia
* Myelodysplastic
syndrome
* liver disease
* hypothyroidism
49
MCV and specificity?
* MCV is not specific! Do not use RBC size alone to rule in/out a specific cause of anemia.
* What about the rest of the red cell indices?
* MCH and MCHC tend to trend with the MCV and are not particularly sensitive or specific
* RDW is not sensitive or specific
50
what is the most common cause of anemia worldwide
iron defieincy anemia
51
what is the most common cause of microcytic anemia (low MCV)
iron deficiency anemia
52
80% of patients with microcytic anemia are from
chronic blood loss
53
prevalence in different groups for IDA
* 1-2% in men <50 years of age
* 10% in menstruating women
* 3% in children aged 1-3
* In United States: 7% in non-Hispanic White women; 20% in Mexican and Black women
54
2 most common causes of iron deficiency
1. chronic blood loss
a. GI bleeds
b. heavy/frequent menses
55
causes of iron deficnicy anemia
* Chronic blood loss
* GI bleeds, heavy/frequent menses, blood donation, hemoglobinuria
* Dietary deficiency (plant-based diets contain nonheme iron which has low bioavailability)
* Decreased/impaired absorption
* Autoimmune gastritis, celiac disease, Helicobacter pylori gastritis, inflammatory bowel disease, hereditary iron-refractory iron deficiency anemia, zinc deficiency
* Increased requirements/demand * Children, pregnancy, lactation
* Iron sequestration
* Pulmonary hemosiderosis
* Idiopathic
56
populations are risk of iron deficiency anemia
* Premenopausal, menstruating women due to menorrhagia and chronic blood loss without proper iron supplementation
* Men and postmenopausal women > age 50 due to colorectal cancer (occult blood loss from GI tract)
* Non-breastfed preschool children on cow’s milk
* Strict vegans/vegetarians
* Low-income families; developing countries
57
signs and symptoms of iron deficiency anemia
* Restless legs
* Pica/pagophagia – craving for specific foods e.g., ice chips
* Glossitis (inflamed tongue) (tender, smooth, red tongue)
* Cheilitis (inflamed lips)
* Brittle nails, koilonychia (spooning of nails)
* Severe iron deficiency: dysphagia due to formation of esophageal webs (Plummer-Vinson syndrome)
58
size and colour in iron deficiency anemia
Typically presents as microcytic, hypochromic anemia on peripheral blood smear
59
what is the best biomarker for iron deficiency anemia
decreased serum ferritin
60
in iron deficiency anemia what happens to
-serum ferritin
-transferrin saturation
-serum iron
-total iron binding capacity
* Decreased serum ferritin
* Ferritin <15 ug/L (LR+ 51)
* Ferritin <30 ug/L (LR+ 46)
* Decreased transferrin saturation
* Transferrin saturation ≤5% (LR+ 10.46)
* Decreased serum iron
* Increased total iron-binding capacity
61
what to do if this GI source of bleeding
fecal occult blood test
62
Serum transferrin receptor-ferritin index
Helps distinguish iron deficiency anemia from other causes when ferritin is midrange
i.e. serum ferritin is usually low in IDA but if there's inflammation it can increase it
63
Serum transferrin receptor-ferritin index of < 1.5 and > 1.5 suggests what
> 1.5 = IDA
< 1.5 = other cause of anemia (i.e. chronic disease, like chronic kidney disease in elders)
64
IDA treatment
-treat underlying cause
- oral iron or IV iron
65
how long to replete iron stores and hemoglobin
6 months of iron therapy to replete iron stores; hemoglobin levels may return to normal by 6-8 weeks
66
when to consider blood transfusion in IDA
* Is hypotensive and actively bleeding
* Has angina, dizziness, syncope, severe dyspnea or severe fatigue * Has very low hemoglobin <70 g/L (7 g/dL)
67
what does b12 deficiency anemia cause
Causes megaloblastic macrocytic anemia (high MCV)
68
MCV in b12 deficiency anemia
high
69
b12 defieicny anemia is characterized by
Characterized by hypersegmented neutrophils on peripheral blood smear
70
pathophysiology in b12 deficiency anemia
* Vitamin B12 deficiency → impaired DNA synthesis → decreased RBC production
71
risk factors for b12 deficiency
vegan diet, autoimmune diseases, elderly
72
symptoms in b12 deficiency anemia
Presents with neurologic symptoms (paresthesias, sensory loss – especially vibration and position sense, ataxia)
73
most common causes of b12 deficiency anemia
* Food-cobalamin malabsorption (B12 not released from food protein due to impaired peptic digestion)
* Affects up to 20% of older adults
* Caused by atrophic gastritis and achlorhydria – can be due to chronic H. pylori infection, gastric surgery, long-term used of acid- suppressing medications
* Lack of intrinsic factor
* Caused by gastrectomy or pernicious anemia
* Dietary vitamin B12 deficiency: vegan diet
74
less common causes of b12 deficiency anemia
* Malabsorption in terminal ileum
* Caused by surgical removal or bypass, Crohn disease, celiac disease, or bacterial overgrowth
* Drugs interfering with B12 absorption
* Metformin, proton pump inhibitors, colchicine, ethanol, neomycin
* Congenital disorders (e.g., transcobalamin II deficiency)
75
b12 deficiency anemia is what type of anemia
pernicious anemia
76
what is the autoimmune cause of b12 defieicny anemia called
pernicious anemia
77
what is pernicious anemia causing b12 deficiency anemia
autoimmune; loss of IF
Perniciousanemia–autoimmune-mediatedgastricatrophy→lossofparietal cells→decreased secretion of intrinsic factor→decreased dietary vitamin B12 absorption
78
who is pernicious anemia most common in
old, comorbid autoimmune disease
* Most common in patients > age 50 (median age at diagnosis: 70-80 years; prevalence ~2%); Uncommon before age 30
* 25% have a family history of pernicious anemia
* 10% have autoimmune thyroid disease; higher incidence of other autoimmune
disorders including diabetes mellitus type 1 and vitiligo
79
how to diagnose pernicious anemia
test for the presence of anti-intrinsic factor
antibodies
80
what are the levels of b12, homocysteine and methylmalonic acid in b12 deificney anemia
b12 is low
homocysteine and MMA are high
81
what can cause b12 to be falsely low
folate deficiency, pregnancy, oral contraceptive use
82
what can cause b12 to be falsely normal
myeloproliferative disorders ,liver disease, bacterial overgrowth syndromes
83
why is homocysteine and methylmalonic acid high in b12 deficiency anemia
because you need b12 to turn homocysteine in methionine and for MMA into succinyl coa
84
reasons for homocysteine elevation (not just b12 deficiency)
folate deficiency, chronic kidney disease, hypovolemia, hypothyroidism
85
reasons for methylmalonic acid elevation (not just b12 deficiency)
chronic kidney disease, hypovolemia
86
what is more specific for b12 deificney: homocysteine or methylmalonic acid (MMA)
MMA
87
when to check for b12 deficiency
in folate deficiency
88
b12 supplement
* Reversible by restoring vitamin B12 through dietary intake, oral supplementation, parenteral supplementation
* Response to therapy is another way to establish the presence of B12 deficiency
89
b12 deficiency and folate deficiency anemia both present as
megaloblastic macrocytic anemia (high MCV)
90
folate deficnicney is caused by
megaloblastic macrocytic anemia
91
what is the MCV in folate deificny anemia
high
92
what is folate deificny anemia characterized by
Characterized by hypersegmented neutrophils on peripheral blood smear
93
pathophysiology of folate defiicney anemia
Folate deficiency → impaired DNA synthesis → decreased RBC production
94
common causes of folate deificny anemia
alcohol abuse, increased folate demand due to pregnancy, sickle cell anemia, starvation/malnutrition, drugs (methotrexate, phenytoin, sulfalazine)
95
folate levels and homocysteine levels in folate deficiency anemia
low folate
high homocysteine
96
what test to differentiate between folate and b12 deificney anemia
increased homocysteine but normal MMA in folate deficiency
97
what non-nutritional anemias may mimic folate of b12 deificny anemia
* Anemia of renal disease
* Anemia of chronic disease
* Thalassemia
* Myelodysplastic syndrome
98
SLIDE 51 for comparing iron stores in anemias
DO!
99
anemia of renal disease (kidney disease) what does it decrease the production of
EPO
* Kidney disease→decreased erythropoietin (EPO) production→ decreased production of RBCs
100
what type of size and colour anemia in anemia of renal disease
Usually normocytic normochromic anemia
* Microcytosis can occur
101
clinical findings in anemia of renal disease
low EPO, low Hb, low iron
* Low EPO levels
* Usually normocytic normochromic anemia
* Microcytosis can occur
* Low hemoglobin concentrations (ranging from mild to severe depending on level of renal failure)
* Variety of morphologic abnormalities
* Low serum iron levels and percentage of iron saturation
* Serum transferrin receptor-ferritin index <1.5 with increased creatinine and decreased GFR suggests anemia due to chronic
kidney disease
102
what is the 2nd most prevalent cause of anemia after iron deficiency anemia
anemia of chronic disease
103
what is anemia of chronic disease associated with
infection, inflammation, malignancy, trauma
104
what is impaired in anemia of chronic disease
Impaired iron transport from iron storage sites (e.g., liver, spleen, bone
marrow) to developing RBCs→decreased production of RBCs
105
size and colour of anemia in anemia of chronic disease
* Usually mild normocytic normochromic anemia, with time can evolve to mild microcytic hypochromic anemia
106
clinical findings in anemia of chronic disease
* Usually mild normocytic normochromic anemia, with time can evolve to mild microcytic hypochromic anemia
* Nearly normal peripheral blood smear
* Low serum iron with normal to increased iron stores
107
CHARTT ON SLIDE 54 to DDX IDA and anemia of chronic diseas
important go look!
108
other tests to consider in anemia of chronic disease
* Liver enzymes if there is history of liver disease * Creatinine if there is history of kidney disease
* Elevated inflammatory markers: ESR and CRP
* If possible, treat the underlying chronic disease
109
steps if suspect microcytic or normocytic anemia
1. serum ferritin level
(if low = IDA)
(high= consider congenital hemoglobiopathies)
2. if midrange then serum transferrin receptor ferritin index
(>1.5= iron deficient, <1.5= continue)
3. obtain basic metabolic panel and look for GFR to see if kidney disease or other unexpalin anemia of chronic disease
(FLOW CHART ON SLIDE 58)
110
if serum ferritin is low midrange and elevated what to do if suspect anemia
low= above treamtent threshold; treat IDA
midrange= do serum transferrin receptor ferritin index (keep testing bc between treatment and testing threshold for IDA)
elevated= consider congenital hemoglobiopathies (below testing threshold for IDA)
111
GFR for chronic kidney disease
<60
112
basic metabolic panel to get GFR for kidney disease
Basic Metabolic Panel
(aka electrolyte panel or chemical screen)
* Glucose
* Calcium
* Sodium
* Potassium
* Carbon dioxide
* Chloride
* Blood urea nitrogen (BUN)
* Creatinine
113
what is the most common inherited disorders
thalassemias
114
what does a thalassemias do
* Congenital abnormality of hemoglobin synthesis → decreased production of RBCs
115
alpha vs beta thalassemia
* α- Thalassemia – due to unbalanced synthesis of alpha globin chains * Highest prevalence of alpha-thalassemia mutations in persons of
African, Mediterranean and Southeast Asian descent
* β- Thalassemia – due to unbalanced synthesis of beta globin chains
* Highest prevalence of beta-thalassemia mutations in persons of Mediterranean, Middle Eastern, and Southeast Asian descent
116
#1 severity of alpha thalassemia
1 defective/missing alpha gene = α- thalassemia minima
* Asymptomatic
117
#2 severity of alpha thalassemia
* 2 defective/missing alpha genes = α- thalassemia minor
* Mild anemia symptoms
118
#3 severity of alpha thalassemia
3 defective/missing alpha genes = Hemoglobin H disease
* Moderate to severe anemia symptoms
119
#4 severity of alpha thalassemia
* 4 defective/missing alpha genes = hydrops fetalis with
Hemoglobin Barts
* Usually fatal in utero
* Rare newborn survival requires lifelong blood transfusions
120
type 1 of beta thalasemia
1 defective/missing beta gene = β- thalassemia
minor
* Mild anemia symptoms
121
type 2 of beta thalassemia
* 2 defective/missing beta genes
* Moderate anemia symptoms = β- thalassemia intermedia
* Severe anemia symptoms = β- thalassemia major (Cooley’s anemia)
122
if 2 missing beta genes in beta thalasemia could be
b-thalassmeia intermedia of b-thalassemia major (Cooley's anemia)
123
what are the moderate to severe forms of thlassemisas
Moderate to severe forms of thalassemia (includes β- thalassemia intermedia, β-thalassemia major, and Hemoglobin H disease) are usually diagnosed in childhood
124
what are the moderate to severe forms of thalassemias symptoms?
* Severe anemia
* Growth disturbances and delayed puberty * Bone abnormalities (e.g., osteoporosis)
* Splenomegaly
* Pallor or jaundice
125
what are the mild forms of thalassemias
(includes β- thalassemia minor and α-thalassemia minor) may be unrecognized into adulthood and appear like a mild iron deficiency anemia
126
size and colour of cell and other symptoms in mild forms of thalassemias
* Mild hypochromic, microcytic anemia
* May have splenomegaly (15-20%)
127
diagnosing thalassemia
* Look for a family history of anemia
* Blood tests: CBC, peripheral blood smear
* Hemoglobin electrophoresis
* Genetic testing
128
myelodysplastic syndrome
aka hyperplastic bone marrow with bone marrow failure, refractory anemia, smoldering leukemia, preleukemia
129
pathophysiology of myelodysplastic syndrome
Blood cell components fail to mature → deficient production of mature cells into peripheral blood (including RBCs)
130
risks for development of myelodysplastic syndrome
* Increased risk with advancing age
* Can be associated with preceding disorders such as malignancy or bone marrow dysfunction
* May follow radiotherapy or chemotherapy
131
5 subtypes of myelodysplastic syndrome
1. Refractory anemia
2. Refractory anemia with excess blasts
3. Refractory anemia with leukemia in transformation 4. Refractory anemia with sideroblasts
5. Chronic myelomonocytic leukemia
can all transform into acute leukemia, #3 the quickest
132
what is the worst myelodysplastic syndrome and why
Refractory anemia with leukemia in transformation
Can transform into acute leukemia within months.
133
what size of anemia in myelodysplastic syndrome
megaloblastic or microcytic anemia
134
when to suspect myelodysplastic syndrome
* Pancytopenia: anemia combined with abnormalities in one or two of the other marrow cell lines (WBCs, platelets)
* Peripheral blood smear findings: abnormalities of
RBC shape and size, polymorphonuclear leukocytes
with hypersegmentation or Pelger-Huët nuclear
anomaly (a bilobular polymorphonuclear leukocyte)
135
pancytopenia in which anemia type
myelodysplastic syndrome
136
a high reticulocyte count is suggestive of
High reticulocyte count and/or RPI > 2.0 suggests
hemolysis. It can also suggest normal bone marrow response to acute blood loss (but we already excluded
acute blood loss in step 1).
137
hemolytic anemia? what is the size and MCV?
Normocytic anemia (MCV 80-100 fL) caused by destruction of RBCs
138
cause of hemolytic anemia
Several ways to classify: acute vs. chronic disease, immune vs. non-immune mediated, intravascular vs. extravascular, inherited vs. acquired, and intracorpuscular vs. extracorpuscular
139
inherited vs acquired causes of hemolytic anemia
Inherited/Hereditary
* Enzymopathies, disorders of hemoglobin (sickle cell), defects in red blood cell metabolism (G6PD deficiency, pyruvate kinase deficiency), defects in red blood cell membrane production (hereditary spherocytosis and elliptocytosis)
* Acquired
* Immune-mediated, infection, microangiopathic, blood transfusion-related, and secondary to hypersplenism
140
extravascular vs intravascular hemolysis causing hemolytic anemia
extravascular= RBCs are prematurely removed from the circulation by the liver and spleen. This accounts for majority of cases of hemolytic anemia.
Intravascular hemolysis: RBCs lyse within the circulation. Less common.
141
what is more common; intravascular or extravascular hemolysis
extravascualr
142
causes of extravascular hemolysis
* Hemoglobinopathies (sickle cell, thalassemias)
* Enzymopathies (G6PD deficiency, pyruvate kinase deficiency)
* Membrane defects (hereditary spherocytosis, hereditary elliptocytosis)
* Drug-induced
143
causes of intravascular hemolysis
* Paroxysmal nocturnal hemoglobinuria (PHH)
* Autoimmune hemolytic anemia (AIHA)
* Transfusion reactions
* Microangiopathic hemolytic anemia (MAHA)
* Disseminated intravascular coagulation (DIC)
* Infections
* Snake bites/venom
144
signs and symptoms of hemolytic anemia
* General signs and symptoms of anemia: shortness of breath, weakness, fatigue, arrhythmias, tachycardia
* Hemolysis may also lead to jaundice
* Lymphadenopathy, hepatosplenomegaly
145
hemolytic anemia with diarrhea vs with hematuria
* Hemolytic anemia with diarrhea → consider hemolytic uremic syndrome
* Hemolytic anemia with hematuria → consider paroxysmal nocturnal hemoglobinuria
146
* Hemolytic anemia with hematuria → consider
* Hemolytic anemia with hematuria → consider paroxysmal nocturnal hemoglobinuria
147
* Hemolytic anemia with diarrhea → consider
* Hemolytic anemia with diarrhea → consider hemolytic uremic syndrome
148
what happens to the following labs in hemolytic anemia
- reticulocyte
-lactate dehydorgenase
-unconjugated bilirubin
haptoglobin
* Elevated reticulocyte count
* Increased lactate dehydrogenase (LDH)
* Elevated unconjugated bilirubin
* Decreased Haptoglobin
149
exam of peripheral blood smear shows what in hemolytic anemia
abnormal RBC shapes (e.g., schistocytes, spherocytes, bite cells)
150
to figure out if hemolytic anemia is immune mediated what test?
Direct antiglobulin (Coombs) test: warm and cold agglutins can differentiate whether the cause is immune-mediated
151
maangment of hemolytic anemia
* Workup and treatment requires interprofessional approach including referral to a hematologist
* Treatment and outcomes vary depending on the underlying cause of hemolysis
152
untreated anemia in pregnancy
premature labour and increased blood loss during birth; low birth weight and risk of anemia in baby
153
untreated anemia in elderly
cardiac complications such as myocardial infarction, angina, arrhythmias, heart failure
154
untreated anemia in kids
impaired neurological development (cognitive, mental, and developmental delays)
155
interprofessional managen of anemia
* Gastroenterologist if a gastrointestinal bleed is suspected
* Nephrologist if anemia of chronic disease in the setting of renal failure is suspected
* Hematologist if a bone marrow disorder is suspected
* Gynecologist if intractable menorrhagia is suspected
* Cardiologist if severe anemia leads to angina, myocardial infarction, heart failure, or arrhythmias
