Term
| 59yo woman presents with DOE. She has Hct 31% with MCV of 89fL. What is the next step? |
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Definition
Order Blood smear
reticulocyte count
renal function tests
LDH
haptoglobin
indirect bilirubin
look for bleeding sites. (FOBT) |
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Term
| What broad causes are there for Normocytic anemia? |
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Definition
Blood loss
Hemolysis
Decreased production |
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Term
| How do patient's with hemolytic anemia present? |
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Definition
Jaundice
Dark urine
Increased unconjugated hyperbilirubinemia
Pigment gallstones
Splenomegaly |
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Term
| What does the reticulocyte count look like in normocytic anemia (if ACD or CKD) |
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Definition
| Normal reticulocyte count |
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Term
| What labs indicate hemorrhage in normocytic anemia? |
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Definition
Increased reticulocyte count
Normal LDH, unconjugated bilirubin and haptoglobin. |
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Term
| What are some causes of hemolysis leading to normocytic anemia? |
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Definition
Microangiopathic hmolytic anemia
hereditary spherocytosis
autoimmune hemolytic anemia
Cold agglutinin disease
sickle cell anemia
G6PD deficiency
Myelofibrosis
Paroxysmal nocturnal hemoglobinuria |
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Term
| What labs suggest hemolysis? |
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Definition
Increased reticulocyte count
Increased LDH
Increased unconjugated bilirubin
Decreased haptoglobin |
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Term
| What indicates microangiopathic hemolytic anemia? |
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Definition
Schistocytes or helmet cells
(created by RBC shearing through partially coagulated capillaries) |
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Term
| What indicates hereditary sperocytosis? |
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Definition
Spherocytes
+ family history
- coombs' test |
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Term
| What indicates autoimmune hemolytic anemia? |
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Definition
Spherocytes
+ Coombs' test |
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Term
| What indicates Cold agglutinin disease? |
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Definition
Acrocyanosis in cold exposure
+ cold agglutinin test
(seen with mono and mycoplasmal infection) |
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Term
| What indicates G6PD deficiency? |
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Definition
Hemolysis in the presence of infection or drugs (sulfa)
Bite cells
G6PD levels normal during hemolysis, but decline afterwards |
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Term
| What indicates Myelofibrosis? |
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Definition
Abnormally activated marrow fibroblasts
Medullary fibrosis
MC idiopathic or 2/2 polycythemia vera or hematologic malignancy
Extramedullary hematopoiesis - hepatosplenomegally
Reticulocytosis
Teardrop RBCs
Increased LDH
Marrow biopsy is diagnostic |
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Term
| What indicates Paroxysmal nocturnal hemoglobinuria (PNH) |
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Definition
Intravascular hemolysis
hemoglobinuria
recurrent thrombosis
may have pancytopenia
Dx via flow cytometry |
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Term
| What is the mneumonic for PNH? |
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Definition
FITS:
Flow cytometry
Intravascular hemolysis
Thrombosis
Supportive treatment for complications |
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Term
| What can cause macrocytic anemia? |
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Definition
Folate or B12 deficiencies
Liver disease
Hypothyroidism
Alcohol abuse
Myelodysplasia
Reticulocytosis |
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Term
| How do you diagnosis macrocytic anemia? |
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Definition
CBC, B12 level, RBC folate level, blood smear (hypersegmented neutrophils
If B12 def; check intrinsic factor antibody and antiparietal cell antibody
Methylmalonic acid will confirm diagnosis in pts with borderline levels. |
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