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