ICS-Heme-Clinical Approach to Anemias
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- Sx of anemia
-
fatigue
dyspnea
palpitations
dizziness
dysphagia - Sx of severe anemia
-
pallor
tachycardia
postural HTN
palmar creases appear pink - Sx of pernicious anemia
-
-skin has "lemmon yellow" tint b/c simultaneous presence of pallor and jaundice
-no papillae on tongue - gingival hypertrophy
- AML
- sx of lead poisoning
- dark line of lead sulfide deposited in gums at base of teeth
- clinical Sx of iron deficiency anemia
- koilonychia (spoon shaped fingernails)
- pencil (cigar) cells
- iron def anemia
- Fe/TIBC for iron def anemia
- Fe/TIBC <= 10%
- Fe/TIBC for chronic dz
- >15%
- iron studies for sideroblastic anemia
-
increaed Fe, norm TIBC, increased Fe/TIBC ,
inc ferritin - hypersegmented polymorphs
- megaloblastic aenmia (B12/folate def)
- spur cells (acanthocytes)
- liver dz (spur/burr cells in Abetalipoprotenia (can't make VLDL, LDL)--thus liver dz)
- target cells
-
-liver dz
-hemoglobinopahties (target cells)
-post-splenectomy - microspherocytes
- autoimmune hemolytic anemia
- Howell Jolly bodies
-
-megaloblastic anemias (B12 def, pernicious anemia, folate def)
-post-splenectomy - rouleax formation
-
-usu seen in multiple myeloma
-stacked RBC's caused by coating of individual cells by charged proteins that neutralize the normally negative surface charge that by repulsion keeps RBC's from agglutinating - increased UB indicates
- hemolysis
- increased LDH indicates
- hemolysis
- decreased haptoglobin
- hemolysis
- hemolytic transfusion rxns have + or - Coombs test?
- + Coombs test
- cause of iron deficiency
- BLOOD LOSS!
- how evaluate iron deficiency
-
evaluate for BLOOD LOSS!
Do upper and lower GI endoscopy. Can't just supplement with iron, must control the bleed - best route for iron therapy
- oral (rather than parenteral)
- what should you do for pts wo don't respond to B12 or folate?
-
evaluate for concurrent iron def:
-BM irons tores are reliable indicators of iron status at any time
-Peripheral blood iron studies: must wait 7-10 days after initation of foldate/B2 Tx to get accurate results - Tx TTP
- plasma exchange
- pathogen of Autoimmune hemolytic anemia (AIHA)
-
binding of Auto-Ig +/- complement to RBC surface-->destroy RBC's in spleen
-75% of Auto-Ig are IgG, 25% IgM - Tx for Autoimmune hemolytic anemia
-
first corticosteroids;
if fail-then splenectomy - tx for Cold Agglutinin Dz
-
(Cold Agglutinin Dz=Auto-ab against RBC's are IgM)
-cold avoidance
(corticosteroids and splenectomy are ineffective) - Sx of iron def anemia
-
(1-3 relate to mouth)
1. PICA
2. Dysphagia
3. no papillae oin tongue
4. koilonychia - neurologic problems
- ALL
- tear drop cells
- BM infiltration
- leukoerythroblastosis
- BM infiltration
- Howell-Jolly bodies
-
megaloblastic anemias
post-splenectomy