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PR3154: Haematological & Musculoskeletal Systems > Anemia > Flashcards

Anemia Flashcards

1
Q

What are the 3 functional classes of anemia and examples of the classes?

A

Hypoproliferative: iron deficiency
Maturation disorders: vitamin b12, folate deficiency, thalassemia
Hemorrhage/hemolysis: blood loss

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2
Q

What are the most common causes of anemia?

A

Iron deficiency anemia (IDA)
Vitamin B12 or folic acid deficiency
Anemia of inflammation eg. CKD
Drug-induced

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3
Q

What type of anemia is IDA?

A

Microcytic

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4
Q

Is thiamine deficiency assoc with macrocytosis?

A

No, it is assoc with CNS complications

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5
Q

What is the Hb levels that define anemia?

A

F: Hb <11
M: Hb <13

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6
Q

What is agranulocytosis/neutropenia?

A

Low neutrophils

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7
Q

What is thrombocytopenia?

A

Low platelets

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8
Q

What is the reversal agent for rTPA/alteplase?

A

TXA = tranexamic acid

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9
Q

What should you ask and what physical exams to determine anemia?

A

Bleeding?
Pallor: nail beds, tongue, bottom of eyelids pale
Jaundice- suggests hemolysis
Chest pain?
SOB on exertion?
Recent cardiac event?

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10
Q

What labs are done to determine anemia?

A

FBC
Reticulocyte count
Peripheral smear

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11
Q

What is the range of FBC that suggests mild anemia?

A

Pregnant: 10-10.9
Non-pregnant >15y/o: 11-11.9
Men >15y/o: 11-12.9

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12
Q

What happens to reticulocyte count if there is acute bleeds?

A

Increases as the body tries to produce RBC

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13
Q

What does hypochromic RBCs shown in peripheral smear suggests?

A

Hypochromic = central pallor over 1/3 of the cells

Suggests Fe deficiency

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14
Q

How would microcytic cells show in peripheral smear?

A

Small cells, smaller than nucleus of a mature lymphocyte

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15
Q

How would poikilocytosis cells show in peripheral smear?

A

Cells of different shapes

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16
Q

What is serum ferritin?

A

Fe storage

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17
Q

What will labs show to diagnose IDA?

A

Low MCV, low serum ferritin

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18
Q

What will labs shows to diagnose acute blood loss or hemolysis?

A

Normal MCV, high reticulocyte count

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19
Q

What will the labs show to diagnose vitamin B12 and folic acid deficiency?

A

High MCV.

Low B12 and normal folate: B12 def
Normal B12 and low folate: folic acid def

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20
Q

What conditions are possible if MCV high and B12 and folate lvls are normal?

A
  • Hepatic disease
  • Drug-induced anemia
  • Hypothyroidism
  • Reticulocytosis
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21
Q

What will the labs show to diagnose aplastic anemia or leukemia?

A

Normal MCV
Low reticulocyte count
Low WBC and platelets

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22
Q

What will the labs show to diagnose low anemia of chronic disease? i.e CKD, RA, IBD

A

Low MCV
Normal or high serum ferritin
Low TIBC

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23
Q

What will the labs show to diagnose chronic inflammation/infection or chronic renal disease?

A

Normal MCV
Low reticulocyte count
Normal or high WBC and platelets

24
Q

What are 2 mechanisms of iron deficiency?

A

Decreases Fe absorption or blood/iron loss

25
Q

What are examples of causes for decreased iron absorption?

A

Atrophic gastritis
Celiac disease
Gastric bypass
H pylori infection
Ca-rich foods
PPI
Other meds that decrease gastric acidity

26
Q

For Fe supplementation, generally how much elemental iron and how long is required?

A

1000-1500mg elemental iron for at least 3-6months

27
Q

Which oral iron preparation has 100% elemental iron?

A

Iron polymaltose drops/tab (Maltofer)

28
Q

How much elemental iron is in 1 tablet of iron polymaltose?

A

100mg

29
Q

How much % elemental iron is in sangobion?

A

12%

30
Q

What additional blood result will suggest B12 def?

A

Autoantibodies to intrinsic factor is positive

31
Q

Is B12 def. a megaloblastic anemia?

A

Yes

32
Q

What are common causes of vitamin B12 def?

A
  • Reduce absorption (lack of intrinsic factor or gastric disruption)
  • Nutritional (B12 are found exclusively in meats)
  • Other causes (PPIs, H2RAs, H pylori)
33
Q

What are common causes of folate def?

A

Nutritional (but uncommon in developed countries as they can be found in foods)

34
Q

What is pernicious anemia?

A

Autoimmune disorder: stomach does not make enough intrinsic factor which absorbs vitamin B12

35
Q

What can be given to treat pernicious anemia?

A

Parenteral (IM/SQ) Vitamin B12, give 1000ug daily for 1w f/b 1000ug weekly x 4wk f/b 1000ug monthly for life

PO is usually insuff. It is absorbed by mass action and not relied on action of intrinsic factor

36
Q

What can be given to treat vitamin B12 of other causes other than lack of intrinsic factor?

A

Parenteral 1000ug or 2000ug daily or PO Vit B12.

37
Q

What can be given to treat folate def?

A

1mg/d of folate for 1-4months or until hematologic recovery is achieved

38
Q

What is found in hemoplex/sangobion multivitamins that helps with constipation?

A

Sorbitol

39
Q

What labs do we look at to determine aplastic anemia?

A

WBC count <= 3.5 x 10^9/L
Platelet count <= 55 x 10^9/L
Haemoglobin value <= 10g/dl + reticulocyte count <=30 x 10^9/L

Only need to satisfy 2 out of 3

40
Q

What are causes of aplastic anemia?

A

Drugs (common)
Radiation
Viruses
Chemical Exposure

41
Q

What is aplastic anemia?

A

Bone marrow cannot make enough new blood cells (affects all cell lines)

42
Q

What is the treatment for drug induced aplastic anemia?

A

For all drug induced haematological disorders, first thing to do is hold off offending drugs.

Infections:
- Prophylactic AB and antifungal agents when neutrophil counts are <0.5 x 10^9/L
- Febrile neutropenia: start broad spectrum ABs

Bleeding:
- transfusion support with erythrocytes and platelets
if heavily transfused, iron chelation therapy with deferoxamine or deferasirox may be needed (avoid iron overload)

May require allogeneic hematopoeitic stem cell transplantation and immunosuppressive therapy (cyclosporine)

43
Q

What neutrophil count suggests drug induced neutropenia or agranulocytosis?

A

Neutropenia: <1500/uL
Agranulocytosis: absence of granulocytes but is often loosely used to indicate severe degrees of neutropenia (<100, <200 or <500u/L)

44
Q

What drugs is assoc with agranulocytosis?

A

Anti thyroid agents: usually >40y/o and within 2months of initiation
Clozapine and other phenothiazines: 2-15wks after initiation esp 3rd/4th wk
Penicillins: rapid onset and dose related. usually due to accumulation of drug to toxic conc –> nvr renal adjust

45
Q

How to manage drug induced agranulocytosis?

A

For all drug induced haematological disorders, first thing to do is hold off offending drugs.

  • Blood cell count shld return to norm within 2-4wks, freq within 4-24days
  • If neutrophil <0.1 x 10^9/L : filgrastim (GCSF) SQ 300mcg/d
  • Not rec to restart offending drug
  • Penicillin: can restart at lower dose after neutropenia resolved
46
Q

What are causes hemolytic anemia?

A

Drugs
G6PD def
IgG and IgM mediated RBC destruction

47
Q

What is hemolytic anemia?

A

When RBCs are destroyed faster than they are made

48
Q

What medications and substances are UNSAFE in mod-severe G6PD def?

A

FQs
Nitrofurantoin
Primaquine and tafenoquine: for malaria
Fava/kidney beans
Henna
Naphthalene (moth balls, lavatory deodorant)

49
Q

What malaria or RA medication is probably safe in G6PD def?

A

Chloroquine and hydroxychloroquine

50
Q

What drugs are assoc with megaloblastic anemia and what is the treatment?

A

Antimetabolite class eg. MTX (chemotherapy)- most common: hold off

Co-tromoxazole- esp when folate/vit B12 def: folinic acid 5-10mg up to 4 times/day

Phenytoin, phenobarbital- inhibit folate absorption or catalyse folate catabolism: folic acid 1mg/day (controversial)

51
Q

What platelet count defined thrombocytopenia?

A

Platelet count <= 100 x 10^9/L or >50% reduction from baseline values

Note: usually presents 1-2wks after drug initiated but may present immediately after a dose when an agent has been used in the past eg. UFH. Rapid onset may also occur with GPIIb/IIIa inhibitor class of drugs eg. eptifibatide

52
Q

What is most common drug to cause thrombocytopenia?

A

Heparin

53
Q

How to mange drug induced thrombocytopenia?

A

Hold off offending druug.

Recovery begins within 1-2days after discontinuation and is complete at 1wk. Antibodies to agent may persist for years so pts shld avoid the drug indefinitely

54
Q

What of the following statements of IDA is/are correct?

a) Manifests as high MCV and low ferritin
b) Shld prompt exclusion of blood loss
c) Cld be attributed to insuff Vit.B12 intake in diet
d) Req adequate elemental Fe replacement of up to 1000mg/day

A

b, d

55
Q

What of the following statements of megaloblastic anemia is/are correct?

a) Vit.B9 def leads to high MCV
b) Gastric bypass surgery is a RF for vit.B12 malabsorption
c) Is assoc with PHT and valproate use
d) Screening for folate and vit.B12 def is necessary

A

a, b, d

56
Q

What of the following statements of thrombocytopenia is/are correct?

a) Is defined as platelet count of <50 x 10^9 /L
b) A drop of >50% from baseline platelet counts
c) Is assoc with eptifibatide use
d) Is assoc w repeated LMWH use

A

b, c

57
Q

What of the following statements of agranulocytosis is/are correct?

a) Is assoc with clozapine use
b) Req the offending drug to be rechallenged at lower dose
c) Is assoc with propylthiouracil and carbimazole
d) Refer to a drop of neutrophils, platelets and haemoblogin

A

a, c

PR3154: Haematological & Musculoskeletal Systems (10 decks)

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