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29 Cards in this Set
- Front
- Back
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What are normal hemoglobin levels?
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Men > 13.5 g/dL
Women > 12g/dL |
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Who should be screen for anemia when asymptomatic?
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Pregnant women and bariatric surgery patients.
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What are the three kinetic types of anemia?
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Hypoproliferative
Hemolysis Bleeding |
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What are the first tests done when working up anemia?
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CBC
Reticulocyte count |
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What does a reticulocyte count tell you?
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Normal .5-1.5%
In anemia, you expect the count to be elevated. When it's not, there could be a hypoproliferative disorder. If elevated, there could be a hemolytic or bleeding disorder. |
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What are the major causes of low RBC production?
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Bone marrow failure (MDS, aplastic anemia, chemo)
EPO deficiency (chronic kidney disease) Iron, B12, folate deficiency |
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When is EPO released? What is it regulated by?
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Released from juxtatubular interstititial cells of kidneys. Stimulated by hypoxemia.
Regulated by HIF1alpha. |
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What are the features of chronic kidney disease anemia?
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EPO deficiency
Normocytic, mild anemia (>10 g/dL) Treat with recombinant erythropoietin |
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What are the tests for hemolytic anemia? What do they reflect?
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CBC: Increased RDW, increased retic
LDH: lactate dehydrogenase increased with rapid cell turnover Haptoglobin: low because bound to free globin Indirect bilirubin: increased unconjugated bilirubin |
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What are intrinsic hemolytic anemias?
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Qualitative- sickle cell
Quantitative- thalassemia |
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What is extrinsic hemolytic anemia? How is it tested for?
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Autoimmune hemolytic anemia
Coombs test will be positive |
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What are the morphologic categories of anemia?
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Normocytic
Macrocytic Microcytic |
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What are the major causes of microcytic anemia?
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Iron deficiency
Anemia of chronic disease Thalassemia |
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What are morphologic features of iron deficient anemia?
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Microcytic
Hypochromic |
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What is tested in iron studies?
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Ferritin (normal 40-200)
Iron (normal 60-150) Transferrin Iron/transferrin = transferrin saturation |
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What are the two mechanisms that can lead to iron deficiency?
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Bleeding
Malabsportion (bariatric) |
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What are the types of alpha thalassemia? What is the severity of disease?
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AAAA- normal
AAAX- silent AAXX- alpha trait (mild anemia) AXXX- alpha thal major (severe anemia) |
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What are the ethnicities associated with thalassemia?
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Alpha- african and asian
Beta- mediterranean |
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What tests are used to determine thalassemia?
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RBC count- will be discordant with Hgb
Microcytosis Elecrophoresis for beta |
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What are lab findings of anemia of chronic disease?
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Normocytic or microcytic
Ferritin elevated, iron low, transferrin low |
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What are the major causes of macrocytosis?
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B12, folate deficiency
Drugs that affect DNA synthesis Myelodysplastic syndrome |
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What do folate and B12 do? What happens in deficiency?
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Folate is a cofactor of thymidylate synthesis for DNA.
B12 recycles folate and is needed for SAM neurotransmitter. Folate and B12 deficiency result in leukopenia. B12 deficiency results in neurologic symptoms. |
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What are lab findings for B12 deficiency?
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Macro-ovalocytes
Megaloblastic erythropoiesis on bone marrow aspirate Hypersegmented neutrophil |
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How do folate and B12 deficiencies happen?
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Folate- chronic alcoholics
B12- autoimmune, alcoholic, anorexia |
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What drugs affect DNA synthesis, causing anemia?
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Chemotherapy
Hydroxyurea (weak chemo) AZT Dilantin (seizure) |
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What is myelodysplastic syndrome?
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Occurs in elderly.
Asymptomatic with macrocytic anemia. Prognosis from months to years. |
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What are common causes of normocytic anemia?
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Chronic disease
Chronic kidney disease and EPO deficiency Mixed deficiencies (will have increased RDW) |
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What are helpful tests to order for anemia?
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Micro: iron, C-reactive protein
Macro: B12, folate, LDH, haptoglobin, Coombs Normo: erythropoietin, serum protein electrophoresis. Reticulocyte, smear |
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When should anemia be consulted?
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Unexplained anemia.
Hemolytic Transfusion dependent anemia. |
