1. Determine MCV 2. Hx/PE 3. Determine MOA

Microcytic anemia Flashcards by E *

Anemia

Reduction of hgb and/or hct

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Anemia is classified how?

Pathophysiologic mechanism

Reduced production RBC
Accelerated loss/destruction of RBCs

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Low iron
Low TIBC
high ferritin
High cytokine levels

Anemia of chronic dz

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Anemia of chronic dz expected lab values

Low iron
Low TIBC
high ferritin

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Low iron
High soluble transferrin recep
High TIBC
Low ferritin
Transferrin saturation low
Hypochromic RBCs

IDA

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IDA expected lab values

Low iron
High soluble transferrin recep
High TIBC
Low ferritin
Transferrin saturation low
Hypochromic RBCs

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High iron
Low tibc
High ferritin

Suspect thalassemia

Must reflec w/ hgb electrophoresis

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Thalassemia expected labs

High iron
Low tibc
High ferritin
—- must get hgb electrophoresis

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High iron
NL TIBC
High ferritin

Sideroblastic anemia

As long as BM iron:
>10% Ringed sideroblast
Review RBC morphology

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Sideroblastic anemis expected lab values

High iron
NL TIBC
High ferritin

BM - >10% ringed sideroblasts

RBC morphology

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Anemia eval steps

Determine MCV
Hx/PE
Determine MOA

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MC cause of anemia (MC pop)

IDA - females (menses/preg)

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Ferritin purpose

Amount of iron stored

Storage protein w/in cells

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Transferrin purpose

Protein that transports iron

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TIBC - total iron-binding capacity purpose

Measures bloods capability to bind iron w/ transferrin

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Hepcidin is?

Hormone that assists regulation of iron storage

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Where is Hepcidin produced?

Liver

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Inflam/infection or increased iron levels changes iron metabolism how?

Hepcidin increases > decreases intestinal iron absorption

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Insoluble form of iron is called?

Hemosidirin

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When is hemosidirin formed?

Excess iron in the body/circulation

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What intestinal cells absorb iron?

Duodenal enterocytes

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Most iron is incorporated into? Where else

RBC 1800mg
Liver parenchyma 1000mg
Spleen 600mg
BM 300mg
Muscle 300mg
Plasma transferrin 3mg

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Iron content NL, in/out?

NL - 3-4mg

In/out - 1-2mg

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IDA mechanisms of cause

Increased loss
Inadequate absorption
Inadequate intake

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IDA development stages

1 - ferritin decreases 2 - RBCs hypochromic 3 - hgb drops 4 - MCV drops

Anema S/S

F- fatigue L- light headed/dizzy A- angina P- palpitations T- tachy-C/Poe H- HOTN P- pallor S- syncope

Other unusual S/S of IDA

Glossitis - swollen, inflam, smooth tongue Cheilosis - scaling, cracking, fissuring of lips (b12 issue usually) Koilonychia - spoon nails Nail dystrophy Pica - craves non-nutritious substances >1mo

Plummer-vinson syndrome

Triad 1- Dysphagia 2- Esophageal webs (causes the dysphagia) 3- IDA

Plummer-vinson syndrome MC affects who

Post menopausal females

TIBC represents

Ability of transferrin to bind more iron

Transferrin saturation represents?

Ratio between serum iron:transferrin

IDA due to decreased absorption suspect?

Celiac sprue Bariatric procedures PPI therapy H. Pylori inf

New onset IDA in a male >50 or postmenopausal female is what?

GI malig until R/O

New onset IDA in a male >50 or postmenopausal female W/U

Eval GI blood loss w/ - EGD - Colonscopy

IDA 1st line TXT

(PO) replacement | -ferrous sulfate 325mg

SE of iron replacement?

Constipation ABD pain Dark stools

How long should iron replacement go for?

3-6mo to replenish stores Until ferritin returns to NL H/H return to NL 6-8wks

IV iron therapy is reserved for? Req?

Cant tolerate or Refrac | Req internal med/hematology consukt

Thalassemias are?

Hereditary dz w/ defects in the synth of globin chains in hgb.

Alpha thalassemia is a genetic issue of

Deletion of the alpha chain allele

Beta thalassemia is a genetic issue of

Mutation of beta chain allele

MC genetic pop?

Mediterranean Africa Asian

Hard sign of thalassemia

Microcytosis out of proportion to the degree of the anemia

Alpha thalassemia mutation causes what to happen?

Unstable - Relative beta chain excess w/ no chance for alpha substitution

Alpha thal minima

1 mutated chain - asymp

Alpha thal Minor

2 mutations Mild anemia Clinically normal

Hgb H disease (intermedia)

3 mutations | Severe chronic hemolytic anemia

Hgb Barts-hydrops fetalis

4 mutations - no alpha chains | Death

Beta thalassemia is

Impaired production of beta chains that leads to a relative excess alpha chains but can be substituted

Beta chain reduction can be substituted w/

Delta chains - hgbA2 | Gamma chains - hgbF

Excess alpha globin chains are

Unstable, incapable of forming soluble tetramers leading RBC membrane damage

What determines severity of beta thalassemia?

Degree of alpha globin chain excess

Homozygous impaired beta globin synthesis results in?

Profound clinical manifestations

Keys to thalassemia dx?

-Microcytosis out of proportion to anemia -positive fam hx/lifelong microcytic anemia -RBC morphology —microcytes —acanthocytes —target cells

Thalassemia trait is described as

Lab features w/out significant clinical impact

Thalassemia intermedia is described as

Req RBC transfusions | Moderate clinical impact

Thalassemia major is described as

Life threat

Thalassemia Dx

R/o IDA Iron shows overload Elevated ferritin Low TIBC

Method of thalassemia detection

Hgb Electrophoresis | Or genetic testing

Hgb electrophoresis resulta A/B thal

Alpha thal trait - NL —-alpha still made Beta thal - ABNL —-gamma/delta high

Mild Thalassemia txt

Avoid unnecessary iron Avoid some Rx -sulfa drugs (oxidative stress > hemolysis

Severe thalassemia txt

Req freq transfusions Folate supplement Splenectomy BM transplant

Freq Transfusions can lead to?

Iatrogenic iron overload syndrome

Anemia of chronic disease is

Ass/w chronic comorbidities like - chronic infectious processes - autoimmune d/o - malig - liver disease - chronic kidney disease

Anemia of chronic disease labs

Normocytic or microcytic Low serum, transferrin, TIBC Nl - ^ ferritin

Anemia of chronic disease txt

Txt underlying condition

Siderobladtic anemia is

Mishandling of serum iron by mitochondria leading to ABNL RBC precursor processing of iron.

W/ sideroblastic anemia bone marrow produces what?

Ringed sideroblast rather than NL RBCs

Bone marrow composition w/ sideroblastic anemia?

>10% bone marrow sideroblast in aspirate

Sideroblast is?

RBCs >1 iron containing granule in Cytoplasm | -iron poorly incorporated into heme of RBC

Sideroblastic anemia causes

1. Inherited | 2. Acquired (MC) (Rx/toxins)

Rx causing sideroblastic anemia?

``` Ethanol Isoniazid INH Cycloserine Chloramphenicol Busulfan ```

Copper chelators causing sideroblastic anemia

Penicillsmine | Triethylene tetramine dihydrochloride

Toxins causing sideroblastic anemia

Lead Zinc Auto-antibodies

Sideroblastic anemia txt

D/C offending agent Supportive pRBC if hgb <7.0 (PO) pyridoxine B6

Microcytic anemia Flashcards

(75 cards)