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Flashcards in Intro Anemia Deck (57)
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1

What is anemia? (i.e. what leads to the final physiologic consequence)

  1. Decreased circulating red cell mass ⇒ 
  2. Decreased hemoglobin concentration of blood ⇒ 
  3. Decreased O2-carrying capacity of blood ⇒ 
  4. Decreased O2 delivery to tissues (final physiologic consequence)

2

What are the physiologic compensatory mechanisms for anemia?

  • Increased red cell production
  • Increased 2,3-DPG
  • Shunting of blood from non-vital to vital areas
  • Increased cardiac output
  • Increased pulmonary function

3

What are signs/symptoms of anemia? What mechanisms lead to these?

  • Weakness, malaise, easy fatigability ⇒ Tissue hypoxia
  • Marrow expansion with potential bony abnormalities ⇒ Increased red cell production
  • Pallor ⇒ Shunting of blood from non-vital to vital areas
  • Tachycardia; cardiac ischemia in severe cases ⇒ Increased cardiac output
  • Dyspnea on exertion ⇒ Increased pulmonary function

4

What kind of disease is anemia?

Anemia is NOT a disease

  • it is a symptom of other diseases and must be explained!

5

What is the functional classification of anemia?

  • Blood Loss
  • Decreased Production
  • Accelerated Destruction

6

What are the morphologic categories of anemia?

  • microcytic
    • normochromic
    • hypochromic
  • normochromocytic/normocytic
  • macrocytic

7

What causes microcytic anemias?

  1. Normochromic
    • Iron deficiency--early
    • Thalassemia trait
    • (Anemia of chronic disease)*
      • Most commonly normochromic/normocytic
    • Some hemoglobinopathies (e.g., hemoglobin E)
  2. Hypochromic
    • Iron deficiency
    • Thalassemia trait
    • Sideroblastic anemia
    • Anemia of chronic disease*
      • Most commonly normochromic/normocytic

8

What causes normochromic/normocytic anemias?

  1. Anemia of chronic disease
  2. Anemia of renal failure
  3. Marrow infiltration
  4. Aplastic anemia
  5. Blood loss**
    • normocytic or macrocytic, depending on degree of blood loss
  6. Hemolysis**
    • normocytic or macrocytic, depending on degree of blood loss

9

What causes macrocytic anemias?

  1. B12 and folate deficiency
  2. Liver disease
  3. Myelodysplastic syndromes
  4. Blood loss**
    • normocytic or macrocytic, depending on degree of blood loss

  5. Hemolysis**
    • normocytic or macrocytic, depending on degree of blood loss

  6. Some drugs

10

Investigation of anemia:

  • Clinical history
  • Physical exam
  • Complete blood count (CBC)
  • Reticulocyte count
  • Examination of peripheral blood smear
  • Specific diagnostic tests (guided by above)

11

What can be assessed on a peripheral blood smear?

  • Red cell shapes (poikilocytosis)
  • Red cell size variability (anisocytosis)
  • Average red cell size (microcytosis, macrocytosis)
  • Hemoglobinization (hypochromia, normochromia)
  • Polychromasia (reticulocytes)
  • Red cell inclusions
  • Red cell arrangement
  • White cell and platelet morphology

12

What CBC parameters are used to evaluate anemia?

this is a really long card, sorry :/

  1. Hemoglobin concentration (Hb; g/dL or g/L)
    • Most important parameter for assessment of O2-carrying capacity of blood
  2. Hematocrit (Hct; %)
    • Packed cell volume (percentage of blood volume comprised by RBCs)
    • Usually 3 times hemoglobin--does not add independent information in vast majority of cases
  3. Red blood cell count (RBC; # x 109/L)
    • Direct measure of # of RBCs per unit volume
    • Generally correlates well with Hb and hematocrit, adds little independent information
  4. Mean cellular (corpuscular) volume (MCV; fL)
    • Very useful in the differential diagnosis of anemia (e.g., microcytic, normocytic, and macrocytic anemias)
  5. Mean corpuscular hemoglobin (MCH; pg)
    • Calculated as Hb/RBC
    • Measure of average amount of hemoglobin per RBC
    • High correlation with MCV
  6. Mean corpuscular hemoglobin concentration (MCHC; g/dL)
    • Measure of “chromicity” of RBCs
    • Calculated as Hb/(MCVxRBC)
    • Decreased in hypochromic anemias
    • Increased in a few “hyperchromic” states (e.g., hereditary spherocytosis, hemoglobin CC disease)
  7. Red cell distribution width (RDW)
    • Measure of variability of red cell volume
    • Coefficient of variation of red cell volumes = svolume/MCV)
    • Useful for the separation of anisocytotic anemias (e.g., Fe deficiency) from non-anisocytotic anemias (e.g., anemia of chronic disease)

13

What is the differential diagnosis for a microcytic anemia?

  1. Iron deficiency
  2. Thalassemia
  3. Anemia of chronic disease
  4. Other (rare)

14

Macrocytic Anemia: Differential Diagnosis

  • Megaloblastic:
  • Non-megaloblastic:

  • Megaloblastic:
    • B12 and folate deficiency
    • Some drugs
    • Myelodysplastic syndromes
  • Non-megaloblastic:
    • Reticulocytosis
    • Liver disease
    • Hypothyroidism
    • Some drugs

15

What measures ''chromicity" of RBCs?

Mean corpuscular hemoglobin concentration (MCHC)

16

What CBC parameter would be used to differentiate between Fe deficiency anemia (anisocytosis) vs. anemia of chronic disease (non-anisocytosis)?

Red cell distribution width (RDW)

17

What CBC parameter is used to differentiate between microcytic, normocytic and macrocytic anemias?

Mean cellular (corpuscular) volume (MCV)

18

Type of cell and associations?

Spherocytes

  • Round
  • Smaller Diameter
  • More densely staining
  • Lack of central pallor
  • Associations:
    • hereditary spherocytosis
    • autoimmune hemolytic anemia

19

Type of cell and associations?

Bite cells

  • Oxidant hemolysis (G6PD deficiency)

20

Type of cell and associations?

Target cells

  • liver dz
  • splenectomy
  • hemoglobinopathies

21

Type of cell and associations?

Elliptocytes (ovalocytes)

  • hereditary elliptocytosis
  • megaloblastic anemia
  • iron deficiency
  • myelofibrosis

22

Type of cell and associations?

Schistocytes (fragments)

  • TTP
  • DIC
  • HUS
  • malignant hypertension

23

Type of cell and associations?

Teardrop cells

  • megaloblastic anemia
  • myelofibrosis
  • extramedullary hematopoiesis

24

Type of cell and associations?

Sickled cells

  • Sickle cell disease

25

Describe this peripheral blood smear:

Macrocytosis

26

Describe this peripheral blood smear:

Microcytosis

27

Describe this peripheral blood smear:

Normochromic

28

Describe this peripheral blood smear:

Hypochromic

29

Describe this peripheral smear: 

What type of cell is this?

Polychromasia = Reticulocytes

30

What is this?

What are the associations?

Howell-Jolly Bodies (nuclear fragments)

  • splenectomy
  • megaloblastic anemia