Anemia Flashcards
Physical exam findings anemia
Koilonychias
Petechiae
Conjunctival pallor
pale palmar creases
brittle nails
brittle hair
glossitis
angular stomatitis
Bounding pulse
Flow murmur
Causes of microcytic anemia, labs to order + Ix results you would expect
ferritin, TIBC, TSAT
IDA
Anemia of chronic disease (high CRP, low iron + TIBC, normal or high ferritin)
Thalassemia (low TIBC, Hb electrophoresis)
Lead poisoning (high ferritin)
Sideroblastic anemia (high ferritin)
Causes of normocytic anemia, labs to order + Ix results you would expect
ABCD
- acute blood loss
- bone marrow failure
- chronic dz
- destruction (hemolysis)
order reticulocytes, LDH, direct + total bili
Low or normal retics:
Renal failure
Anemia of chronic dz
Liver dz
Hypothyroidism
Myeloma
Marrow infiltration
High retics
Hemolytic anemia (sickle cell, autoimmune, meds, infection)
High LDH, high indirect bili, low haptoglobin
Causes of macrocytic anemia, labs to order + Ix results you would expect
ABCDEF
- alcohol + aplastic anemia
- B12 def
- cancer (MM)
- dz of liver + Downs
- endocrine (hypothyroidism)
order reticulocytes, B12, blood smear, TSH, ALT
Megaloblastic (low B12, low retic, high RDW)
Liver dz (high retic, target cells)
Alcohol abuse
Myelodysplasia (neutropenia w/ macro-ovalocytes)
Aplastic anemia
Multiple myeloma
Hypothyroidism
Downs
What does group, screen and crossmatch mean?
Group - what blood type + Rh, screen - what antibodies, cross-match - how pt’s blood reacts with donor blood
When to transfuse blood
If stable, transfuse if Hb <70 in otherwise healthy. Give 1 unit, check Hb after
If sepsis, ischemic heart or brain injury, transfuse if Hb <80
I unit = 250mls, give over 2 hr (give slowly first 30 mins, then increase rate)
If unstable - group O negative for women of childbearing age, group O positive for men or postmenopausal
What would you see on blood smear for hemolysis?
Schistocytes
What ix would you order for aplastic anemia, and what would you expect the results to be?
CBC = pancytopenia
Bone marrow biopsy = would show hypocellularity + space occupied by fat
CKD - high Cr, low eGFR
What are some causes of B12 deficiency?
Pernicious anemia
MTX use
What is the difference between megaloblastic and non megaloblastic anemia?
Both types of macrocytic anemia
Megaloblastic - peripheral smear shows oval macrocytes with hypersegmented neutrophils
Causes: b12 or folate deficiency, pernicious anemia, MTXC use
Non-megaloblastic - liver disease, excessive EtOH, hypothyroidism, bone marrow failure
When is serum ferritin not helpful?
Ferritin is acute phase reactant so not as useful in ACD, so fasting serum iron and transferrin saturation (TIBC) = low in iron deficiency
Causes of IDA
Bleeding:
Menorrhagia most common cause, ask about daily bleeding, consider referral to gynae, investigate for bleeding disorders like vWB
GI bleed - FIT test
Bladder cancer - urinalysis
Malabsorption
Diet
Medical conditions that put people at higher risk of IDA
Anticoagulation
NSAID use
Hemolysis (e.g. mechanical valve)
Angina
CHF
What is the most sensitive and specific physical exam finding for IDA?
Conjunctival rim pallor
Palmar crease pallor
What are causes of low Hb?
Hemoglobinopathies - thalassemia
Menorrhagia
Occult bleeding
Chronic disease
