Anemia Summary
Anemia Diagnostic steps
- CBC: HCT
- Iron Def: M - <135; F - < 115
- CBC: MCV
- If microcytic
- CBC: RDW
- If Iron deficiency - blood = 0.5 mg Fe/mL (~1/2 of blood is RBC)
- Serum ferritin (Bone marrow aspiration gold standard)
- Even if ferritin is normal patient can still be anemic because in inflammation, serum ferritin levels rise (more ferritin is released)
- peripheral blood smear has hypochromic, microcytic, (and target) cells
- Others such as TIBC, T sat, etc are more unreliable (fluctuate with diet, drugs, infections, etc)
- Serum ferritin (Bone marrow aspiration gold standard)
- If normocytic
- Reticulocyte count (stain for RNA) >1%
- high in hemolysis and acute blood loss. To confirm:
- Unconjugated bilirubin
- LDH (high)
- Haptoglobin (low)
- (Hemosiderinuria)
- (Schistocyte)
- Intrinsic or Extrinsic
- Spherocytes
- Burn
- Autoimmune hemolytic anemia
- Bacterial infection
- Diagnostic: DAT (Coombs)
- Warm (IgG) vs. Cold (IgM)
- high in hemolysis and acute blood loss. To confirm:
- Reticulocyte count (stain for RNA) >1%
- Treatment
- Find root cause!
- Iron deficiency: oral, then IV
- Hemolytic:
- Prednisone 1mg/kg
- Folate supplement
- Second line: Take out spleen
- Causes
- 3L - Lupus, Leukemia, Lymphoma + Medications
Summary of All Anemia
Low MCV <79 fL | Normal MCV 79-97 fL | Macrocytic >97 fL |
Microcytic Anemia | Normocytic Anemia | Macrocytic Anemia |
T halassemia A nemia of chronic illness I ron deficiency L ead poisoning S ideroblastic (Myelodysplastic Syndrome (MDS)) |
Hemolysis Blood loss Bone marrow/production disorders Anemia of chronic illness (Myelodysplastic Syndrome (MDS)) |
Megaloblastic
Non-megaloblastic
|
Differences in RDW
- Poikylocytosis - different shapes
- Anisocytosis - different sizes
RDW > 15.0 Iron Deficiency |
RDW normal or low Thalassemia |
Variability in size of RBCs Older cells are smaller (MCV low) Newer cells (reticulocytes) have larger MCV (In extreme cases, there is no iron, narrow RDW) |
Less variability in size of RBCs New and old cells are both small, due to lack of hemoglobin (In extreme cases, will get wide RDW - anisocytosis) |
In a state of limited resources, resource distribution is not equal Will get some normal cells, but most will be small |
In a state of no resources, everyone is small |
Intrinsic Vs. Extrinsic Hemolytic Anemia
Intrinsic | Extrinsic |
Red cell membranopathies e.g. hereditary spherocytosis Enzymopathies * G6PD deficiency * Pyruvate kinase deficiency Hemoglobinopathies * Sickle cell * Thalassemia PNH - Paroxysmal noctural hemoglobinuria |
Immune mediated * Autoimmune hemolytic anemia * Alloimmune hemolytic anemia Microangiopathic hemolytic anemia * DIC - Disseminated intravascular coagulation * TTP/HUS Mechanical * Cardiovascular valve damage Infections * Malaria * Other intracellular parasites (comes out and cell burst) Other causes |
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page revision: 31, last edited: 29 Oct 2011 06:20