normo/normo anemia notes

anemia of renal disease is what type of anemia

an anemia d/t deficient erythropoiesis - normochromic-normocytic

_____ of anemia roughly parallels extent of renal dysfunction

• Chronic renal lesions in glomerular region à excretory failure

• Chronic kidney disease

Severity

• Anemia is usually _____ finding

• Renal insufficiency symptoms more _____

incidental

prominent

name some renal insufficiency symptoms

- edema

- hypertension

- fatigue

- decrease urine output

- increase frequency of urination

- muscle cramp

- weakness

anemia of renal disease lab findings

CBC:

UA:

additional tests:

CBC:

- anemia

- normo/normo

-PBS: echinocytes

UA:

- proteinuria

additional tests:

- kidney function test

- renal imaging studies

- nephrologist

management of anemia of renal disease

directed at underlying renal disease

anemia due to hypothyroidism is what type of anemia

Anemia d/t deficient erythropoiesis - normochromic-normocytic

anemia due to hypothyroidism

general

anemia due to hypothyroidism

clinical findings -

- related to primary disease

- fatigue

- brain fog

- increased sensitivity to cold

- constipation

- weight gain

- weakness

- thinning outer 1/3 of eyebrow

anemia due to hypothyroidism

CBC:

additional tests:

CBC:

- anemia

- hypo/micro

- normo/normo

- macro

additional tests:

- thyroid panel

- iron panel

- serum B12/RBC folate

anemia due to hypothyroidism

management -

hormonal therapy to correct primary disease will also stimulate production of more erythrocytes

- slower response to care

- endocrinologist

what type of anemia is aplastic anemia

Anemia d/t deficient erythropoiesis - normochromic-normocytic

aplastic anemia

general facts -

• Panhypoplasia

• Pancytopenia (decrease RBC, WBC, & plts) and hypocellular bone marrow (absence of abnormal cell infiltrate)

• Very severe

aplastic anemia

etiology -

• Idiopathic - most cases

• Drugs - 1/3 cases

• Viral (immunocompromised)

• Toxic exposures - glues, pesticides, insecticides

• Immune disorders

• Congenital (Fanconi anemia)

• Radiation treatment

aplastic anemia

clinical findings -

• Increased susceptibility to infections

• Hemorrhagic difficulties

• Pallor

• Fever

• Dyspnea

• Palpitations

aplastic anemia

CBC:

additional tests:

CBC:

- anemia (normo/normo)

- leukopenia; neutropenia

- thrombocytopenia

additional tests:

- low reticulocyte count

- bone marrow biopsy -> hypocellularity

aplastic anemia

management:

• Bone marrow transplantation

• Often refractory

Myelophthisic Anemia is what type of anemia

Anemia d/t deficient erythropoiesis - normochromic-normocytic

Myelophthisic Anemia

etiology -

• Carcinoma metastasizing to bone marrow from primary tumors

(breast, prostate, kidney, lung, adrenal, thyroid)

• Myelofibrosis - polycythemia vera

• Myeloproliferative conditions - Multiple myeloma, leukemias,

lymphoma, Hodgkin's

• Osteopetrosis

Myelophthisic Anemia

clinical findings -

• Symptoms of anemia

• Symptoms of underlying disease

• Hepatomegaly and splenomegaly

Myelophthisic Anemia

lab findings -

• Normochromic, normocytic anemia

• Nucleated RBCs

- teardrop RBC

• Immature WBCs

• Reticulocytosis, polychromatophilia

Myelophthisic Anemia

- management

• Directed toward underlying disease

Hypersegmentation of neutrophils indicates

B9/B12 anemia

Anemia due to Deficient Erythropoiesis - Megaloblastic/Macrocytic Anemia general facts -

• Defective DNA synthesis

• RNA synthesis continues

• All cell lines impacted

• Leukopenia

• Thrombocytopenia

Anemia due to vitamin B12 deficiency is what type of anemia

Anemia d/t deficient erythropoiesis - macrocytic/megaloblastic anemia

Anemia due to vitamin B12 deficiency

general facts -

• Synthesized by microorganisms - present in meat and other animal products

• Stored in liver - 5-6 years under healthy conditions

• B12 necessary for adequate DNA synthesis - folic acid metabolism

• Myelin synthesis

• Tissues which make new cells rapidly are most affected by deficiency of vitamin B12

Anemia due to vitamin B12 deficiency

etiology -

Deficiency of intrinsic factor

• Gastrectomy/gastric bypass (decrease IF -> decrease B12 absorption -> anemia)

• Myxedema

• Pernicious anemia (MCC B12 def.) (antibodies to IF & parietal cells)

Malabsorption Syndromes

• Celiac disease

• Crohn's disease

• SIBO

• Chronic pancreatitis or pancreatic cancer

Inadequate intake (strict vegans)

Anemia due to vitamin B12 deficiency

patient presentation -

Gastrointestinal

• Glossitis- sore tongue, beefy, red

• Weight loss (digestive issues)

• Anorexia

• Constipation w/ diarrhea

• Poorly localized abdominal pain

Neurological - MC

• May be present in absence of anemia

• Peripheral nerve involvement - most common

• Next - dorsal white column

• Vibratory sense

• Position sense

• Ataxia = difficulty walking

• Finally, spasticity, hyperactive reflexes, Babinski sign

Anemia due to vitamin B12 deficiency

PE findings -

Neuro Exam

• Position sense - decreased

• Vibration sense - decreased

• Abnormal reflexes

• Ataxia

• Babinski's sign +

• Extremity numbness, paresthesias

• Hypoalgesia "sock and glove"

• Poor finger coordination

• Romberg's sign +

• Vertigo

• Weakness

• Mental status changes

• Weight loss

• Glossitis

•Hepatomegaly/splenomegaly

• Skin pigmentation changes

• Anemia S/Sx

Anemia due to vitamin B12 deficiency

CBC:

PBS:

chem panel:

special tests:

CBC:

- anemia (macrocytic)

- increase RDW

- mild leukopenia

- mild thrombocytopenia

PBS:

- hyperhsegmented neutrophils

chem panel:

- increased serum bilirubin (unconjugated.)

special tests:

- decrease serum B12

- autoantibodies to IF & parietal

- increase MMA - borderline low serum B12

Anemia due to vitamin B12 deficiency

management -

• Emphasize meat, animal proteins

• Intramuscular B12 injections

• Oral B12 (cyanocobalamin & methylcobalamin) - 1,000-2,000 micrograms daily

• Hematologic correction - 6 weeks

• Neural improvement - up to 18 months

- retest B12 1-2 months (MMA) after treatment, if improvement retest 6-12 months

• PRECAUTION: folic acid treatment without B12 in patients with

pernicious anemia or B12 deficiency is contraindicated

-> severe and sudden neurologic symptom worsening

Anemia due to Folic Acid

Deficiency is what type of anemia

Anemia d/t deficient erythropoiesis - macrocytic/megaloblastic anemia

Anemia due to Folic Acid

Deficiency

general -

• Folic acid necessary for adequate synthesis of certain purines and

pyrimidines

DNA• Vegetables, yeast, liver, mushrooms

• Absorption: duodenum, jejunum

• Less liver storage

• Folic acid deficiency à macrocytic/megaloblastic anemia

- May look identical to B12 deficiency anemia on every lab except:

-- decrease RBC folate levels

*important for neural tube defect, CVD, cancer, cognitive functions

Anemia due to Folic Acid

Deficiency

etiology -

• Deficient dietary intake

• Tea and toasters

• Chronic alcoholics

• Chronic liver disease

• Increased requirements - pregnancy and lactation (MCC)

Anemia due to Folic Acid

Deficiency

clinical findings -

• Anemia symptoms - skin discoloration

• GI disturbances

• No neurological deficits ***

Anemia due to Folic Acid

Deficiency

CBC:

PBS:

special test:

CBC:

- same as B12

- anemia

PBS:

- hypersegmental - neutro/macro

special test:

*RBC folate

**if macro anemia: serum B12 & RBC folate

Anemia due to Folic Acid

Deficiency

management -

• Active folate (5-methyl-tetra-hydrofolate) - 400-1000 micrograms/day

- 1-3 months, retest RBC folate & CBC

- reticulocyte count @ 7-10 days

when pregnant what is the dosage for folate

400-800 mcg/day