Hematology 2 Flashcards
(28 cards)
iron-deficiency anemia: characteristics
Microcytic and hypochromic anemia (small and pale RBCs) caused by iron deficiency.
It is the most common type of anemia in the world for all races, ages, and gender.
iron-deficiency anemia: S/Sx
Pallor of the skin, conjunctiva, and nail beds. Daily fatigue and exertional dyspnea. May have glossitis and angular cheilitis. Cravings for ice or dirt. Severe case will cause spoon-shaped nails, systolic murmurs, tachycardia, or HF
iron-deficiency anemia: etiology
Most common–> blood loss. Risk factors: reproductive-aged female (heavy periods, pregnancy), poor diet, GI bleed, postgastrectomy, increased physiologic requirement.
Infants: r/o chronic intake of cow’s milk before 12 m.o. of age (causes GI bleeding)
iron-deficiency anemia: lab
Decreased: Hgb/Hct, microcytic (MCV<80 fL), MCHC, ferritin and iron level.
Increased: TIBC, RDW
Blood smear: anisocytosis and poikilocytosis
iron-deficiency anemia: Tx plan
*R/o GI malignancy
Ferrous sulfate 325 mg PO TID btw meals (take w/ vit. C or OJ) for 3-6 m.o.
Iron-rich food: red meat, green leafy vege.
Increase fiber and fluids to prevent constipation.
F/u retic and CBC counts in 2 wks (retic, Hgb, Hct will increase)
Thalassemia minor: characteristics
Genetic Dz in which the bone marrow produces abnormal Hgb. Results in microcytic/hypochromic anemia. Occurs in ppl from Mediterranean, North Africa, Middle East, and Southeast Asia (incl. China).
Asymptomatic and no Tx needed.
Thalassemia minor: diagnostic
Gold-std diagnostic test is Hgb electrophoresis
anemia of CKD: characteristics
Hypoproliferative, normocytic, normochromic
Hgb < 11 g/dL in pregnant F, < 12 g/dL in nonpregnant F, < 13 g/dL in M
Occurs 2/2 decrease in renal EPO production secondary to CKD
anemia of CKD: initial testing
CBC, serum ferritin, serum transferrin saturation, B12, folate, and retic count
aplastic anemia: characteristics
Destruction of the pluripotent stem cells inside the bone marrow 2/2 multiple causes (radiation, adverse effect of a drug, viral infection, etc.). Results in pancytopenia (leukopenia, anemia, thrombocytopenia)
aplastic anemia: S/Sx
Severe case of anemia w/ fatigue and weakness. Pallor of skin and mucosa. Tachy and systolic murmur. Recurrent bacterial/fungal infections. Large bruises from trauma and bleeding 2/2 thrombocytopenia.
aplastic anemia: lab
CBC w/ differential, Plt count, gold-std is bone marrow biopsy
aplastic anemia: Tx
hematologist referral ASAP
Vit. B12 deficiency anemia: characteristics
The most common cause is pernicious anemia (autoimmune disorder)
Other causes: B12 malabsorption (GI Dz, infection, medications such as antacids, H2-receptor antagonist, PPI, metformin)
Chronic B12 deficiency causes nerve damage (peripheral neuropathy, paraplegia) and brain damage (dementia)
Highest incident in older women
pernicious anemia: characteristics
Autoimmune caused by the destruction of parietal cells in the fundus resulting in cessation of intrinsic factor production.
Iron deficiency commonly coexist w/ pernicious anemia
pernicious anemia: S/Sx
Tingling/numbness of hands and feet, difficulty walking, difficulty performing fine motor skills (hands)
Decreased reflexes in affected extremity.
Weak hand grip, abnormal Romberg, decreased vibration sense
pernicious anemia: labs
Antibody tests: parietal Ab test, intrinsic factor Ab test –> if positive, Pt has pernicious anemia
pernicious anemia: Tx
Initial: B12 injection 1 mg per wk for 4 wks
Maintenance: B12 injection 1 mg per month for lifetime
B12 deficiency: clinical pearl
B12 level in a Pt w/ B12 deficiency may be normal (< 5%).
Check B12 level as well as antibodies, urine MMA, etc.
Any Pt complaining of neuropathy or who has demential should have B12 level checked.
folic acid-deficiency anemia: characteristics
Macrocytic (MCV > 100 fL)
folic acid-deficiency anemia: S/Sx
Elderly and/or alcoholic Pt complains of anemia S/Sx (tired, fatigue, pallor, reddened and sore tongue). No neurological complaints. If anemia is severe, may hav tachy, palpitations, angina, or HF.
folic acid-deficiency anemia: causes
Most common: inadequate dietary intake (alcoholism, overcooking veges, low citrus intake).
Long term meds use: phenytoin (Dilantin), trimethoprim-sulfa, metformin, methotrexate, sulfasalazine, zidovudine (Retrovir, azidothymidine), etc.
folic acid-deficiency anemia: labs
CBC (decreased Hgb, Hct; increased MCV). Blood smear (macro-ovalocytes, hypersegmented neuts. Folate level < 4 ng/mL
What to look out for a woman of childbearing age regarding folic acid
Advise all women to take 400 mcg folic acid supplement daily at least 1 mo prior to getting pregnant. –> For normal fetal development and decrease the incidence of neural tube defects.
