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42 Cards in this Set
- Front
- Back
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What is the definition of anemia?
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hemoglobin concentration or hematocrit two or more standard deviations below the mean value for age, sex
not a disease but sympmtom of another disorder |
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How does the hemoglobin concetration change in a newborn? to adulthood?
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Relativel high in newborn
Declines reaching a nadir known as physiologic anemia of infancy Thereafter hemoglobin concetration rises gradually during childhood, reach adult values after puberty |
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When does the nadir of physiologic anemia come in infants?
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6 weeks in the premature infant
2-3 months in term infant |
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What are the causes of anemia?
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decreased red cell production
increased red cell destruction blood loss |
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What are the reasons for decreased red cell production?
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deficiency of hematopoietic precursors of bone marrow failure
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What are the reasons for increased red cell destruction?
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Hemolytic disease, due to extracorpuscular or intracorpuscular defects
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For what is adjustred reticulocyte count used for and how is it calculated?
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used to determine whether there has been an adequate erythropoietic response to the given anemia
ARC calculated= measured hematocrit/ expected hematocrit x reticulocyte count |
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What are the readings for ARC?
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ARC <2 signifies ineffective erythropoeisis
ARC>2 signifies effective erythropoeisis, suggesting hemolysis or chronic blood loss |
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What are causes of anemia in an infant?
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perinatal hx of twin-twin fetomaternal transfusion
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What are causes of anemia in a child?
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dietary history may suggest factors for iron, Vitamin B12, or folate deficiency anemia
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How can iron deficiency anemia and lead poisoning manifest?
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both are microcytic anemias that have pica
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What are signs of overt or occult bleeding?
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melena, hematochezia, hematuiria, hematemesis, abnormal menses, or epistaxis
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What are symptoms indicate an inherited hemolytic anemia as?
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patient's race/ethnicity and family history of splenectomy or cholecystomy suggest an inherited hemolytic anemia
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What medications can cause either bone marrow suprresion or hemolysis? What are the signs of anemia?
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history of fever, weight loss, fatigue, rash, bruising, jaundice and cough
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What are important findings on PE that indicate the presence of anemia?
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pallor (skin, conjunctiva, mucosa) and loss of palmar crease pigmentation, comparing complextion of patient to parent useful
tachycardia and postural change in heart rate and blood pressure are seen with acute blood loss congestive heart failure (hepatosplenomegaly, lower extremity edema, tachycardia) pancytopenia (petechiae, purpura) blood loss (positive stool guiac, or gastroccult, gross hematuria) hemolysis (scleral icterus, jaundice, urobilinogen in the urine) or infiltrative disorders (lympadenopathy, hepatosplenoegaly) |
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What are the ways to notice decreased pallor?
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pallor (skin, conjunctiva, mucosa) and loss of palmar crease pigmentation, comparing complextion of patient to parent useful
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What are the physical signs of acute blood loss?
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tachycardia and postural change in heart rate and blood pressure are seen with acute blood loss
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What are the physical signs that can be seen with CHF secondary to anemia?
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congestive heart failure (hepatosplenomegaly, lower extremity edema, tachycardia)
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What are the physical signs that can been with pancytopenia secondary to anemia?
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pancytopenia (petechiae, purpura)
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What are the ways for assesing blood loss?
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blood loss (positive stool guiac, or gastroccult, gross hematuria)
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What are the physical signs of anemia due to hemolysis?
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hemolysis (scleral icterus, jaundice, urobilinogen in the urine)
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What are the physical signs of anemia due to infiltrative disoders?
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infiltrative disorders (lympadenopathy, hepatosplenoegaly)
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What are the goals of testing and diagnostic evaluation in anemia?
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To determine whether the anemia results from decreased production, increased destruction or blood loss
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What are the initial lab tests needed to evaluate anemia?
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CBC with man diff and RBC indices, reticulocyte count, and peripheral blood smear
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What two parameters can be used to classify the anemia into a microcytic, normocytic, or macrocytic anemia with adequate, inadequate red blood cell production?
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mean corpuscular volume (MCV) and adjusted reticulocyte count
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What is peripheral blood smear used to assess?
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Red and white blood cell morphology and the platelet number and size
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What diagnostic tests should be considered for hemolytic anemia?
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electrolytes, lactate dehyfrogenase, bilirubin, Coomb's test (indirect and direct) and serum haptoglobin
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How can urinobilinogen be dected?
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detected on urinalysis
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What cause of anemia should be considered in all African Americans and Mediterranean populations who present with hemolytic anemia?
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glucose-6- phosphate dehydrogenase
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What test is should be ordered to diagnose suspected hemoglobinopathies?
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hemoglobin electrophoresis
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How can iron deficiency anemia be evaluated?
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serium iron level, total iron binding capacity, and serum ferritin level are needed for analysis
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When is a lead level indicated?
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If lead posioning is contemplated
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How can Free erythrocyte protoporphyrin (FEP) levels be obtained and what do elevated FEP leverl suggest?
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FEP levels can be obtained quickly and with a small amount of blood
elevated FEP levels suggest disordered heme incorporation seen with iron deficiency and lead poisoning |
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What diagnostic test should be ordered for anemia of chronic disease?
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elevated erythrocyte sedimentation rate
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What tests indicate GI Bleeding?
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positive heme tests of stool or gastric contents
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What is the treatment for macrocytic anemia?
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VB12 and RBC folate levels
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What are the causes of microcytic anemias?
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iron deficiency
severe lead posioning thalassemia syndrome sideroblastic anemia |
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What are some causes of megaloblastic macrocytic anemia?
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vitamin B12 deficiency, folate deficiceny, orotic aciduria
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What are some causes of nonmeaglbloastic macrocytic anemia?
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aplastic anemia, diamond blackfan anemia, bone marrow infiltration, hypothyroidism, liver disease
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What are some causes of normocytic inheritedhemolyic anemieas?
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anl Sickel Cell Disease
RBC enzyme disorders G6PD deficiency Pyruvate Kinase Deficiency RBC membrane disoders Hereditary spherocytosis, elliptocytosis Paroxysml nocturnal hemoglobinuria |
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What are some causes of causes of acquired hemolytic anemias?
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antibody-mediated anemias
autoimmune hemoyltic anemiase isoimmune hemolytic anemias microangiopathic hemolytic anemias hemolytic uremic syndrome disseminated intravascular coagulation |
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What is the differential diagnosis for anemia?
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Microcytic, macrocytic (megaloblastic vs nonmegaloblasti), inherited hemolytic normocytic anemias, acquired hemolytic normocytic anemias, chronic inflammation, acute blood loss, splenic sequestration, chronic renal disease
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