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Flashcards in Anemia 3 Deck (19):

hemolytic: LDH levels? why?

increased: enzyme found in red cells, released when RBC is broken open


hemolytic: bilirubin levels? why?

increased bilirubin and unconjugated bilirubin. Hb released from RBC metabolized to bilirubin. when liver is overwhelmed by the increased bilirubin, it's unable to keep up with the conversion to conjugated bilirubin


hemolytic: haptoglobin levels?

decreased: present in blood to mop up toxic free hemoglobin, so decreased because it's quickly consumed


why do a blood film for hemolysis

red cells that are hemolyzing often change shape, and shape can be a clue to the cause


why do a DAT (Coombs test) for hemolysis

look for antibodies bound to the RBC surface, supporting immune cause of hemolysis


MAHA triad

low platelets. low hemoglobin. red cell fragmentation hemolysis


MAHA: what is key to diagnosis

blood film:look for red cell fragments


Life threatening conditions associated with MAHA

disseminated intravascular coagulopathy, thrombotic thrombocytopenia purpura, hemolytic uremic syndrome, syndrome in pregnancy, preeclampsia


MAHA: platelet and Hb levels

both low. activated platelets


immune mediated hemolytic anemia: mechanism

antibodies to RBC antigens: immune cells bite off bits of RBC membrane, hemolytic markers. red cells lose biconcave shape = spherocytes


4 reasons for decreased marrow production

doesn't have the "tools" needed, poisoned by toxins, normal cells being crowded by others, or bone marrow intrinsically failing


bone marrow not having necessary tools to make RBCs: 4 explanations

hemantinic deficiency (low iron, B12, folate). low EPO (renal failure). anemia of inflammation (Fe stores present, but not accessible). hemoglobinopathy, thalassemia (abnormal Hb)


bone marrow poisoned by toxins: 4 examples

alcohol, drugs like chemotherapy, infection by HIV, parvovirus, radiation therapy


bone marrow being crowded out by others: explanation

by non hematologic malignancy aka metastatic cancer, or by hematologic malignancies. infection. myelofibrosis: BM replaced by collagenous deposition


bone marrow failing (what would you call this) + examples

primary bone marrow failure: myelodysplasia, aplastic anemia, inherited BM failure syndromes


how to diagnose primary bone marrow syndrome, or bone marrow being crowded out

bone marrow exam


blood film for anemia

hypochromic microcytic anemia (could still be normocytic too)


etiology of iron deficiency

premature infants, inadequate dietary iron, heavy menstrual loses, pregnancy, GI sources of blood loss, colon cancer, malabsoprtion like celiac or inflamm bowel disease


how to determine iron deficiency

measure serum ferritin: indicates body's total iron stores