Heme Anemia Types

Type Cause Decreased RBC production  Iron-deficiency Most common Poor diet, malabsorption, GI surgery, chronic blood loss, hemolysis (High risk – very young, reproductive women, poor diet)  Thalassemia Genetic disorder, more common in Mediterranean people (T Major develops in kids)  Cobalamin (B12) deficiency  Folic acid deficiency   Pernicious anemia Poor nutrition after GI surgery Long-term use of PPIs Strict vegetarians Dietary deficiency Malabsorption Drugs (ie. MTX, Dilantin) Alcohol abuse Hemodialysis Aplastic anemia Rare Can be congenital (Fanconi’s) or acquired (chemical agents, drugs, idiopathic, pregnancy, radiation, infection) Anemia of chronic disease ESRD Chronic liver disease Hepatitis Immune disorders Endocrine disorders Types of Anemia Signs/Symptoms Diagnostic Tests Treatment None Pallor Glossitis (beefy red, sore, shiny tongue) Cheilitis (lip imflammation) Burning sensation on tongue Low iron High TIBC Microcytic (low MCV) May need endoscopy or colonoscopy to determine cause Treat the underlying problem Increase iron in diet – red meat, liver, eggs, legumes, leafy green veggies Oral iron T Minor – few symptoms T Major – severe mental and physical retardation, pallor, jaundice, hepatosplenomegaly Microcytic (low MCV) Hypochromic (low MCHC) Insidious, usu. after age 4060 Glossitis (beefy red, sore, shiny tongue) GI problems Neuromuscular problems Glossitis (beefy red, sore, shiny tongue) No neuro involvement (differentiates from cobalamin deficiency) Pancytopenia Macrocytic (high MCV) Abnormally shaped cells Abnormal Schilling test Need frequent screening for gastric cancer None If T minor, body will adapt If T major, chelation (Desferal), transfusions, splenectomy, NO IRON, only cure is HSCT IM or intranasal cobalamin for life (no oral) Protect from falls, burns, trauma None (usu. mild anemia) Macrocytic (high MCV) Abnormally shaped cells Low serum folate Folic acid replacement Increase folic acid in diet – green leafy veggies, liver, meat, whole grains Pancytopenia Hypocellular bone marrow Remove causative agent Supportive care BMT or immunosuppression Normocytic Normochromic Decreased RBCs Treat underlying disorder Epogen or Procrit Rarely need transfusions Blood Loss Acute hemorrhage Chronic blood loss (GI/GU) Increased RBC destruction (hemolysis)  Sickle cell anemia Hereditary disease with an abnormal form of Hgb (Hgb S) in the blood Several types Looks like iron-deficiency anemia b/c iron stores are depleted Clinical s/s are more important than lab values Shock and pain are very important s/s RBC, Hgb, Hct won’t drop for 2-3 days Normocytic Normochromic Prevent shock Hetastarch, LR, PRBCs, Dextran May need iron For chronic blood loss, treat like iron-deficiency anemia Other than anemia may have no symptoms until they have sickle cell crisis Common to have chronic health problems (ie. jaundice, gallstones) Hgb electrophoresis Peripheral blood smear with sickled cells Positive sickling test High bilirubin Avoid sickle cell crisis (SCC) – avoid high altitude, good fluid intake, treat infections promptly, vaccinate against flu, pneumonia, hepatitis For SCC – oxygen, pain meds (PCA), rest, IV fluids, PRBCs, prevent DVTs For chronic – may need chelation, Hydrea, HSCT is only possibility of cure  G6PD deficiency  External damage to RBCs Hereditary – discuss in Peds More common in African Americans and Mediterraneans Physical trauma (ECMO, hemodialysis, prosthetic heart valves, narrowed vessels) Antibodies (transfusion reactions, SLE, leukemia, meds) Infectious agents/toxins (malaria, clostridium, arsenic, lead, snake venom) Jaundice Hepatosplenomegaly Normoctyic Normochromic May have high bilirubin Focus on maintaining kidney function and preventing Acute Tubular Necrosis (ATN)