questions 3

Anemia Overview

Author:
Topic updated on 09/07/17 9:17am

Snapshot
  • A 20-year-old woman who is a vegan with a history of heavy menses presents with fatigue.  She states that she barely has the energy to do anything anymore.  She denies substance abuse and states she gets a good 9 hours of sleep every night.  On exam you see a thin young woman who is tired appearing with palor of her conjunctivae on physical exam.  Her blood pressure is 95/60 mmHg and pulse is 88/minute.
Introduction

  • Defined as low hematocrit and/or hemoglobin relative to normal values
  • Risk factors include
    • neoplasia
    • family history
    • alcoholism
    • GI bleeding
    • vegan diet
    • African-American descent
    • Mediterranean descent
Presentation
  • Symptoms
    • weakness
    • fatigue
    • dyspnea on exertion
  • Physical exam
    • pallor
    • tachycardia
    • systolic flow murmor
    • jaundice
    • positive stool guiac
  • May present as angina
Evaluation
  • Initially assess 
    • hematocrit
    • MCV
    • reticulocyte count
    • peripheral blood smear
  • If microcytic follow with
    • ferritin
    • iron
    • TIBC
  • If macrocytic follow with
    • RBC folate
    • serum B12
  • If normocytic follow with
    • Coombs test
    • iron studies
    • bilirubin
  • Screen for malignancy, haptoglobin levels, and Guiac
Differential
 
Microcytic Anemias
Findings
Iron deficiency  
Low ferritin
Low serum Fe
High TIBC
Thalassemia HbF increased, low MCV, hemolysis
Sideroblastic Anemia
High ferritin
High serum Fe
Low TIBC
Lead poisoning Low MCV, basophilic stippling, increased free erythrocyte porphyrins            
Macrocytic Anemia
Labs and Miscellaneous
B12 / Folate deficiency  Increased MCV, increased LDH, decreased haptoglobin
Hemolytic Anemia Mechanical Increased reticulocyte count
Immunologic Positive Coombs test
Drug exposure History of phenytoin, phenobarbital, or MTX
Normocytic
Labs and Miscellaneous
Hypoproliferative Anemia
Hemorrhage Watch CVP, not the Hct 
Chronic disease
High ferritin
Low serum Fe
Low TIBC
Renal failure
Infection Osteomyelitis, HIV, Mycoplasma, or EBV
Bone marrow disease  Leukemia, lymphoma, or myelodysplasia
Intrinsic Hemolysis
G6PD Decreased serum haptoglobin
Hereditary spherocytosis Decreased serum haptoglobin
Extrinsic Hemolysis
Cold agglutinins Osteomyelitis, HIV, Mycoplasma, or EBV
Autoimmune  Increased LDH, K+ and bilirubin, decreased haptoglobin
Mechanical destruction Microangiopathic Hemolytic (TTP, HUS, or DIC)



  RATE CONTENT
5.0
AVERAGE 5.0 of 1 RATINGS

Qbank (0 Questions)

Sorry, this question is only available for Study Plan members.
Access to 600+ Questions not available in Free Qbank

This is a Never-Been-Seen Question that can only be seen in Study Plan Mock Exams.
Access to 600+ Questions not available in Free Qbank



Evidence & References Show References




Topic Comments

Subscribe status: