Term
| Differential Dx for Microcytic Anemia |
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Definition
1. Iron Deficiency
2. Acute and Chronic Inflammation
3. Disorders of Globin Chains
4. Some Sideroblastic Anemias |
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Term
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Definition
- Craving for Ice or PICA (non nutritive substances)
- Esophageal Web (Plummer-Vinson Syndrome)
- Extreme Fatigue
- Will See (Always):
Decreased serum iron
Increased iron binding capacity
Decreased serum ferritin
- Hemosiderin in urine
Causes:
- Hookworm
- Aspirin, EtOH or other drugs
- Genitourinary problems |
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Term
| Iron Deficient Anemia Treatment |
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Definition
Treat underlying causes of iron deficiency
Can give Ferrous salt (oral form) to restore Iron levels |
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Term
| Anemia of Chronic Disease |
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Definition
- Decreased serum iron AND total iron binding capacity
- Blunted erythropoietin response (low retic count)
- Increased serum ferritin (acute phase reactant)
- Increased Hepcidin (decrease absorption and transport & acute phase reactant)
- Increased avidity of RES (less available iron) |
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Term
| Anemia of Chronic Disease Treatment |
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Definition
Treat underlying disorder. Erythropoietin ONLY in select cases (Chemo or chronic renal failure) |
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Term
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Definition
- Family History of microcytic anemia
- Target cells & Basophilic Stippling on peripheral blood smear
- Increased Hgb A2 on on Electrophoresis
- Increased serum iron and ferritin
- α, β forms
- minor β-form seen in Mediterranean heritage |
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Term
| B-thalassemia & Treatment |
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Definition
| Minor: Mild microcytic anemia, no treatment indicated Major: Heinz bodies on peripheral smear, severe microcytic anemia, chipmunk faces; Treat with transfusions |
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Term
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Definition
| - Deletion of alpha genes from chromosome 16 - Hemoglobin barts (y4) detected in newborn - Hemoglobin H unstable, detected in small amounts Deletions: 1 - Silent carrier 2 - Mild microcytic anemia 3 - Hemoglobin H disease: Variable anemia, bone defects and splenomegaly; HEINZ bodies 4 - Failure to thrive |
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Term
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Definition
- 10% of nucleated RBCs in bone marrow will have iron laden mitochondria surrounding the nucleus
- Abnormalities of mitochondrial metabolism
Causes: Primary- X-linked or autosomal recessive Secondary- Drugs, lead poisoning, inflammatory conditions, neoplasms |
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Term
| Microcytic Anemia Findings |
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Definition
Low Hemoglobin
Low Hematocrit
Low MCV, <80
May find hypochromia (increased central pallor) and anisocytosis (different sized cells) |
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Term
| Megaloblastic Anemia Findings |
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Definition
Impaired DNA synthesis
- Howell Jolley Bodies
- Hypersegmented Neutrophils
- Macroovalocytes fragmented cells and poikilocytosis
- Marked increase in red cell volume (MCV) but MCHC normal |
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Term
| Differential Dx for Megaloblastic Anemia |
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Definition
Pernicious Anemia
Folate Deficiency |
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Term
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Definition
- Associated with chronic immunologically mediated gastritis and gastric atrophy
- Parietal cells don't secrete intrinsic factor, Vitamin B12 doesn't get absorbed
- Associated with Autoimmune disorders
- Increased risk of gastric carcinoma
Pts. Present w/:
- Jaundice, pigment changes and vitiligo
- Symptoms of anemia
- Loss of Position and vibratory sense
- Shuffling, wide-based gate
- Depression, psychosis and dementia |
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Term
| Pernicious Anemia Labs & Treatment |
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Definition
- Low serum B12
- Low serum haptoglobin
- Increased serum LDH
- Increased serum indirect bilirubin
- Increased serum and urinary *METHYLMALONIC ACID*
Treat with IM B12 injections; Must watch potassium levels (may drop as BM production resumes) |
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Term
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Definition
Deficiency seen in people whose boiling methods include prolonged boiling or ALCOHOLICS
Drugs including Methotrexate, Dilantin and oral contraceptives |
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Term
| Folic Acid Deficiency Labs and Treatment |
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Definition
Do Serum Folate, Serum B12 and RBC folate (most accurate measure of tissue folate levels)
NO increase in serum and urine methylmalonic acid (will see increase in B12 deficiency, distinguishing characteristic)
Treatment:
- Give Folic Acid ONLY if there is positively NO B12 deficiency (underlying B12 deficiency can cause neurologic deterioration)
- Treat underlying disorder acutely or continue oral folic acid if chronic condition |
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