Normocytic anemia Flashcards by E *

Anemia considerations -

Rate of H/H alteration (slow vs fast)
evidence of
- Jaundice, scleral icterus
- Hepatosplenomegaly
- ^-retics
- v-haptoglobin (reclaiming hgb)
-Spherocytes/schistocytes

How well did you know this?

Not at all

Perfectly

DDx of normocytic anemia

Anemia of chronic dz
Acute blood loss
Multifactorial anemia
Renal-failure ass/w anemia
Aplastic anemia
Dilutional anemia (in-pt) 
Hemolysis

How well did you know this?

Not at all

Perfectly

2nd MC anemia (behind IDA)

Anemia of chronic disease

How well did you know this?

Not at all

Perfectly

Anemia of chronic disease has what morphology of RBCs?

Normochromic, normocytic

How well did you know this?

Not at all

Perfectly

Underlying causes of Anemia of chronic disease?

Dilutional anemia (25% due to IVF inpt)
Systemic inflammatory process (SLE, RA, Malig)

How well did you know this?

Not at all

Perfectly

Anemia of chronic disease pathophys

Inflam process disrupts iron hemostasis
IL-6 stimulates hepcidin release from liver
Decrease iron in BM > Erythropoiesis reduction
+
Systemic inflam destroying RBC’s (v-Survival)

How well did you know this?

Not at all

Perfectly

Anemia of chronic disease TXT

UC
Iron replacement
Blood transfusion PRN
EPO if - anemia is symptomatic + Hgb <10g/dL OR
- Cancer w/ active chemo
- CKD (GFR <30mL/min)
- HIV txt w/ evidence of myelosupression

How well did you know this?

Not at all

Perfectly

Acute blood loss occult reasons?

GI bleed
Retroperitoneal bleed (S/P Cardiac cath)
Post-op bleeding

How well did you know this?

Not at all

Perfectly

Acute blood loss RBC morpholoy is initially? But evolves into?

Normocytic > microcytic

How well did you know this?

Not at all

Perfectly

CKD anemia GFR?

<30mL/min

How well did you know this?

Not at all

Perfectly

CKD - etiology of the anemia?

Decrease EPO > decreased BM production of RBCs

How well did you know this?

Not at all

Perfectly

CKD anemia management

EPO bld measurement - not req (PRN)
TXT - synthetic EPO stimulating agents when
-1. GFR <30mL/m AND -2. hgb <10g/dL

How well did you know this?

Not at all

Perfectly

CKD anemia TXT goal

Hgb - 11g/dL

HCT - 33%

How well did you know this?

Not at all

Perfectly

Primary Aplastic anemia is?

IgG autoantibody against BM stem cells

How well did you know this?

Not at all

Perfectly

Secondary Aplastic anemia is due to?

Inheritied/acquired

Chemo/Rad
Rx
Infections

How well did you know this?

Not at all

Perfectly

Pancytopenia BM D/O

Aplastic anemia
MDS
Acute leukemia
Myelofibrosis
Infiltrative D/O (lymphoma, myeloma, carcinoma)
Megaloblastic anemia

How well did you know this?

Not at all

Perfectly

Pancytopenia Non-Clonal (Non-BM) D/O

Hypersplenism

SLE

How well did you know this?

Not at all

Perfectly

Aplastic anemia clinical features

Hallmark is Pancytopenia (+hypocellular BM)
Anemia - weak, fatigue, pallor (Usually very severe)
Neutropenia - high risk of infection
Thrombocytopenia - bleeading

How well did you know this?

Not at all

Perfectly

Aplastic anemia population age group

Bimodal
15-25yo
AND
>60yo

How well did you know this?

Not at all

Perfectly

Aplastic anemia TXT

BM transplant - younger and/or better fx status
Immunosupression - Older patients (graft vs Host dz)
Case by case however

How well did you know this?

Not at all

Perfectly

Hemolytic anemia general attributes

Continuous or intermittent

Intrinsic or Extrinsic

How well did you know this?

Not at all

Perfectly

Intrinsic Hemolytic anemia is due to?

Defect in the RBC itself (usually hereditary)

membrane defect = hereditary spherocytosis
oxidation vulnerability = G6PD
hemoglobinpathy = SCA or Thalassemia

How well did you know this?

Not at all

Perfectly

Extrinsic Hemolytic anemia is due to?

Study These Flashcards

Immune - (autoimmune, lymphoproliferative, Rx toxicity)
Microangiopathic - TTP, HUS, valve hemolysis
Infection - plasmodium, clostridium, borrelia
Burns

Hemolytic anemia smear findings

Study These Flashcards

Schistocytosis (req’d for hemolysis to be Dx)

Hemolytic anemia labs

Indirect bili - INC - esp if intravascular hemolysis Hemoglobinuria - INC - telltale intravascualr hemolysis LDH - INC - released from lysed RBCs Retic - INC - (however, Low-NL if + BM D/O) Haptoglobin - DEC - binds free Hgb as RBCs lyse

MC intrinsic hemolytic anemia?

Hereditary Spherocytosis

Hereditary Spherocytosis is due to?

ABNL spectrin or actin (proteins that provide membrane structure) thus become trapped in spleen and rupture. (Chronic hemolysis)

Hereditary Spherocytosis have RBCs that cannot?

Pass through small fenestrations of the spleen due to lack of plaibility (Increased fragility)

Hereditary Spherocytosis RBCs appear on smear?

Normocytic anemia - Round RBCs, lack concavity, central pallor

Hereditary Spherocytosis pop predisposition?

Autosomal dominant D/O | MC Dx in childhoos (can be adult)

Important Hereditary Spherocytosis Labs

``` MCHC is increased (rounded shape increases surface area and allows more room for Hgb) Reticulocytosis Spherocytosis Negative Coombs test = (not autoimmune) Increased osmotic fragility test ```

Hereditary Spherocytosis TXT

Supportive pRBCs if Hgb <7g/dL Folic acid supplement (required for Erythropoiesis) Splenectomy (rare - eliminates hemolysis site)

MC enzymatic RBC D/O?

G6PD deficit

G6PD deficit causes?

Hemolysis if RBCs are exposed to oxidative stress.

G6PD deficit genetic predisposition?

X-linked recessive | Southeast asia, Mediterranean, African American

G6PD deficit pathophy

NL G6PD acts on glutathione in a reduced state which protects Hgb from oxidative denaturation

Oxidative stress is?

bodys inability to detoxify oxygen free radicals > thus they attack biological molecules (DNA, lipids, Proteins)

Oxidative stress and a pt w/ G6PD deficit causes

Episodic hemolysis in relation to the insult

Oxidized stress onto Hgb causes what to happen?

Denatures into Heinz Bodies (inclusion w/in RBCs)

Rx that induce oxidative stress?

Antimalarials - (Primaquine, Dapsone) | Sulfonamides - (Sulfonamethoxazole)

G6PD deficit clinical course?

Pt is perfectly healthy unless exposed to oxidative stress - Rx - Dehydration - Hypoxia

G6PD deficit labs to focus on

``` Retics - INC Indirect bilirubin - INC LDH - INC Haptoglobin - DEC Blood smear - Heinz bodies (denatured hgb) ```

SCA genetic predispostion

Autosomal recessive D/O African American Usually Dx 1st yr life (Hgb F stops revealing Hgb S)

SCA mutation is?

Point mutation in Beta chain at 6th position resulting in the formation of Hgb-S > sickling RBCs

ABNL hgb shape causes?

Chronic hemolytix Anemia | Acute painful episodes due to vaso-occlusion

Acute vaso-occlusions w/ SCA occur when?

Spontaneously OR Oxidative stress (Inf, Dehydrated, hypoxia)

Vaso-occlusions are a risk factor for?

Stroke

Acute manisfestations of vaso-occlusions

``` Bacterial Sepsis/meningitis Recurrent Pain - dactylitis, MSK, Abd pain Stroke Splenic sequestration Aplastic crisis Priapism Hematuria (including papillary necrosis) ```

Chronic manifestations of vaso-occlusions

``` Anemia Jaundice Splenomegaly Fx asplenia + others ```

SCA features?

Chronic hemolysis Smear = Sickles and Howell-Jolly bodies (nuclear remnants - usually removed by spleen) Fx hyposplenism/Asplenia

SCA Dx is confirmed how?

Hgb electrophoresis

SCA TXT

Hydroxyurea - INC Hgb F (if >2 acute painful crises/yr) Pneumococcal Vaccine - encapsulated bugs - asplenia Transfusion therapy - Hgb <7.0g/dL IVF - NS or LR Pain - ( 1-3 APAP, 4-7 NSAIDS, 8-10, (hydro)-morphine

Autoimmune hemolytic anemia (AIHA) is?

acquired autoantibodies to RBCs membranes

AIHA important features

Episodic hemolysis trigger w/ physiologic stress Rapid onset anemia - possibly life threatening + Coombs DAT (checks for antihuman antibodies)

Purpose of a Coombs direct antiglobulin test

Checks for antihuman antibodies in the blood

Microangiopathic Hemolytic anemia (MAHA) is?

group of D/O w/ intravascular hemolysis due to RBC fragmentation

Hallmark S/S of MAHA is?

Schistocytes

Normocytic anemia Flashcards

(57 cards)