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47 Cards in this Set
- Front
- Back
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Reticulocyte Index (RI) |
reticulocyte %x pt's Hct/45/0.5 |
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Low RI <2 |
Bone marrow hypo proliferation: Production problems |
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Normal RI >2 |
Bone marrow hyper proliferation Hemolytic anemia or acute blood loss |
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Microcytic Anemias (MCV<81) |
-Iron deficiency, thalassemia, sideroblastic, anemia of chronic dz |
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Normocytic anemia (MCV 81-98) |
chronic dz, aplastic, bone marrow infiltration, Kidney dz, acute blood loss |
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Microcytic anemia (MCV >98) |
alcohol, B-12, folate def, myelodysplastia, liver dz, reticulocytosis |
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sideroblastic anemia |
inabilityto incorporate iron into hemoglobin, can be congenital or acquired (drugs –INH, chloramphenicol, EtOH, lead poisioning), get“ringed sideroblasts” –mitochondria with lead deposits circling the nucleus of developing RBC in thebone marrow.
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myelodysplasia |
Myelodysplasia: hematologic condition, abnl myeloid cell production (RBC, plt, PMNs, notlymphocytes), high risk of transformation into AML
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26 y-o female, labs reveal:
low reticulocyte count, Hct 33%, MCV 74, iron 35 (low), TIBC 540 (high), ferritin 14 (low). What do you donext? |
Treat with oral iron |
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Single most useful test for iron deficiency anemia |
Ferritin test: Specific, but not sensitive <15, iron deficient >100, no iron deficiency |
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Other tests to r/o iron def |
TIBC (low) Transferrin saturation (low) Serum iron level (low) |
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Common cause |
Menses in menstruating women Bleeding in all others |
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Treatment of iron deficiency anemia |
Ferrous sulfateor gluconate 325 mg, 1-3times a day.
Ideal is 3 times, but seldom tolerated |
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Three months later 26 y-o pt returns, still beingtold she can’t give blood! Her Hct is34% and ferritin 15. What do youdo now?
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Review how she's taking meds. Compliance with iron supplementation common b/c of side effects. |
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Other potential reasons pt may still be iron deficient after 3 most of iron replacement therapy, other than lack of compliance |
-poor absorption:celiac sprue, IBD -taking with anantacid -PPI -calcium |
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Amount of time until results should be seen in iron replacement |
Several weeks |
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When to discontinue |
6 mos to1 year. Ferritin levels should ideally be normal |
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If pt cannot tolerate PO iron replacement |
Use parenterally. -Iron dextran -Sodium ferric gluconate complex -Iron sucrose |
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Tx for acute iron toxicity |
-Seen primarily in children
-Whole bowel irrigation -Deferoxamine -Chelating agent |
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Anemia of Chronic Dz, lab findings |
-Hypoproliferative anemia (low reticulocyte count)
-normocytic anemia, though25% of cases are microcytic -normal -elevated ferritin -low serumiron and TIBC. Etiology:multiple contributing factors including decreased transfer of iron to red bloodcells, decreased response to Epo,decreased Epo releaseØTreatment: Treatunderlying cause |
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Treatment for anemia of chronic dz |
-Treat underlying cause |
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Etiology of anemia of chronic dz
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-decreased transfer of iron to red blood cells -decreased response to Epo -decreased Epo release |
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48 year oldfemale is admitted to the hospital for severe alcohol withdrawal. She isexperiencing alcoholic hallucinosis and you areunable to obtain a reliable history. Admission labs are remarkable for: Hct 34%, MCV 105,RI <2 . Her PMHx is remarkablefor rheumatoid arthritis.
Macrocytic etiology in this case. Additional tests |
-AlcohollDrug toxicity -zidovudine (AZT) -hydroxyurea -Hypothyroidism -Liver disease -Myelodysplasia -Reticulocyte count to eval stress erythropoiesis |
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Causes of Megaloblastic, macrocytic anemia |
-B12 deficiency
-folate deficiency -drugs that cause abnl DNA synthesis -folate metabolism -myelodysplastic syndromes |
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Causes of Non-megaloblastic macrocytosis |
-liver disease
-hyposplenism -large target cells -acanthocytes -Howell-Jolly bodies |
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Folate deficiency anemias causes |
-alcohol
-Malabsorption (celiacdisease, IBD) Syndromes with rapid cell turnover: - sickle cell disease -psoriasis -pregnancy -Medications-: trimethoprim, phenytoin, methotrexate |
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Sequelae of B12 def |
-metabolicperipheral neuropathy
-neuropsychiatric disease (not the case for folate deficiency) |
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Low Folate levels correspond to low B-12 levels |
False. Evaluate and treat separately |
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Treatment low B-12 |
-Oral dosing is1000 – 2000 mcg po q day
-IM dosing is1000 mcg IM q day x 7 days, then q wk x 4 wks then q month |
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A 28 year old AfricanAmerican female presents to clinic with fatigue. She has a history of cellulitis and just finishing a 14 daycourse of therapy with Bactrim. TSH is normal, Hct is 25%, MCV 98.
Diagnosis? |
Hemolytic Anemia |
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Labs to order to fine tune dx for pt above (28 y-o AA female with hemolytic anemia) |
reticulotye count
-peripheral smear -haptoglobin -indirect bilirubin -LDH (The peripheralsmear will help you differentiate between causes of hemolysis) |
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Etiologies of extravascular hemolytic anemia |
-Congenital hemoglobinopathies
-Erythrocytemembrane abnormalities -hereditary spherocytosis -Erythrocytemetabolic abnormalities: G6PD deficiency - Auto-immuneprocess: idiopathic, underlying malignancy -CVD -lymphoproliferative disorders -medications (PCN, cephalosporins, NSIADs) |
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Glucose6-phospate dehydrogenase deficiency Causes |
-X-linked enzyme deficiency that results indecreased glutathione levels
-Most common form results in severe hemolysis withmedications (primaquine, sulfa, dapsone), fava beans and some infxn. |
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G6PD: Dx |
-enzyme activitytesting
-may have false negative test in the setting of acute hemolysis, re-test at 2-3months |
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When to transfuse |
-Hct <21%,consider at <25% in pt’s with multiple medical problems
-on-going rapid blood loss -highly symptomatic patients -patient withlow Hct and severecardiovascular disease -Hct should increase 3%for each unit of blood transfused |
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63 year old female with DM and CKD presentsfor evaluation of fatigue. Labs reveal Hct31%, MCV 87, iron 43 (40-155), TIBC 241 (270-535), ferritin 95 (10-180), transferrin sat. 18%(10-45%).
Diagnosis? How can you treat her anemia? |
Anemia of Chronic Dz, hypo proliferative EPO therapy and iron |
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In above case (63 y-o female), when would you treat with EPO only? |
-ferritin >100 -transferrin level>20% |
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Electropoiesis stimulating agents (ESA) Names of drugs |
-Epoetin
-Darbepoetin |
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Uses of ESA's |
-CKD
-primary and secondary bonemarrow disorders |
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Side effects of ESA's |
-HTN
-Thrombotic events |
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Myeloid Growth Factors |
-Recombinant technology
-G-CSF (filgrastim, Neupogen) -GM-CSF(sargramostim,Leukine) -G-CSF (filgrastim-PEG, Neulasta) |
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Uses of myeloid growth factors |
-Reduce duration of neutropenia following chemotherapy
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Side effects |
-arthralgia
-myalgia -fever -malaise -capillary leak syndrome |
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A 27 yr old manof SE Asian descent comes in for a routine exam required for employment. He isin good health, without weight loss, fatigue or bleeding sx. FH negativefor anemia. Exam is unremarkable and pt has no HSM. Neg stool guaiac.Labs: WBC 5.3, HCT35%, MCV 65, plts 330K, Retic index 0.8.
Tests to confirm dx |
-Obtain CBC on siblings
-ultrasound for spleen size -serum ferritin and iron studies -glucose-6-phosphate dehydrogenase screen -hemoglobin electrophoresis |
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Dx for Asian pt above |
Thalassemia minor: mild anemia with marked microcytosis |
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Myeloid growth factors |
-G-CSF (filgrastim, Neupogen)
-GM-CSF(sargramostim,Leukine) -G-CSF (filgrastim-PEG, Neulasta) |
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Side effects myeloid growth factors |
-arthralgia-myalgia-fever-malaise-capillary leak syndrome
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