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What are the causes of microcytic anemia?
- Iron def anemia
- lead poisoning
- sideroblastic anemia
What are the causes of normocytic anemia
- Increased retics:
- Decreased retics
- -renal/liver failure -marrow failure (e.g. aplastic anemia) -early iron deficient anemia
What are the causes of macrocytic anemia
- -Megaloblastic anemia(b12, folate deficiency)
- -drugs (e.g. methotrexate)
- -liver disease
What are the following PBS smears characteristic of? target cells, tear drops, spherocytes, elliptocytes, bite cells, sickle cells, fragments, nucleated RBCs, Roleaux, Schistocytes, auer rods
- -target cells: thalassemia (many, micro); Fe def (few, micro); liver disease (macro)
- -Weird shapes
- -tear drops: myelofibrosis
- -spherocytes: immune hemolysis, heriditary spherocytosis
- -elliptocytes: Fe deficiency
- -bite cells: G6PD deficiency
- -sickle cells
- -fragments: DIC, mech heart valve
- -nucleated RBCs: marrow inf, severe hemolysis
- -Roleaux: MM, inflammatory states
- -Schistocytes: HUS/TTP
- -auer rods: AML
When do you see hypersegmented WBC nuclei in PBS?
B12 or folate deficiency
What are the 4 major causes of iron deficiency anemia with some examples?
- 1) decreased intake: ask about red meat
- 2) decreased abs: low acid, gastric/duod problems
- 3) increased demands: normal growth, preg, post op
- 4) bleeding
What would the iron studies show for IDA, thalassemia, and ACD?
What Hb electrophoresis do you expect to see in thal beta major, thal alpha, sickle trait and sickle cell disease?
Describe what pernicious anemia is all about.
- -AI disease that attacks the parietal cells of the stomach
- -causes loss of stomach acid and intrinsic factor
- -causes B12 malabsorption
Complications of Sickle Cell Disease (SICKLE mnemonic)
- S: Strokes, Swelling of hands and feet, Spleen problems, Salmonella causes osteomyelitis
- I: Infections, Infarctions
- C: Crises (painful, sequestration, aplastic), cholelithiasis, chest synd., cardiac probs
- K: Kidney probs
- L: Liver disease, Lung problems
- E: Erection (priaprism), Eye probs (retinopathy)
What is the triad of HUS, pentad of TTP?
HUS: hemolytic anemia, renal insufficiency, thrombocytopenia
TTP: HUS + neurological signs and fever
What does hydroxyurea do?
lower WBC count, tmt for sickle cell
When you have an elderly patient with Fe def anemia, what MUST you rule out?
What causes most macrocytic anemias?
processes that screw with DNA synthesis
Describe the spectrum in beta thal. (2)
- Thal-major (0/2 beta genes present): severe anemia in first year, need chronic transfusions to survive
- Thal minor (1/2 beta genes present): asymptomatic, but microcytic and hypochromic on PBS
Describe the spectrum in alpha thal (4)
- Hydrops fetalis (0/4 alpha genes present): die in utero
- Hemoglobin H disease (1/4): chronic hemolysis, elevated retic count to compensate, skeletal changes because of increased erythropoiesis
- alpha thal trait (2/4): low MCV, but usually asymp.
- silent carrier (3/4): no signs or Sx of disease
What dose for iron supplementation
Describe the purpose of the following blood components:
-platelets (magakaryocytes are progenitor
What does a left shift mean?
increase in granulocyte precursors (e.g. blasts, myelocytes, etc) in the peripheral blood. Mean that there is increased marrow production because of some process.
What does it mean if you see a normal or low reticulocyte count in the setting of anemia?
a sign of decreased production
How does hydroxyurea help in sickle cell disease?
increases the production of HbF (fetal heme.), which decreases the production of HbS
Differentiate warm and cold autoimmune hemolytic anemia based on:
-direct coombs test
- Warm and cold
- -Ab type: IgG, IgM
- -direct coombs test: positive for IgG, positive for compliments
- -PBS: Spherocytes, agglutination
- -aggultination temp: 37, 4-37
What should you never give alone to someone with megaloblastic anemia?
folate. It will just mask a B12 deficiency, and the neurological symptoms will persist