OME: Microcytic Anemia
Types of people w/ iron deficiency anemia (2)?
(1) Old man w/ fecal occult bleeding (2) Young woman w/ menorrhagia (3) Gastrectomy: decrd iron absorption
How to treat iron deficiency anemia?
(1) Stop source of bleeding (2) Give iron supplements: serum iron replenished in 6 wks, stored iron replenished in 6 months
How to treat anemia of chronic disease?
(1) Treat underlying disease (infection) (2) If that's not possible (ex. rheu arthritis, SLE) give *EPO*
Workup for microcytic anemia?
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What is the presentation of BETA thalssemia? Which do you see on board exam?
1 deletion - minor anemia (minor) 2 deletions - severe anemia (major) You see these 2 on boards
What are iron studies of thalssemia? Serum iron Ferritin TIBC
All normal!
What are the types of thalassemia?
Alpha thalassemia - one deletion, two deletions (minor), three deletions (major), four deletions Beta thalassemia - one deletion (minor), two deletions (major)
What is the presentation of ALPHA thalssemia? Which do you see on board exam?
Alpha thalssemia: 1 deletion - asymptomatic (never diagnosed) 2 deletions - minor anemia (minor) 3 deletions - severe anemia (major) 4 deletions - hydrops fetalis (dead) Will only see 2 or 3 deletions
Patient has rheumatoid arthritis or systemic lupus erythematosis. Anemia type?
Anemia of chronic disease.
Anemia of chronic disease pathogenesiss?
Chronic disease --> iron sequestered in stored form
Iron deficiency anemia labs? Serum iron, ferritin, TIBC
Decrd serum iron Decrd ferritin Incrd TIBC
Sideroblastic anemia: Two findings? This is low yield!
Elevated iron Ringed sideroblasts in smear (iron stuck in mitochondria)
What is the pathogenesis of thalssemia?
HgbA1 is made of A2B2 globins. Patho: Globin gene deletion Alpha thalassemia: 1-4 deletions (b/c 4 genes) Beta thalassemia: 1-2 deletions (b/c 2 genes)
How to use Hgb electrophoresis to diagnose thalassemia?
If you see weird hemoglobins, like HgbA2 (alpha2delta2) and HgbF (alpha2gamma2) --> beta thalassemia. If you see normal hemoglobins like HgbA1 (alpha2beta2) --> alpha thalassemia
What are the major ways to diagnose anemias?
Iron studies Symptoms Hgb Electrophoresis** (gold standard)
Young woman w/ menorrhagia (heavy periods). Anemia type?
Microcytic - iron deficiency
Old man w/ fecal occult bleeding. Anemia type?
Microcytic - iron defiency
How to treat thalassemia?
Minor - don't do anything!!! Major - give monthly blood transfusions PLUS deferoxamine or deferesox (iron chelators to prevent hemosiderosis)
NBS in iron deficiency anemia workup? Gold standard in diagnosing iron deficiency anemia?
NBS: iron studies Gold standard: bone marrow biopsy
Does trauma cause iron deficiency anemia?
No!! Only slow bleeds cause iron deficiency anemia, because the body can keep up with bleed (hence decrd MCV)
Anemia of chronic disease labs? Serum iron, ferritin, TIBC
Serum iron down Ferritin up TIBC down
Types of microcytic anemia?
TICS Thalassmia Iron deficiency Chronic disease Sideroblastic
