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Session 3 CM- Hem-3

CM- Hem-3 - Anemia Microcytic and Macrocytic

QuestionAnswer
What is the normal Hgb level and hematocrit for men vs women Men HGB-13.6-17.5, HCT 39-49; Female Hgb 12-15.5, HCT 35-45%
What is a macrocytic anemia defined as anemia where MCV is >100
What is a mcicrocytic anemia defined as anemia where MCV is <80
What is normocytic anemia anemia where MCV is 80-100
apart from checking the MCV (mean corpsucular volume) you also do a peripheral blood smear looking at what? Looking at types of cells present in blood- ie shistocytes, target cells, tear drops, spherocytes etc.
Why do you check reticulocyte count when evaluating anemia Reticulocyte count will help you determine what may be the cause of the anemia Elevated reticulocytes indicate hemolysis while depressed indicates marrow disease. Normal in presence of anemia indicates under production
What does an elevated reticulcyte count indicate in anemia hemolysis or acute blood loss is likely the cause of the anemia
what does a depressed reticulocyte count indicate in anemia indicates bone marrow disease may be the likely cause of the anemia
What is the normal reticulocyte index and how is it calculated normal is less than 2% and is calculated by (Reticulocyte count % x Pt Hct/ normal hct (45) x2)
If your patient has anemia with a normal MCV and an elevated reticulcyte index what is always indicated as the cause of the anemia hemolytic anemia
Patient presents with fatigue, dyspnea, hypotension and tachycardia and anemia what is the likely cause of their anemia acute blood loss
Patient presents with fatigue, pale mucous membranes, spooning of nails, angular stomatitis, pagophagia (ice craving) or pica what is likely causing their anemia iron deficiency anemia
Patient presents with a waxy compexion, beefy red tongue, paresthesia, diminished vibratory sensation and loss of proprioception, delirium and dementia what is likely causing their anemia B12 Deficiency anemia
What are the common causes of microcytic anemias TAILS- Thallasemia, Anemia of chronic disease, Iron deficiency, Lead poisoning, Sideroblastic
How doe the blood cells apear on peripheral blood smear in microcytic anemia small hypochromic cells
You discover that your patient has deficiency in synthesis of globin chain where are they likely from and what are they suffering from thallasemia- most likely of mediterranean, asian or african decent
What is normal adult hemoglobin(Hgb A) made of 2 alpha chains and 2 beta chains
what is fetal Hbg made of (Hgb F) 2 alpha and 2 gamma chains
What is the varian adult Hgb made of (Hbg A2) 2 alpha and 2 delta chains
What is Hgb G made of 4 beta chains- not compatible w/ life
What is Hgb Barts made of 4 gamma chains- not compatible with life
What is the tx for thallasemia Transfusion therapy but you must follow with chelation therapy for Iron to avoid increasing iron levels resulting in deposition of iron in hepatic and cardiac cells leading to cirrhois and cardiac failure
What is Beta Thallasemia one or both genes that produce beta globin chains are defective
You run a Hgb electrophoresis on a patients blood sample and get the following results what condition do they have? Increased Hgb A2, increased Hgb F, and decreased Hgb A Beta Thallasemia
what will Hgb electrophoresis show in beta thallasemia Increased Hgb A2, increased Hgb F, and decreased Hgb A
If you see tear drop shaped RBC or fine basophilic striplin on peripheral blood smear what dx should cross your mind Thallasemia or myelofibrosis
Patient is anemic and electrophoresis of Hgb shows the following results, decreased Hgb A, Decreased Hgb A2, and decreased Hgb F, what condition are they suffering from Probably Hgb H disease where one alpha chain gene is deleted a form of Alpha thallasemia
what will Hgb electrophoresis show in alpha thallasemia decreased Hgb A, Decreased Hgb A2, and decreased Hgb F
What is hydrops fetalis syndrome complete deletion of all genes that produce alpha Hgb results in still birth both parents suffer from Hbg H disease
What is basophilic strippling dark-blue granules in red blood cells on smears stained w/ cresyl blue, Granules are precipitated ribosomes and mitochondria
What type of anemia can result from diabetes, liver disease, neoplasms, infections or inflammatory processes Anemai of chronic disease
How does inflammation cause anemia cytokines released in inflammation cause poor use of marrow iron and deficient erythropiesis- body can't make enough new RBC to replace older blood cells Hgb drops
Patients lab values are MCV <80, HCT 24,low serum iron and high ferritin, low transferrin (free iron binding protein) what are the likely suffering from Anemia of Chronic Disease, a microcytic anemia.
What will your labs show in anemia of chronic disease low serum iron and high ferritin, low transferrin (free iron binding protein)
What is ferritin storage iron and will hold iron in inflammatory state
How do you tx anemia of chronic disease treat underlying disease
What is the most common form of anemia Iron deficiency anemia- most often cauesd by GI blood loss, can alos be due to pregnancy, malabsorption of iron, or menorrhagia
What is a common cause of iron deficiency anemai in 3rd world countries hook worm feeding on blood
Patient's lab values are low serum iron, low ferriting and increased Total iron binding capacity (high transferrin) MCV is less than 80 and Hct is less than 34 what are they suffering from Iron Deficiency anemia, a microcytic anemia
What will your lab values be in iron deficiency anemia low serum iron, low ferriting and increased Total iron binding capacity (high transferrin)
what is the tx for iron deficiency anemia transfussion therapy for majory hemorrhage and iron supplementation in malabsorption (can give ferrous hydroxide and dextran in a colloid solution IM or IV if pills are tolerated)
What should you combine with iron pill to increase absorption vitamin C increases iron absorption
Anemia caused by disorder of mitochondrial function and porphyrin synthesis disrupting iron transport to mitochondria and inablility to incorporate iron into heme lead/sideroblastic anemia
what are common causes of sideroblastic anemia heavy metals (lead, gold produce ring sideroblasts) also drugs isoniazid, cycloserine, hydralzine, L-dopa, chemotherapeutic agents and ETOH. Also hereditary form
What will your lab values show in sideroblastic anemia increased free erythrocyte protoporphrin (FEP) alos check lead level
what is tx for sideroblastic anemia chelate lead using EDTA and BAL stop medications if they are the cause
Patient presents with anemia they have been feeling depressed, have lost their appetite and suffer from abdominal pain, nausea, diarrhea/constipation and muscle pain. They haven't been sleeping well and have had mood swings what is likely going on? Lead poisioning causing anemia other early signs include unusual taste in the mouth and personality changes
What are the signs of severe lead poisoning somnolence or severe lethargy and paralysis.
What are the macrocytic anemias FAB- Folate Deficiency, Alcoholism, B-12 deficiency
Most common macrocytic anemia folate deficiency
what does folate do in the body acts a a methyl donor storage pool is recycled through bile
What are some common causes of folate deficiency intestinal disease-elderly and alcoholics; Medications can cause folate deficiency as well by blocking absorption of folate
Patient has serum folic acid <3pg/ml (normal >4pg/ml) and Red Cell Folate < 100pg/ml (normal >200pg/ml) and an increased LDH. MCV > 100 what condition do they likely have folate deficiency a macrocytic anemia
What will you see on peripheral smear in folate deficiency macroovalocytes
What is the tx for folate deficiency anemia folic acid
what will you see on lab values of patient with folate deficiency anemia caused by alcoholism SGOT>SGPT (AST > ALT) remember the sargent, private and lieutenant go together
what is the tx for folate deficiency anemia caused by alcoholism abstain from alcohol and nutritional counseling
What will you see on peripheral smear in alcoholism induced anemia stomatocytes and target cells
what is another name for B12 deficiency anemia and another name for vit B12 Megaloblastic anemia- B12 is also called cobalamin
where is B12 stored in the liver
What is essential to absorbing B12 in the intestines Intrinsic Factor
Patient presents with glossitis (beefy red tongue), bilateral parestheisa of hands and feet, loss of vibratory sense and position sense and slowed reflexes. Confusion and memory loss are also present what is patient likely suffering from B-12 Deficiency
What is the most common cause fo B-12 deficiency Pernicious Anemia- autoimmune attack of parietal cells that secrete intrinsic factor needed to absorb B12
What do gastric atrophy or bypass surgery, intestinal parasites such as fish tape worm, bacterial overgrowth in blind loops of gastric surgery, crohn's disease, vegetarianism, homocystinuria, methlymalonic aciduria and pancreatitis have in common all are causes of B-12 deficiency
Patient has an MCV > 100, serum B-12 is < 100pg/ml, blood smear shows hypersegmented neutrophils and shilling test <7% exretion what is their likely cause of anemia B-12 deficiency
What test will you order to determine cause of B-12 deficiency shilling test- give patient radiolabeled cobalt and unlabelled cobalamin normal will absorb and exrete >7% gastric atrophy or pernicious anemia will excrete <7%, give hog intrinstic factor is excretion is still <7% treat for bacterial overgrowth.
What will the shilling test show in pernicious anemia in stage 1, stage 2, and stage 3 stage 1 excretion will be <7%, Stage 2 excretion will normalize >7%, stage 3 shouldn't be needed
What will shilling test results be if bacterial overgrowth is causing B12 deficiency stage 1 excretion <7%, Stage 2 excretion still <7%, stage three excretion should normalize
What will shilling test results be if terminal ileum (crohn's) disease is the B-12 defiency cause Stage 1,2 and 3 will all remain <7% which is below normal
Created by: Max Smith Max Smith on 2010-03-09



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