Hematology
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| Microcytic anemia: DDx | TICS: thalassemia, iron deficiency, chronic inflammation, sideroblastic
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| Macrocytic anemia suggests: | folate or B12 deficiency
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| Anemia: RBC production problem (vs destruction problem) distinguished by: | Retic count; hypoproliferative = retic low (<2); hyper = retic high (>3)
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| Causes of Fe deficiency anemia | Poor diet/intake; decreased absorption (atrophic gastritis, GI surg, sprue, achlorhydria); increased loss (GI bleed, menorrhagia, neoplasm); increased requirements (PG, lactation)
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| Anemia of chronic dz: lab pattern | Likely microcytic. Low Fe, low ferritin, high TIBC. Low erythropoietin
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| Glossitis, peripheral neuropathy (stocking-glove paresthesias); MCV 110-140; low retic, hyperseg PMNs, high methylmalonic acid = | B12 def
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| Triad: anemia, splenomegaly and jaundice = | Hereditary spherocytosis
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| Fe deficiency anemia tx | ferrous sulfate 325mg tid
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| pernicious anemia tx | lifelong B12 supplementation
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| Hx HTN, nephrotic syndrome, CRF or Renal insufficiency; do CBC: | Anemia
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| PICA, Pregnant & fatigue, Menstruation; cheilosis: | Fe Deficiency Anemia
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| Anemia after colectomy, partial gastrectomy; glossitis, decreased vibratory sensation = | B12 or Pernicious anemia
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| G6PD + Quinidine, Nitrofurantoin, Sulfa, fava beans => | Hemolytic anemia
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| Fatigue, weakness, low fever, purpura, pallor, gingival bleeding; low retic; no HSM = | Aplastic anemia
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| folate def is ______ anemia; erythropoeisis is due to lack of: | megaloblastic anemia; lack of methylation
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| sideroblastic anemia tx: pts do not respond to: | EPO; tx underlying cause, poss txn/ chelation
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| sideroblastic anemia causes | myelodysplasia, chronic EtOH, Pb tox
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| N/N anemia pathophysiology | hepcidin upregulation in response to inflammatory mediators
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| N/N anemia etiology | organ fail d/t systemic dz (renal, endo, thy, liver), or impaired marrow fn (2/2 chronic infxn, aplastic anemia, PRCA)
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| macro anemia 2/2 folate def: S/S | glossitis, no neuro sx
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| macrocytic anemia 2/2 B12 def S/S | glossitis, pale icterus, GI sxs; neuro sxs (posn, vib sense, stocking-glove paresthesia, ataxia)
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| B12 def causes | No. 1 pernicious anemia; veganism, blind loop syndrome, gastric surg, panc insuff, Crohn dz
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| Most common cause of anemia worldwide | Fe def anemia
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| HYPOproliferative anemia due to: | Marrow damage, Fe def, dec'd stimulation
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| HYPERproliferative anemia due to: | BM failure to compensate for blood loss or RBC destruction
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| Enzyme disorder: adequate Fe but can't get it into Hgb; Fe accumulates in ? | Sideroblastic anemia; in RBC mitochondria
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| Causes of B12 def | Diet (vegans); malabsorption: inadequate intrinsic factor prodn (70%), terminal ileum dz (sprue, Crohns), tapeworm, drugs
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| B12 def vs folic acid def | B12: meat/dairy; to 5000 mcg in liver (3 yrs); Folic acid: fruit/veg; 5-20 mg stored (few mos)
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| Acquired stem cell disorder making RBC membrane prone to lysis by complement | PNH
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| In PNH, there is increased risk of: | leukemia/myelofibrosis
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| Acquired hemolytic anemia due to IgM autoantibody | Cold agglutinin dz
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| Evans syndrome | (immune thrombocytopenia) AIHA
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| Anemia: morphology relative to MCV | <80 = microcytic; 80-100 = normo; >100 = macro
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| Anemia: RBC production problem (vs destruction prob) distinguished by: | Retic count; hypoproliferative = retic low (<2); hyper = retic high (>3)
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| Hypoproliferative anemia due to: | Marrow damage, Fe deficiency, decreased stimulation
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| Hyperproliferative anemia due to: | BM failure to compensate for blood loss or RBC destruction
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| Most common cause of anemia worldwide | Fe deficiency anemia
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| Macrocytic anemias | Folic acid def; B12 def
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| Tx B12 def | Replacement tx: IV B12; frontload dose
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| B12 def vs folic acid def | B12: meat/dairy; to 5000 mcg in liver (3 yrs); Folic acid: fruit/veg; 5-20 mg stored (few mos)
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| Causes folic acid def | Inadeq intake (ETOH, teens, elder); inc’d req: PG, malignancy, anemias, hemodialysis; Malabsorption [sprue, drugs (phenytoin, barbituates)]; Impaired metabolism (ETOH, methotrexate)
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| Folic acid def findings | Malnourished; glossitis, cheilitis; NO neuro S/S; RBC folate <150 ng/mL
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| PRCA is contracted: | Acquired or idiopathic
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| Autoimmune dx mediated by T lymphocytes or (rarely) IgG antibody against erythroid precursors | PRCA (pure red cell aplasia)
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| Poss causes include thymoma, solid tumors, SLE, RA, HIV/hep, phenytoin | PRCA
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| PRCA findings | Normal lab except low retic; severe anemia S/S
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| PRCA Tx | Stop all meds; poss thymoma resection; IV Ig
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| Due to BM failure (injury or suppression); pancytopenia | Aplastic anemia
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| Causes of aplastic anemia | Idiopathic (50-65% ; likely autoimmune); Phenytoin, sulfonamides; chemotherapy, radiotherapy; benzene, solvents, insecticides; hep, HIV, EBV; PG, SLE, GVHD; Hereditary (rare): Fanconi’s anemia
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| Aplastic anemia findings | NO hepatosplenomegaly; pancytopenia (purpura, pallor, petechiae); low retic; hypocellular BM
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| Aplastic anemia: diff dx from: 1-MDS; 2-hairy cell; 3-normo | 1=abn cells; 2=splenomegaly & abn lymph cells; 3=SLE, hypersplenism, dissem'd infxn
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| Aplastic anemia tx | Family HLA typing; supportive tx (txn/infxn); immunosuppn; GF; BM txplant
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| Aplastic anemia prognosis | Untx'd = fatal; HLA matched txplant: 60-90% cure; ATG tx: partial remission 60-80% (1/3 relapse & 20-50% MDS)
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| Hemolytic anemias: intrinsic vs extrinsic | Intrinsic = prob w/membrane, z defects, hgb (usu hereditary); Extrinstic = autoimmune, drugs or mechanical trauma (often acquired)
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| Hemolytic anemia lab findings | Low haptoglobin; high LDH, indirect bili (not >4-5mg/dL unless underlying liver dz), retic; hemoglobinuria; stable or falling hgb
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| Workup to distinguish etiology of Hemolysis | Clinical & FH; Direct Coombs; Peripheral blood smear; morpho (Heinz bodies, sickle cells, parasites); Hgb electrophoresis
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| Acquired stem cell disorder making RBC membrane prone to lysis by complement | PNH
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| PNH findings | Episodic hemolytic anemia; Venous thrombosis; Deficient hematopoiesis -> pancytopenia; reddish-brown urine; Hemoglobinuria, esp. first morning urine
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| Episodic hemolytic anemia; Venous thrombosis; Deficient hematopoiesis -> pancytopenia ... indicate: | PNH
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| In PNH, increased risk of: | leukemia/myelofibrosis
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| PNH tx | Tx Fe def; prednisone for hemolysis; BM txp if severe
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| Acquired disorder which IgG autoantibody formed that binds to RBC membrane | AIHA (autoimmune hemo anemia)
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| AIHA: ___% are idiopathic; seen in ___ | 50% ; lupus, NHL, CLL
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| AIHA findings | Pos coombs test; severe anemia (6-10); high retic & ind bili; spherocytes & NRBC; Evans syndrome (immune thrombocytopenia)
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| AIHA tx | Prednisone 1 mg/kg/d; splenectomy if fail; Rituximab, Danazol, IVIG if fail; avoid txn
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| Acquired hemolytic anemia due to IgM autoantibody | Cold agglutinin dz
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| Cold agglutinin dz causes | Idiopathic or neoplasm or post-infxn (Monoclonal gammopathy, mono, mycoplasma)
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| Cold agglutinin dz findings | Mottled/numb fingers/toes; anemia is rarely severe; mild reticulocytosis; spherocytes; Pos Coombs for complement; Pos cold agglutinin test; Chilled blood will look clumped on slide
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| Cold agglutinin dz tx | Symptomatic, avoid cold; poss Rituximab or immunosupp or plasmapheresis; no splenectomy/steroid
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| Evans syndrome | (immune thrombocytopenia) AIHA
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| Neutropenia findings | Stomatitis; fever; poss septicemia, pneumonia and cellulitis
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| Neutropenia tx | DC potl causative agents; tx infxns; poss GF (G-CSF) for severe
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| Anemia: no hepatosplenomegaly | aplastic anemia
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| Anemia without neuro Sx/Sx suggest: | Folic acid def
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| Aplastic anemia sx/sx do not include: | hepatosplenomegaly
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| Dark blue-gray line along gingival border may be sx of: | lead poisoning
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| most common anemia of hospitalized patients = | anemia of chronic disease
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| Anemia of chronic disease etiologies | Chronic inflammatory conditions: infection, IBD, RA, malignancy. CKD
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| Macrocytic anemia etiologies (PALER) | Pernicious anemia. Lung (COPD). EtOH (AST > ALT 2x, increased GGT). Rx (antiseizure meds, methotrexate)
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| Elevated retic count may be due to: | Hemolytic anemia; acute blood loss; response to therapy (within 5-7days)
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| Low or Normal retic count may be due to: | All other forms of anemia (other than hemolytic or acute blood loss)
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