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First Aid Step 3 Hematology 1
Microcytic Anemia
26
Medical
Professional
12/23/2013

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Term
A 9yo boy recently treated for meningitis in a developing country develops purpura and pallor. He is found to have plt ct 42,000, hematocrit of 26%, and WBC of 1.7

Which antibiotic that is rarely used in US is known to cause pancytopenia?
Definition
Chloramphenicol
Term
What are the three kinds of anemia?
Definition
Microcytic: MCV <80fl
Normocytic: MCV 80fl-100fl
Macrocytic: MCV >100fl
Term
How do you diagnosis anemia?
Definition
CBC, MCV, blood smear, and reticulocyte count.
Term
What secondary tests should be ordered to evaluate for anemia?
Definition
Ferrotin, serum iron, TIBC, %transferrin sturation, serum folate, TSH, serum B12, hemolysis labs and DIC panel.
Term
What labs are in hemolysis labs?
Definition
LDH, unconjugated bilirubin, haptoglobin, Coombs test
Term
What labs are in DIC panel?
Definition
D-dimer, fibrinogen, blood smear, soluble fibrin monomer complex.
Term
What illnesses will likely effect serum ferritin levels?
Definition
Acute illness, chronic inflammatory or chronic liver disease.
Term
When should you transfuse?
Definition
When Hct <21
When symptomatic
Term
what causes pancytopenia?
Definition
Toxins, drugs, infection, myeodysplasia, manignancy, radiation, vit B12/Folate deficiencies, SLE and congenital causes.
Term
Treatment for anemia?
Definition
Fluid resuscitation and RBC transfusion.
Identify the cause and treat underlying disorder.
Term
What causes microcytic anemia?
Definition
Mneumonic is TICS
Thalassemia
iron-deficiency anemia
chronic disease
sideroblastic
Term
Microcytic anemia exam contains what?
Definition
look for pica (iron-deficiency)
Ask about melena
FOBT
Family history of anemia (thalassemia)
Mentzer index (MCV/RBC)-if >13, more likely iron deficiency than thalassemia
Term
What do labs look like for Iron-deficiency Anemia?
Definition
Ferritin: Decreased (may be nl/ inflm &CA)
Serum Iron: Decreased
TIBC: Increased
RDW: Wide
Term
What etiologies lead to iron-deficiency anemia?
Definition
Malabsorption, chronic blood loss, and malnutrition. Thrombocytosis is common.
Term
What do labs look like for Thalassemia?
Definition
Ferritin is increased
Serum iron is normal to increased
TIBC: Normal to increased
RDW: normal
Hb electrophoresis: will vary on type
MCHC elevated
Mentzer index <13
Term
What do the labs look like for anemia of chronic disease?
Definition
Ferritin: Increased (may be nl)
Serum iron: Slight Decrease
TIBC: Normal to decreased
Term
What are the etiologies for anemia of chronic disease?
Definition
Chronic inflammation, infection and malignancy
Term
What do the labs look like for sideroblastic anemia?
Definition
Ferritin: Increased
Iron: Increased
TIBC: Nl to decreased
Smear: dimorphic RBCs with basophilic stippling
Bone Marrow: erythroid hyperplasia and ringed sideroblasts
Term
What are the etiologies of Sideroblastic anemia?
Definition
Chronic alcohol use, drubs (antitubercular, chloramphenicol) and lead poisoning (order lead levels if increased transferrin levels)
Term
Clinical presentation of alpha-thalassemia looks like?
Definition
x4: babies stillborn (hydrops fetalis)
x3: HbH - chronic hemolytic microcytic anemia and splenomegally.
x1-2: usually asymptomatic
Term
Clinical presentation of Beta-thalassemia?
Definition
x4: No HbA; presents in 1st year as HbF declines. Growth retardation, bony deformities, hepatosplenomegaly, and jaundice.
x1-3: diagnosed by increased HbA2 on electrophoresis. (much less severe)
Term
How do you diagnose Thalassemia?
Definition
CBC (microcytic anemia with normal RDW and increased RBC count)
Hemoglobin electrophoresis is definitive
Term
How do you treat thalasemmia?
Definition
Severe: Allogenic bone marrow transplantation. Give blood transfusions for symptomatic control with folate supplementation.
Give deferoxamine to prevent hemosiderosis.
Genetic counseling.
Term
32 yo woman wiht Crohn's dz and hx of partial bowel resection comes to you for fatigue and is found to have Hct of 29% and MCV of 104fl. What is she at risk for and why?
Definition
Vit B12 deficiency
Intrinsic factor receptors are located in the terminal ileum and it was likely part of the resection.
Term
What causes folate deficiency?
Definition
Poor diet (as with alcoholism)
Drugs (TMP-SMX, phenytoin, zidovudine, methotrexate and other chemotherapeutic agents.)
Term
What causes B12 deficiency?
Definition
Strict vegan diet
pernicious anemia
gastrectomy
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