Clinical Hematology Anemia Due To Blood Loss and Nutrient Deficiencies
Acute Blood Loss:
Due to sudden blood loss (accident)
Acute Blood Loss blood picture:
Normocytic/Normochromic No poik Once bleeding stops it takes 4-6 weeks for RBCs to return to normal, only a few days for WBCs and platelets return to normal
Chronic Blood Loss:
Slow loss of blood (erythropoietin not secreted)
Chronic Blood Loss blood picture:
Normocytic/Normochromic, unless iron stores become depleted then Micro/Hypo. No significant increase in Poly
Chronic Blood Loss normally seen in:
Bleeding peptic ulcers heavy menstrual periods
Iron Deficiency Anemia (IDA)
State in which body iron stores are depeted
Lab findings for IDA:
Micro/Hypo Hb and Hct decreased Poik: Elliptocytes, Target cells, Pencil cells, Teardrops Deceased serum iron Increased total iron binding capacity (TIBC)
Symptoms of IDA:
Fatigue, lethargy, dizziness, shortness of breath, soresin mouth, spoon shaped convexed finger nails, and pica (craving strange things)
Macrocytic anemia/ non-megaloblastic are seen in:
Liver disease, hypothyroidism, increased poly
Megaloblastic anemia is seen in:
Vitamin B-12 deficiency and folic acid deficiency
Other causes of Megaloblastic anemia:
Myeloidysplastic syndromes and erythroleukemia
Lab findings for Megaloblastic anemia:
CBC: pancytopenia, MCV greater than 100 and normal MCHC. Blood Smear: Oval Macrocytes and teardrops, HJ bodies and Cabot Rings, Hypersegmented neutrophils present. Chemistry Tests: Increased LD and normal iron and TBIC Bone Marrow: Hypercellular; megaloblastic RBCs
Vitamin B-12 Deficiency is caused by:
Dietary intake (meats, eggs, liver, dairy products) Mal-absorption: Patients with resection of the small intestine, gastrectomy, tropical and nontropical sprue, chronic wasting disorder, fish tapeworm, bacteria in the blind loop, defective production of the intrinsic factor.
Clinical symptoms of B-12 Deficiency:
Pallor, weakness, shortness of breath, slight jaundice due to bilirubin increased, neurological malfunctions.
Folic Acid Deficiency causes:
Leading cause is dietary intake, liver disease due to alcoholism, elderly
Folic Acid Deficiency malabsorption :
Patients with gastrectomy or resection of the intestine, bacteria that competes for folic acid in the intestine
Folic Acid Deficiency increased utilization:
Infancy, pregnancy, hemolytic anemia
Folic Acid Deficiency inadequate utilization:
Impairment of the metabolism of folic acid: chemotherapy, malignancy, anticonvulsive drugs
Anemia of Chronic Disorders:
Anemia usually signals the production of erythropoietin, but in Anemia of Chronic Disease, the stimulus is absent and there is nothing wrong with the kidney. Iron can not be transported from the bone marrow so eventually a Micro/Hypo blood picture occurs.
Anemia of Chronic Disorders most striking feature:
Decreased serum iron and decreased TIBC in the face of increased storage iron in the tissues.
Anemia of Chronic Disorders blood picture:
Mild to moderate anemia in the first few weeks of illness, Normocytic/Normochromic, decreased Retic count, increased WBC, increased Sed Rate. Later becomes Micro/Hypo, increased storage iron in the bone marrow.
Treatment of Anemia of Chronic Disorders:
Only treatment of illness can reverse the anemia.
Anemia of Chronic Renal Disease:
Decreased erythropoietin level. May move into megaloblastic or IDA.
Anemia of Chronic Renal Disease blood picture:
Usually normocytic/normochromic, decreased Hb, Burr cells
Anemia of Liver Disease:
Variable blood pictures: N/N with burr cells Macro/N with target cells Macro/N or N/N with acanthocytes Macro/N with oval macrocytes and teardrop cells * Only with lover disease will the target cells be macro
Anemia associated with malignancies blood findings: