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Flashcards in Anemia 4 Deck (17):

ferritin is an ___ ___ reactant? meaning?

acute phase reactant = proteins whose synthesis is upregulated in infection or inflammation


how to interpret ferritin levels

<15 definitely iron def. <30 almost certainly iron def. > 100 probably not def.


how to interpret ferretin levels in patients with inflammation

divide by 3, if <30 iron def is likely


other iron indices

low serum iron, increased TIBC, decreased iron saturation


iron saturation

serum iron divided by total iron binding capacity


vitamin B12 def causes? name of anemia

macrocytic anemia. may also cause decrease in platelet and neutrophil counts. pernicious anemia


vit B12 def: what test do you do and what do you see

blood smear : large red cells, but clear sign = hypersegmented neutrophils because of impaired DNA synthesis


anemia of inflammation: aka? MCV?

anemia of chronic disease. mild microcytosis, usually normocytic


anemia of inflammation: seen in who?

sick, hospitalized patients, cancer, infections, inflammatory disorders, patients in ICU


anemia of inflammation mechanism (4)

iron trapped in macrophages = decreased availability for RBC synthesis. blunted BM response to EPO, less EPO production by kidney, shortened TBC life span.


iron def anemia vs. anemia of chronic disease

hard to distinguish: both have low serum iron and iron saturation. iron has low ferritin, AI has normal/high. iron def has high TIBC, low in AI


how to diagnose anemia of inflammation

very difficult: will be a diagnosis of exclusion, you have to consider and treat other reversible or sinister causes. no clear diagnostic tests for it


anemic patient: basic steps

CBC, MCV, reticulocyte count. do history/physical exam. ask about potential blood loss in all patients!!


anemia workup: what initial investigations do you do if microcytic

ferritin, hemoglobinopathy


anemia workup: what initial investigations do you do if macrocytic

B12/folate, liver enzymes, TSH, retic count


consider blood film: why

confirm cell count abnormalities. look at morphology. can give important clues other tests normal, unexplained anemia, or suspected hemolysis


why do a reticulocyte count? serum ferritin?

check if marrow is working. assess iron stores