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ClinMed Lab II > Anemia Short Case > Flashcards

Anemia Short Case Flashcards

1
Q

What is the definition of anemia?

A
  • Low H/H or RBC count compared to NL age & gender controls
  • More than 2 STD below mean
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2
Q

What are the H/H levels for females to be considered anemic?

A

Hgb < 12 or Hct < 36

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3
Q

What are the H/H levels for males to be considered anemic?

A

Hgb < 13.5 or Hct < 41

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4
Q

What is the lab value on a CBC that represents the average size (volume) of the patient’s RBCs?

A

MCV

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5
Q

What is the lab value on a CBC that represents the average hemoglobin content in a RBC?

A

MCH

Low = low hemoglobin content per cell - on peripheral blood smear would show up as hypochromia

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6
Q

What is the lab value on a CBC that is a measure of the variation in RBC size?

A

RDW

Low = RBC are all around the same size

High = a lot of variation in RBC size

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7
Q

Anemia is never normal. What are some questions you should be asking yourself?

A
  • Is the patient bleeding?
  • Is their bone marrow suppressed?
  • Is the patient iron deficient?
  • Are they B12 or Folic deficient?
  • Do they have chronic dz or recurrent infxn?
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8
Q

There are numerous S/S of anemia. What are a few?

A
  • Fatigue, weakness
  • Palpitations, Tachycardia
  • Dyspnea
  • Dizziness, Syncope
  • Bleeding
  • Angina
  • Tachypnea
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9
Q

What are some clues of anemia from the HPI?

A
  • Melena, Abd pain, NSAID/OAC usage, Hx ulcers
  • Menstrual history
  • Pica
  • Diet
  • Gastric bypass, parasthesias, gait problems, memory issues
  • EtOH abuse - Moonshine, lead paint/pipe exposure
  • FHx blood disorders - G6PD, sickle cell, thalessemia
  • Jaundice, New meds, Transfusions, infxn
  • Hx of prolonged bleeding, epistaxis, bleeding gums, easy bruising
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10
Q

What is one of the main things to check for on PE?

A

Stool for occult blood!

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11
Q

What are some other things to look out for on PE?

A
  • Pallor of skin, conjunctiva
  • Jaundice
  • Petechiae/ecchymoses
  • Wt loss
  • Glossitis, angular stomatitis
  • Tachy, new murmur
  • Orthostatic hypotension
  • Splenomegaly
  • Sx scars
  • LAD
  • Dec. vibratory sense, impaired proprioception
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12
Q

When anemia is detected on the CBC what do you look at next?

A

MCV

Low < 80 (microcytic RBCs present)

NL 80 - 100 (normocytic)

High > 100 (macrocytic)

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13
Q

What DDx are you thinking of if a patient has microcytic anemia?

A
  • IDA
  • Thalassemia
  • Sideroblastic (lead toxicity)
  • Copper deficiency
  • Zinc poisoning
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14
Q

What is the most common cause of anemia worldwide?

A

IDA

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15
Q

If a patient has IDA what should be high up on your DDx for cause?

A

Need to r/o:

  • GI bleeding!
    • PUD
    • CA
    • NSAID use
  • Also consider menstrual losses
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16
Q

S/S of IDA?

A
  • Pallor, easily fatigued
  • Irritability, anorexia
  • Tachy, tachypnea on exertion
  • Pica
  • Severe deficiency: Hct <25% - cheilosis, smooth tongue, brittle nails, formation of esophageal webs (Plummer-Vinson syndrome)
17
Q

What would you expect to see on IDA labs?

A
  • Dec ferritin
  • Inc TIBC (indirect way to measure transferrin sat)
  • Dec serum Iron concentration
18
Q

How many protein chains is Hgb made up of?

A

4

2 alpha

2 Beta

19
Q

What is an inherited disorder with abnormal hemoglobin production in either the alpha or B chains of Hgb?

A

Thalassemia

20
Q

T/F: A patient with Thalassemia could be anywhere along the spectrum: silent carrier to profound anemia

A

True

21
Q

Thalassemia Labs: What should you look for on peripheral smear?

A
  • Target cells
  • Basophilic stippling
  • Poikilocytes
22
Q

What would you see on Thalassemia Labs? What would you use to Dx?

A

Serum iron, Ferritin levels and RBCs usually NL to Elevated

Dx: hemoglobin electrophoresis

23
Q

What is your DDx if a patient has normocytic anemia?

A
  • Acute blood loss
  • Anemia of chronic dz (AOCD)/Anemia of inflammation
  • Chronic renal insufficiency
  • Hemolysis
  • Bone marrow suppression (may be macrocytic)
  • Endocrine dysfunction (hypothyroid, hypopituitary)
24
Q

What conditions could possibly cause AOCD?

A
  • CKD
  • DM
  • Chronic autoimmune disorders
  • Many more
25
Q

What is the pathophys of AOCD?

A
  • Underlying medical condition creates ongoing state of inflammation
  • Cytokine release
  • Dec RBC production
  • Dec RBC survival
  • Dec EPO production
  • Dec iron absorption
  • Anemia
26
Q

What would you see on AOCD Labs?

A
  • Normochromic, normocytic, mild anemia Hgb 10-11
  • Dec serum iron
  • TIBC NL to low
  • Serum ferritin NL to high (acute phase reactant)
  • ESR and/or CRP
27
Q

In what type of anemias do you see decreased RBC survival and increased cell lysis?

A

Hemolytic Anemias

28
Q

What are some hereditary causes of hemolytic anemia?

A
  • G6PD
  • Sickle cell
  • Hereditary spherocytosis
  • Thalassemia
29
Q

What are trauma/immune attack causes of hemolytic anemia?

A
  • TTP
  • HUS
  • DIC
  • Valvular hemolysis
  • Infxn
  • Burns
  • Hypersplenism
30
Q

What would you expect to see on hemolytic anemia labs?

A
  • Inc reticulocyte count (> 2)
  • Falling Hgb
  • Inc Indirect bilirubin
  • Inc LDH (LDH in RBCs - if lysed = released)
  • Dec Haptoglobin
  • Could see schistocytes on peripheral smear
31
Q

What is on your DDx if a patient has macrocytic anemia?

A
  • Alcoholism
  • Folate deficiency
  • Vit B12 deficiency
  • Myelodysplastic syndromes (MDS)
  • Liver dz
  • Reticulocytosis
    • (Inc MCV is a NL characteristic of reticulocytes, therefore conditions that cause this will be assoc with Inc MCV)
  • Drug-induced anemia
  • AML
32
Q

What is Myelodysplastic Syndrome?

A
  • Group of malignant hematopoietic stem cell disorders with dysplastic (have abnl cell morphology) and ineffective blood cell production
  • Risk of transformation to acute leukemia
33
Q

How does Myelodysplastic Syndrome arise?

A
  • Can arise de novo
  • Or after exposure to chemo, environmental toxins, radiation
34
Q

WBC might also be helpful in determining the cause of anemia. What would be on your DDx if WBCs are LOW?

A
  • Aplastic anemia (pancytopenia)
  • Bone marrow suppression
  • Vit B12 deficiency
  • Hypersplenism
35
Q

What would be on your DDx if WBCs were HIGH in an anemic patient?

A
  • INfxn
  • INflammation
  • Hemotologic malignancy

ClinMed Lab II (12 decks)

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