What is the most common etiology of anemia
iron deficiency anemia
It is also by far the most common cause of microcytic anemia.
What are the risk factors for iron deficiency anemia? (x2)
- bleeding of any kind
- Low iron diet (ex. vegan)
In iron deficiency anemia, what would the:
1. MCV
2. Ferritin
3. TIBC
4. Tsat
- MCV < 80 (microcytic)
- Low ferritin
- High TIBC
- Low Tsat
Note: iron deficiency anemia is normocytic early, and microcytic later, so you should reference the RDW to see the spread of size.
What is the intial confirmatory testing for iron deficiency anemia
NOT the gold standard of marrow iron on biopsy.
Ferritin.
Note: low ferritin is confirmatory, but normal or high ferritin can be present if there is also an inflammatory disorder.
What is the treatment of iron deficiency anemia?
Iron supplements
Can use diet or tablets (Ferrous sulfate). Uncommonly needs IV iron
In anemia of chronic disease, what would the:
1. MCV
2. Retic count
2. Ferritin
3. TIBC
4. ESR/CRP
- MCV < 80
- Retic count = low
- Normal or high ferritin
- Low TIBC
- High ESR/CRP
What is the treatment of anemia of chronic disease?
Treat underlying disease.
What is the myelodysplasia, and what is it’s most common risk factor?
.
These are hematopoietic stem cell neoplasms that is characterized by impaired proliferation and differentation of myeloid stem cells within the bone marrow.
Most common risk factor: older age (>65)
What are two findings in the CBC that raise your concern for myelodysplasia?
- unexplained cytopenias (i.e. anemia with associated thrombocytopenia or leucopenia)
- Abnormal blood smear (i.e. dysplasias on smear)
Bone marroq biopsy and cytogenic analysis are gold standard for diagnosis.
In anemia caused by hemolysis, what would the:
1. MCV
2. retic count
3. bilirubin
4. LDH
- MCV = 80-100 (normocytic)
- High retic count*
- High bilirubin
- High LDH
*Need to rule out acute bleeding (which also has high retic count)
In anemia caused by B12 deficiency, what would seen on:
1. MCV
2. blood smear?
3. history/physical exam?
- MCV > 100 (macrocytic)
- Hypersegmented PMNs.
- neurologic or neurophsyiatric symptoms
What is the confirmatory testing for anemia caused by B12 deficiency? (x2)
- B12 LEVEL (>300 umol/L rules out deficiency)
- High methlmalonate and high homocysteine*
*Rarely measured. Usually after CBC and B12 levels, you can trial B12 supplementation and see improvement of symptoms.
The differential diagnosis for microcytic anemia can be rememered by the mnemonic “TAILS”
Thalassemia
Anemia of chronic disease
Iron deficiency anemia
Lead poisoning
Sideroblastic anemia
The differential diagnosis for macrocytic anemia can be remembered by the mnemonic FAT RBC
F: fetus (ie. pregnancy)
A: alcohol
T: thyroid disease (ie. hypo)
R: retiulocytosis
B: B12 and Folate deficiency
C: cirhosis OR chronic liver disease
The general causes of Normocytic anemia can be remembered by the mnemonic “A B C D”
A: Acute blood loss
B: Bone marrow failure
C: Chronic Disease
D: Destruction (hemolysis)
- Acute blood loss -> self explanatory
- Bone marrow failure -> Marrow ilfiltration, stem cell defect, myeloma, Marrow toxin (look at drug history for this one)
- Chronic disease -> Inflammatory disorder, Liver disease, Renal failure (lack of EPO), combined anemia (ex. Iron deficiency anemia and B12 deficiency
- Hemolysis -> self explanatory
In terms of normocytic anemia, how can you differentiate between a hypoproliferative or hyperproliferative cause
Reticulocyte count.
For our purposes,
- hypoproliferative = < 0.5%
- Normal value = 0.5-2.0%
- Hyperproliferative = > 2.0%
In most cases, hyperproliferative will be due to hemolysis.
What is primary literature?
Original research available as journal pubs, presentations, and discovery
What is the general benefit of primary literature vs other types of literature?
Results are most transparent and you can evaluate bias and validity.
What is the general problem of primary literature compared to other types? (x2)
Results can be less valid or generalizable depending on the results of the single study.*
There is also way too many primary literature publications to try to parse through to answer your specific question.
*Can be due to BIAS or METHODS, such as recruitment/selection, low sample numbers, or statistics.
What is secondary literature?
Synthesis of primary literature, and usually published as systematic reviews, meta-analyses, or practice guidelines
What is the MAIN benefit of secondary literature compared to others?
The results are more valid because you are analzying multiple sets of data.
What are the general problems of secondary literature compared to others?
“Garbage in = garbage out” If the primary literature being analzyed is bad, then you have a synthesized literature that is just as bad.
It is also harder to look at the secondary literature and assess for bias/methodological issues.
What is Tertiary Literature?
Summary or condensed version of material found in textbooks or online databases (like uptodate.com)
Whats are the benefits of tertiary literature compared to others
Most accessible and readable: summarizes all the stats in the primary and secondary research into key points (like uptodate)
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Tutorial #24: Pulmonary Embolism44
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Tutorial #25: Anemia39
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Tutorial #26: DVT21
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Tutorial #27: Unintentional Weight Loss29
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Tutorial #28: Transient Loss of Consciousness35
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Tutorial #29: Substance Use Disorder20
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Tutorial #30: Febrile Seizures26
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Tutorial #31: Dizziness40
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Tutorial #32 - Acute Headache41
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Tutorial #33 - Coma54
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Tutorial #34: Adult Seizures30
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Tutorial #35: Delirium34
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Tutorial 36 - Acute Abdomen I45
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Tutorial 37 - Acute Abdomen II33
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Tutorial #38: Dyspepsia27
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Tutorial 39 - Sepsis18
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Tutorial 40 - Chronic Diarrhea24
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Tutorial 41 - Acute Kidney Injury26
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42 - Osteoarthritis27
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Tutorial 43 - Hip Pain in a Child21
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Midterm131
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Midterm248
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Final39
