Term
A 9yo boy recently treated for meningitis in a developing country develops purpura and pallor. He is found to have plt ct 42,000, hematocrit of 26%, and WBC of 1.7
Which antibiotic that is rarely used in US is known to cause pancytopenia? |
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Definition
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Term
| What are the three kinds of anemia? |
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Definition
Microcytic: MCV <80fl
Normocytic: MCV 80fl-100fl
Macrocytic: MCV >100fl |
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Term
| How do you diagnosis anemia? |
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Definition
| CBC, MCV, blood smear, and reticulocyte count. |
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Term
| What secondary tests should be ordered to evaluate for anemia? |
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Definition
| Ferrotin, serum iron, TIBC, %transferrin sturation, serum folate, TSH, serum B12, hemolysis labs and DIC panel. |
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Term
| What labs are in hemolysis labs? |
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Definition
| LDH, unconjugated bilirubin, haptoglobin, Coombs test |
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Term
| What labs are in DIC panel? |
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Definition
| D-dimer, fibrinogen, blood smear, soluble fibrin monomer complex. |
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Term
| What illnesses will likely effect serum ferritin levels? |
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Definition
| Acute illness, chronic inflammatory or chronic liver disease. |
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Term
| When should you transfuse? |
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Definition
When Hct <21
When symptomatic |
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Term
| what causes pancytopenia? |
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Definition
| Toxins, drugs, infection, myeodysplasia, manignancy, radiation, vit B12/Folate deficiencies, SLE and congenital causes. |
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Term
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Definition
Fluid resuscitation and RBC transfusion.
Identify the cause and treat underlying disorder. |
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Term
| What causes microcytic anemia? |
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Definition
Mneumonic is TICS
Thalassemia
iron-deficiency anemia
chronic disease
sideroblastic |
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Term
| Microcytic anemia exam contains what? |
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Definition
look for pica (iron-deficiency)
Ask about melena
FOBT
Family history of anemia (thalassemia)
Mentzer index (MCV/RBC)-if >13, more likely iron deficiency than thalassemia |
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Term
| What do labs look like for Iron-deficiency Anemia? |
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Definition
Ferritin: Decreased (may be nl/ inflm &CA)
Serum Iron: Decreased
TIBC: Increased
RDW: Wide |
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Term
| What etiologies lead to iron-deficiency anemia? |
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Definition
| Malabsorption, chronic blood loss, and malnutrition. Thrombocytosis is common. |
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Term
| What do labs look like for Thalassemia? |
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Definition
Ferritin is increased
Serum iron is normal to increased
TIBC: Normal to increased
RDW: normal
Hb electrophoresis: will vary on type
MCHC elevated
Mentzer index <13 |
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Term
| What do the labs look like for anemia of chronic disease? |
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Definition
Ferritin: Increased (may be nl)
Serum iron: Slight Decrease
TIBC: Normal to decreased |
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Term
| What are the etiologies for anemia of chronic disease? |
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Definition
| Chronic inflammation, infection and malignancy |
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Term
| What do the labs look like for sideroblastic anemia? |
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Definition
Ferritin: Increased
Iron: Increased
TIBC: Nl to decreased
Smear: dimorphic RBCs with basophilic stippling
Bone Marrow: erythroid hyperplasia and ringed sideroblasts |
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Term
| What are the etiologies of Sideroblastic anemia? |
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Definition
| Chronic alcohol use, drubs (antitubercular, chloramphenicol) and lead poisoning (order lead levels if increased transferrin levels) |
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Term
| Clinical presentation of alpha-thalassemia looks like? |
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Definition
x4: babies stillborn (hydrops fetalis)
x3: HbH - chronic hemolytic microcytic anemia and splenomegally.
x1-2: usually asymptomatic |
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Term
| Clinical presentation of Beta-thalassemia? |
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Definition
x4: No HbA; presents in 1st year as HbF declines. Growth retardation, bony deformities, hepatosplenomegaly, and jaundice.
x1-3: diagnosed by increased HbA2 on electrophoresis. (much less severe) |
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Term
| How do you diagnose Thalassemia? |
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Definition
CBC (microcytic anemia with normal RDW and increased RBC count)
Hemoglobin electrophoresis is definitive |
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Term
| How do you treat thalasemmia? |
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Definition
Severe: Allogenic bone marrow transplantation. Give blood transfusions for symptomatic control with folate supplementation.
Give deferoxamine to prevent hemosiderosis.
Genetic counseling. |
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Term
| 32 yo woman wiht Crohn's dz and hx of partial bowel resection comes to you for fatigue and is found to have Hct of 29% and MCV of 104fl. What is she at risk for and why? |
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Definition
Vit B12 deficiency
Intrinsic factor receptors are located in the terminal ileum and it was likely part of the resection. |
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Term
| What causes folate deficiency? |
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Definition
Poor diet (as with alcoholism)
Drugs (TMP-SMX, phenytoin, zidovudine, methotrexate and other chemotherapeutic agents.) |
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Term
| What causes B12 deficiency? |
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Definition
Strict vegan diet
pernicious anemia
gastrectomy
PPI's |
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