Anemia

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Introduction 3 Classification 4 Etiology 5 Clinical-manifestations 6 Laboratory 7 Diagnostic-procedures 8 Management 9 More General Terms 10 Additional Terms 11 References

More Specific Terms

• anemia in pregnancy
• congenital dyserythropoietic anemia (CDA-II or HEM-PAS)
• hemolytic anemia
• HIV-associated anemia
• hypochromic anemia
• hypoplastic anemia
• macrocytic anemia
• megaloblastic anemia
• microcytic anemia
• myelophthisic anemia
• Plummer-Vinson; Patterson-Kelly syndrome; sideropenic dysphagia

Introduction

• Any condition in which there is a reduction of either:
• hemoglobin concentration
• erythrocyte count
• volume of packed erythrocytes

Classification

• microcytic

• iron-deficiency anemia
• thalassemia
• anemia of chronic disease
• sideroblastic anemia
• lead poisoning
• unstable hemoglobins
• hemoglobin E

• normocytic

• anemia of chronic disease (most common)
• acute hemorrhage
• endocrinopathy
• HIV-related anemia
• dilutional
• sports anemia
• mixed anemias
• myelophthisic anemia
• liver disease
• uremia
• hemoglobinopathy
• renal failure

• macrocytic

• pure red cell aplasia
• alcoholism
• aplastic anemia
• myelodysplastic syndrome
• megaloblastic anemia

• vitamin B12 deficiency
• folate deficiency

• hemolytic anemia
• cold agglutinin disease
• hypothyroidism
• pharmaceutical agents

Etiology

• blood loss
• decreased red blood cell ( RBC) production
• increased RBC destruction ( hemolysis)

Clinical-manifestations

• symptoms

• fatigue
• exercise intolerance
• headache
• dizziness
• faintness
• exertional dyspnea
• angina pectoris
• palpitation
• claudication
• symptoms develop only when Hgb < 7 g/ dL if anemia is chronic unless coexistent pulmonary or cardiovascular disease

• signs

• hypotension
• tachycardia
• tachypnea
• jaundice
• hepatosplenomegaly
• loss of proprioception & vibration sense ( B12 deficiency)
• evidence of underlying disease as etiology of anemia

Laboratory

• general

• complete blood count ( CBC) with differential

• Hgb < 13.5 g/ dL (males), < 11.5 g/ dL (females)
• RBC count

• < 5 x 10E12/L in Fe deficiency
• > 5 x 10E12/L in thalassemia

• RDW

• > 16 in Fe deficiency
• < 16 in thalassemia

• reticulocyte count
• iron studies

• serum iron
• total iron-binding capacity ( TIBC)
• serum ferritin

• < 10 ng/mL confirms iron deficiency
• > 100 mg/l rules out iron deficiency even with inflammation [3]

• transferrin saturation

• measured by serum iron/ total-iron binding capacity ( TIBC)
• <10% is consistent with iron deficiency [3]
• >15% is consistent with anemia of chronic disease
• 10-15% indicates a bone marrow biopsy to distinguish iron deficiency from anemia of chronic disease

• fecal occult blood
• peripheral smear

• hemolysis: spherocytes, schistocytes, blister cells

• direct antiglobulin test ( Coomb's test), especially if spherocytes on peripheral smear
• low serum erythropoietin level may confirm hypoplastic marrow
• serum LDH is elevated in serum with hemolytic anemia & megalobastic anemia (non-specific)
• hemoglobin electrophoresis

• target cells, sickle cells on peripheral smear
• splenomegaly
• evidence of bone remodelling
• hemoglobinopathy
• beta-thalassemia

• hemoglobin A2 3-7% in beta-thalassemia minor
• hemoglobin A2 7-90% in beta-thalassemia major

• bone marrow biopsy & bone marrow aspiration if indicated

• leukopenia
• thrombocytopenia
• myelocytes
• nucleated erythrocytes
• lymphadenopathy
• splenomegaly

• microcytic anemia

• iron studies (see above)
• fecal occult blood
• hemoglobin electrophoresis (see above)
• free erythrocyte ( zinc) protoporphyrin ( FEP)

• increased in:

• iron deficiency
• anemia of chronic disease
• heavy metal exposure

• normal in:

• thalassemia
• sideroblastic anemia

• Heinz body prep
• lead in blood - basophilic stippling
• serum protein electrophoresis

• normocytic anemia

• specific tests for underlying disorder based upon clinical findings
• hemoglobin electrophoresis
• serology for Helicobacter pylori
• fecal occult blood

• macrocytic anemia

• serum B12
• serum folate
• thyroid function tests

Diagnostic-procedures

• upper GI endoscopy

• suspicion of upper GI bleed
• telangiectasias ( hereditary hemorrhagic telangiectasias) [2]

• colonoscopy for positive fecal occult blood

Management

• blood transfusion

• even if fully matched erythrocytes are not available for severe anemia in critically ill patients [3]

• treat underlying disorder
• removal of toxic agent

More General Terms

• hematologic disease (blood disorder, blood dyscrasia)

Additional Terms

• bone marrow biopsy
• complete blood count (CBC)
• direct antiglobulin test (DAT, direct Coomb's test)
• erythropoietin in serum
• fecal occult blood; fecal immunochemical testing (FOB, FIT, iFOBT, ColonCARE, Hemoccult, ICT, InSure)
• ferritin in serum/plasma
• folate in serum/plasma
• Heinz body
• Helicobacter pylori
• hemoglobin electrophoresis
• iron (Fe+2/Fe+3) in serum
• iron-binding capacity in serum (TIBC)
• lactate dehydrogenase (LDH) in serum
• lead in blood
• peripheral blood smear
• pharmaceutical agents associated with anemia
• protoporphyrin free in erythrocytes
• reticulocyte count
• thyroid function test

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 572-74
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 409-415
3. Schiller G, UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
4. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
5. Anemia: NIH Institute and Center Resources [1]
6. National Guideline Clearinghouse
   - Anemia in the long-term care setting. American Medical Directors Association ngc-guideline: [2]

anemia