Hematology & Oncology Pathology Anemia

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Spherocyte RBCs indicate

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Hereditary spherocytosis, autoimmune hemolysis

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Elliptocyte RBCs indicate

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Hereditary elliptocytosis

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Macro-ovalocyte RBCs indicate

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Megaloblastic anemia, marrow failure

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Helmet cell, schistocyte RBCs indicate

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DIC, traumatic hemolysis

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Sickle cell RBCs indicate

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Sickle cell anemia

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Bite cell RBCs indicate

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G6PD deficiency

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Teardrop cell RBCs indicate

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Myeloid metaplasia with myelofibrosis

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Acanthocyte RBCs indicate

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Abetalipoproteinemia

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Target cell RBCs indicate

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HALT: HbC disease, Aplenia, Liver disease, Thalassemia

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Poikilocyte RBCs indicate

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thrombotic thrombocytopenic purpura/HUS, microvascular damage, DIC

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Burr cell RBCs indicate

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thrombotic thrombocytopenic purpura/HUS

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Basophilic stippling RBCs indicate

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TAIL: Thalassemias, Anemia of chronic disease, Iron deficiency, Lead poisoning

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List the causes of microcytic, hypochromic anemias (MCV < 80)

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Iron deficiency, thalassemias, lead poisoning, sideroblastic anemias

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List the causes of macrocytic (MCV > 100) anemias

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Drugs that block DNA synthesis (eg: sulfa drugs, phenytoin, AZT), vitamin B12/folate deficiency

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List the causes of normocytic, normochromic anemias

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Acute hemorrhage, enzyme defects - G6PD deficiency, PK deficiency; RBC membrane defects, bone marrow disorders (aplastic anemia, leukemia), hemoflobinopathies (sickle cell disease), autoimmune hemolytic anemia, anemia of chronic disease

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Anemia cause: decrease serum iron (primary mech), increased transferin/TIBC, decreased ferritin, decrease (x2) percentage of transferrin saturation

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Iron deficiency

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Anemia cause: decrease serum iron, decrease transferin/TIBC, increase ferritin (primary mech)

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Anemia of chronic disease

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Anemia cause: increased transferrin/TIBC (primary), decreased % transferrin saturation

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Pregnancy/OCP use

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Anermia cause: increased serum iron (primary mech), decreased transferin, increased ferritin, increased (x2) % transferin saturation

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What is % transferrin saturation?

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serum Fe/TIBC

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What are some causes of aplastic anemia? What is the general mechanism?

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Radiation, benzene, chloramphenicol, alkylating agents, antimetabolites, viral agents (parvovirus B19, EBV, HIV), Fanconi's anemia, idiopathic (immune mediated, primary stem cell defect), following acute hepatitis.

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What are some pathological features of aplastic anemia and how do you diagnose the disease?

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Pancytopenia with normal cell morphology, hypocellular bone marrow with fatty infiltration; dx with bone marrow biopsy

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What is the etiology of sickle cell anemia?

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Single amino acid replacement in the beta chain of valine for glutamic acid

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What are some complications of sickle cell anemia?

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Aplastic crisis due to parvovirus B19 infection, autosplenectomy, increased risk of encapsulated organism infection, Salmonelle osteomyelitis, painful crisis (vaso-occlusive), renal papillary necrosis, splenic sequestration crsis

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Which popluations are alpha-thalassemia prevalent in? How about beta-thalassemias?

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alpha: Asia and Africa; beta: Mediterranean

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A Coombs positive anemia indicates…

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Autoimmune hemolytic annemia

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What kind of antibody is warm agglutinin autoimmune anemia? What is it associated with?

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IgG; chronic anemia seen with SLE, CLL or certain drugs (eg: alpha-methyldopa)

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What kind of antibody is cold agglutinin autoimmune anemia? What is it associated with?

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IgM; Mycoplasma pneumoniae infections or infectious mononucleosis

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What kind of hemolysis is autoimmune anemia?

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Extravascular hemolysis

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What kind of hemolysis is hereditary spherocytosis?

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Intrinsic extravascular hemolysis hemolysis

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What kind of hemolysis is paroxysmal nocturnal hemoglobinuria?

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Intravascular hemolysis

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What kind of hemolysis is microangiopathic anemia?

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Intravascular hemolysis

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What is the etiology of hereditary spherocytosis?

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Spectrin or ankyrin defect causing small, round RBCs with central pallor

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What is the etiology of paroxysmal noctural hemoglobinuria?

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Impaired synthesis of GP1 anchor in RBC membrane increases RBC sensitivity to the lytic activity of complement

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What are some of the causes of microangiopathic anemia?

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DIC, TTP/HUS, SLE, malignant hypertension

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Anemia clues: Howell-Jolly bodies

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Hereditary spherocytosis

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Anemia clues: increased urine hemosiderin

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Paroxysmal nocturnal hemoglobinuria

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Anemia clues: schistocytes (helmet cells)

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Microangiopathic anemia