Archive:Anemia: Difference between revisions

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Initial Assessment

1. Is the patient anemic?

Hgb < 12 g/dL, Hct < 37% in females, Hgb < 14 g/dL, Hct < 42% in males

2. Is this anemia acute or chronic?

3. Is this dilutional anemia? (hematocrit)

4. What is the size of the RBC? (MCV)

5. Is body appropriately responding? (reticulocyte count)

6. What does the peripheral blood smear show?

MCV < 80

(hypochromic)

normocytic (normochromic)

low reticulocytes

normocytic

high reticulocytes

MCV > 100

Fe deficiency

Anemia of chronic disease (ACD)

chronic liver disease

thalassemia trait

liver disease

megaloblastic

marrow failure (pancytopenia)

myelodysplasia

leukemia

alcohol

myeloma

hypothyroidism

mets

infection

blood loss

hemolysis

lead overload

renal failure (uremia)

B12 lack

sideroblastic

endocrine (thyroid)

folate lack

ACD

hematinic lack

drugs

Microcytic

Fe deficiency - ↓ ferritin, ↑ TIBC
- < 15 confirms, 15 - 25 suggests, 25 - 100 not helpful, > 100 rules out

Anemia of chronic disease (ACD)
- associated with inflammation (RA, infection, carcinoma)
- ↓ TIBC (Fe not transferred to developing RBCs)

Thalassemia
- target cells, serum electrophoresis (↑ HbgA2)

Lead poisoning - ↑ serum Pb

Sideroblastic - ↑ in cellular iron uptake
- ↑ ferritin, ring sideroblasts

Macrocytic

megaloblastic anemia - hypersegmented polymorphonucleocytes(PMNs)
defects in DNA synthesis that lead to hematologic abnormalities
↓ folate or ↓ vit B12
drugs: methotrexate, azathioprine (Imuran - immunosuppressant)

myelodysplasia
- dimorphic smear (micro/macrocytosis)

chronic liver disease
- ↑ GGT, target cells

Normocytic

High reticulocyte

Hemolysis
- hypersplenism, drugs, sepsis, autoimmune
- cell morphology (from peripheral smear) is crucial: see below
  - ↑ LDH, ↑ bilirubin, ↑ serum Hbg, ↓ haptoglobin (Hgb scavenger), + Coombs

Low reticulocyte

bone marrow failure
- pancytopenia (↓ WBC, ↓ plt)
- BM aspirate (cell morphology), BM biopsy (structure)

Misc

Red cell distributuion width (RDW)

Normal:
- ACD, thalassemia

Increased
- iron deficiency
- duel deficiency (fe, folate)
- pernicious anemia
- liver disease
- AIHA

Blood smear

Shape

normal: biconcave
spherocyte - immune hemolytic anemia
schistocytes - MAHA: DIC, vasculitis, prosthetic heart valves, HUS/TTP
sickle cell - sickle cell disorders
target cell - liver disease, thalassemia, Fe deficiency
teardrop cell - myelofibrosis

Distribution

rouleaux formation - aggregates of RBC resembling stacks of coins
paraprotein (multiple myeloma)

Inclusion

nuclei (immature RBC)
- serious medical disease
- severe anemia, leukemia, bone marrow metastases

Heinz bodies (denatured hemoglobin)
- G6PD deficiency

Howell-Jolly bodies
- post-splenectomy, hyposplenism

basophilic stippling (blue granulations of variable size and number, aggregation of ribosomes)
- lead intoxication, thalassemia

Other OSCE modules

@@ Line 1: / Line 1: @@
 ==Initial Assessment==
 . Is the patient anemic?
-*Hgb < 115 in females, < 125 in males
+*Hgb < 12 g/dL, Hct < 37% in females, Hgb < 14 g/dL, Hct < 42% in males
 . Is this anemia acute or chronic?
@@ Line 12: / Line 12: @@
 . What does the peripheral blood smear show?
+{{ntnes}}
 {| border="1" cellpadding="2" cellspacing="0"
 |-
@@ Line 24: / Line 24: @@
 |-
 |Fe deficiency
-ACD
+Anemia of chronic disease (ACD)
 |chronic liver disease
 thalassemia trait
 liver disease
 megaloblastic
 marrow failure (pancytopenia)
 myelodysplasia
 leukemia
 alcohol
 myeloma
 hypothyroidism
 mets
 infection
 |blood loss
 hemolysis
 |lead overload
 renal failure (uremia)
 B12 lack
 sideroblastic
 endocrine (thyroid)
 folate lack
 ACD
 hematinic lack
 drugs
 |}
+==Microcytic==
+*Fe deficiency - ↓ ferritin, ↑ TIBC
+**< 15 confirms, 15 - 25 suggests, 25 - 100 not helpful, > 100 rules out
+*Anemia of chronic disease (ACD)
+**associated with inflammation (RA, infection, carcinoma)
+**↓ TIBC (Fe not transferred to developing RBCs)
+*Thalassemia
+**target cells, serum electrophoresis (↑ HbgA2)
+*Lead poisoning - ↑ serum Pb
+*Sideroblastic - ↑ in cellular iron uptake
+**↑ ferritin, ring sideroblasts
+==Macrocytic==
+*megaloblastic anemia - hypersegmented polymorphonucleocytes(PMNs)
+*defects in DNA synthesis that lead to hematologic abnormalities
+*↓ folate or ↓ vit B12
+*drugs: methotrexate, azathioprine (Imuran - immunosuppressant)
+*'''myelodysplasia'''
+**dimorphic smear (micro/macrocytosis)
+*chronic liver disease
+**↑ GGT, target cells
+==Normocytic==
+===High reticulocyte===
+*Hemolysis
+**hypersplenism, drugs, sepsis, autoimmune
+**cell morphology (from peripheral smear) is crucial: see below
+***↑ LDH, ↑ bilirubin, ↑ serum Hbg, ↓ haptoglobin (Hgb scavenger), + Coombs
+===Low reticulocyte===
+*bone marrow failure
+**pancytopenia (↓ WBC, ↓ plt)
+**BM aspirate (cell morphology), BM biopsy (structure)
+==Misc==
+===Red cell distributuion width (RDW)===
+*Normal:
+**ACD, thalassemia
+*Increased
+**iron deficiency
+**duel deficiency (fe, folate)
+**pernicious anemia
+**liver disease
+**AIHA
+==Blood smear==
+===Shape===
+*normal: biconcave
+*spherocyte - '''immune hemolytic anemia'''
+*schistocytes - MAHA: DIC, vasculitis, prosthetic heart valves, HUS/TTP
+*sickle cell - sickle cell disorders
+*target cell - liver disease, thalassemia, Fe deficiency
+*teardrop cell - myelofibrosis
+===Distribution===
+*'''rouleaux formation''' - aggregates of RBC resembling stacks of coins
+*'''paraprotein''' (multiple myeloma)
+===Inclusion===
+*nuclei (immature RBC)
+**serious medical disease
+**severe anemia, leukemia, bone marrow metastases
+*Heinz bodies (denatured hemoglobin)
+**G6PD deficiency
+*Howell-Jolly bodies
+**post-splenectomy, hyposplenism
+*basophilic stippling (blue granulations of variable size and number, aggregation of ribosomes)
+**lead intoxication, thalassemia
+==Other OSCE modules==
 {{OSCE2}}
-[[Category:Medicine]][[Category:OSCE]]
+[[Category:Hematology]][[Category:OSCE]]

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