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Flashcards in Anemia Deck (16):
1

Mechanisms of anemia

1. Blood loss
2. Increased destruction
3. Decreased production

2

Increased destruction

1. Inherited
G6PD
PK deficiency
Hb->thalasemia, sickle cell
2. Membrane lipid abnormality
Hepatocellular
Renal failure
3. Sequestration
Hypersplenism
4. Acquired defect
Paroxysmal nocturnal anemia
5. Antibody mediated
New born transfusion
Autoimmune
6. Mechanical
HUS, DIC, TTP
Valves
7. Infections
Malaria
8. Toxic/chemical
Clostria
Lead
Snake venom

3

Decreased RBC production

1. Inherited genetic
Fanconi
2. EPO deficiency
Renal failure
Chronic disease
3. Nutritional deficiency
Vitamin B12
Folate
Iron
4. Inflammation induced iron sequestration
Anemia of chronic disease
5. Immune injury progenitors
Aplastic anemia
Red cell aplasia
6. Infection of progenitor
Parvovirus
7. Space occupying BM
Metastatic
Granulomatous
8. Primary hematopoietic
Leukemia
MDS
MPS
9. Unknown
Endocrine->hypothyroid
Liver

4

Microcytic anemia

1. Iron deficiency
2. Thalassemia
3. Sideroblastic

5

Normocytic

1. Acute blood loss
2. Anemia of chronic disease
3. BM failure
4. Renal failure
5. Hypothyroidism
6. Hemolysis
7. Pregnancy

6

Macrocytic

1. B12 or folate
2. Alcohol and liver
3. Reticulocytosis
4. Cytotoxicx
5. Myelodysplastic
6. Marrow infiltration
7. Hypothyroid
8. Antifolate drugs

7

When to suspect hemolysis

1. Jaundice
2. Reticulocytosis
3. Mild macrocytosis
4. Low haptoglobins
5. Increased bilirubin
6. Increase urobilinogens

8

Severe anemia with HF

1. Slow infusion of pRBCs with frusemide
2. Monitor for fluid overload
3. If immediate transfusion needed->exchange transfusion

9

History

1. Features of anemia: breathless, fatigued, reduced exercise. Duration, previous blood results
2. Fever->infection, neoplasms, vasculitis
3. Stools->malabsorption
4. Diet
5. Blood loss
Pregnancy, miscarriage, menstrual
Change in bowel, melena
Hemoptysis
Dark urine
Hx peptic ulcer/NSAID use, diverticular, IBD
Renal/hepatic
Anticoagulants
6. Cold intolerance->hypoT, SLE->rash, joint
6. Family Hx->anemia, jaundice, cholelithiasis, splenectomy, Hb, bleeding
7. Occupation, social (alcohol), medical history
8. Medication, transufsions, drugs, exposure to solvents/insecticide

10

Physical examination

1. Evidence of anemia
Pallor, wide pulse pressure, systolic flow murmur
2. Evidence of complications-> CV
Displaced
Lung base crackles
S4
Arrythmia
3. Evidence of underlying
General->malnourished, chronic disease
Liver
Renal
Jaundice
Rashes
Bruising
LN, organomegaly
Neurological (TTP)
Thyroid
PR
Pelvic

11

Investigations

1. Microcytic
Iron studies
FOBT
Upper GI endoscopy
IgA-tTG
Colonoscopy
Flow cytometry
TVUS
Stool MCS
2. Normocytic->hypoproliferative
FBC
B aspirations, biopsy
Antiparvovirus
Hepatitis serology
MS test
Peripheral smear
TSH, free T4
ANA
RF
CK
CXR
EPO
3. Normocytic->hyperP
Creatinine
Coagulation
Direct coombs test
CMV/EBV
4. Macrocytic
Vitamin B12, folate
Anti-intrinsic, parietal cell antibodies
BM aspiration
Cytogenetics

12

What indicates IDA

Low serum iron
High TIBC
Low ferritin

13

What indicates ACD

Low serum iron
Low TIBC
Low ferritin

14

Causes of IDA

1. Decreased uptake
Inadequate diet
Achlorhydria
Gastric surgery
Celiac
Pica
2. +Iron loss
PUD
Diverticulosis
Neoplasm
IBD
Hemorrhoids
Menorrhagia
Blood donation
GoodP, HHT, angiodysP
Renal failure
Runner's anemia
Hemaglobinuria
3. +requirements
Infancy
Pregnancy
Lactation
4. Unknown

15

Investigations in iron deficiency anemia

1. FBC->low
3. Iron studies->low serum iron, low ferritin, low TIBC, low transferrin saturation
3. PLT->N or elevated
4. Smear->microcytic, hypochromic
5. Reticulocyte count->low

Tests to consider
1. Celiac serology
2. H pylori
3. AutoI gastritis
4. Upper GI endoscopy, small bowel biopsy
5. Lower GI endoscopy, sigmoidoscopy

16

Management of IDA

1. Treat underlying cause
2. Ferrous sulphate + ascorbic acid for 3-6 months
3. Encourage red meat 3 serve/week with juice
4. If severe deficiency->parenteral iron infusion may be required.