|
wikademia>Captain Vandal strikes yet again! |
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| ==Initial Assessment==
| | DADADADAAAAAAA. CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!! |
| 1. Is the patient anemic?
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| *Hgb < 115 in females, < 125 in males
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| 2. Is this anemia acute or chronic?
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| 3. Is this dilutional anemia? (hematocrit)
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| 4. What is the size of the RBC? (MCV)
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| 5. Is body appropriately responding? (reticulocyte count)
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| 6. What does the peripheral blood smear show?
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| {| border="1" cellpadding="2" cellspacing="0"
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| |-
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| |'''MCV < 80'''
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| '''(hypochromic)'''
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| |'''normocytic (normochromic)'''
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| '''low reticulocytes'''
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| |'''normocytic'''
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| '''high reticulocytes'''
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| |'''MCV > 100'''
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| |-
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| |Fe deficiency
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| Anemia of chronic disease (ACD)
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| |chronic liver disease
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| thalassemia trait
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| liver disease
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| megaloblastic
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| marrow failure (pancytopenia)
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| myelodysplasia
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| leukemia
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| alcohol
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| myeloma
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| hypothyroidism
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| mets
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| infection
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| |blood loss
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| hemolysis
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| |lead overload
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| renal failure (uremia)
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| B12 lack
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| sideroblastic
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| endocrine (thyroid)
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| folate lack
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| ACD
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| hematinic lack
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| drugs
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| |}
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| ==Microcytic==
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| *Fe deficiency - ↓ ferritin, ↑ TIBC
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| **< 15 confirms, 15 - 25 suggests, 25 - 100 not helpful, > 100 rules out
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| *Anemia of chronic disease (ACD)
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| **associated with inflammation (RA, infection, carcinoma)
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| **↓ TIBC (Fe not transferred to developing RBCs)
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| *Thalassemia
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| **target cells, serum electrophoresis (↑ HbgA2)
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| *Lead poisoning - ↑ serum Pb
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| *Sideroblastic - ↑ in cellular iron uptake
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| **↑ ferritin, ring sideroblasts
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| ==Macrocytic==
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| *megaloblastic anemia - hypersegmented polymorphonucleocytes(PMNs)
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| *defects in DNA synthesis that lead to hematologic abnormalities
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| *↓ folate or ↓ vit B12
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| *drugs: methotrexate, azathioprine (Imuran - immunosuppressant)
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| *'''myelodysplasia'''
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| **dimorphic smear (micro/macrocytosis)
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| *chronic liver disease
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| **↑ GGT, target cells
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| ==Normocytic==
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| ===High reticulocyte===
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| *Hemolysis
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| **hypersplenism, drugs, sepsis, autoimmune
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| **cell morphology (from peripheral smear) is crucial: see below
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| ***↑ LDH, ↑ bilirubin, ↑ serum Hbg, ↓ haptoglobin (Hgb scavenger), + Coombs
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| ===Low reticulocyte===
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| *bone marrow failure
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| **pancytopenia (↓ WBC, ↓ plt)
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| **BM aspirate (cell morphology), BM biopsy (structure)
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| ==Misc==
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| ===Red cell distributuion width (RDW)===
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| *Normal:
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| **ACD, thalassemia
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| *Increased
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| **iron deficiency
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| **duel deficiency (fe, folate)
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| **pernicious anemia
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| **liver disease
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| **AIHA
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| ==Blood smear==
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| ===Shape===
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| *normal: biconcave
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| *spherocyte - '''immune hemolytic anemia'''
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| *schistocytes - MAHA: DIC, vasculitis, prosthetic heart valves, HUS/TTP
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| *sickle cell - sickle cell disorders
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| *target cell - liver disease, thalassemia, Fe deficiency
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| *teardrop cell - myelofibrosis
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| ===Distribution===
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| *'''rouleaux formation''' - aggregates of RBC resembling stacks of coins
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| *'''paraprotein''' (multiple myeloma)
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| ===Inclusion===
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| *nuclei (immature RBC)
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| **serious medical disease
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| **severe anemia, leukemia, bone marrow metastases
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| *Heinz bodies (denatured hemoglobin)
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| **G6PD deficiency
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| *Howell-Jolly bodies
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| **post-splenectomy, hyposplenism
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| *basophilic stippling (blue granulations of variable size and number, aggregation of ribosomes)
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| **lead intoxication, thalassemia
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| ==Other OSCE modules==
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| {{OSCE2}}
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| [[Category:Medicine]][[Category:OSCE]]
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DADADADAAAAAAA. CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!
