![]() ![]() Morphology-thalassemia causes microcytic target cellsĭISTINGUISHING FEATURES BETWEEN IRON DEFICIENCY AND ANEMIA OF CHRONIC DISEASE ![]() RBC-RBC high or normal if thalassemia but tend to decrease proportionally to Hb in iron deficiency MCV-red cells in thalassemia tend to be smaller than in iron deficiency RDW-red cells in thalassemia tend to have a narrower distribution than in iron deficiency Depleted iron stores is associated with increased sTfR levelsīone marrow aspirate and biopsy with iron stainĭISTINGUISHING FEATURES BETWEEN IRON DEFICIENCY AND THALASSEMIA Soluble transferrin receptor (sTfR)-helps to distinguish between iron deficiency and anemia of chronic disease. Labs-CBCD, peripheral smear, reticulocyte count, serum iron, serum ferritin, TIBC (transferrin), % sat, Hb electrophoresis, fecal occult blood (if suspect GI bleed)Įndoscopy-gastroscopy and/or colonoscopy targeting symptoms in any man or post-menopausal woman with iron deficiency or in anyone with suspected GI bleeding vitals, koilonychia (spoon nails), alopecia, blue sclerae, conjunctival pallor, angular cheilitis, atrophic glossitis, lymphadenopathy (anemia of chronic disease), rectal examination for occult blood and pelvic examination for blood loss Investigations BASIC shortness of breath, chest pain, dizziness, fatigue, bleeding (GI, menstrual), pica (ice, dirt), diet history, fever, night sweats, weight loss, past medical history (malignancy, chronic infections, rheumatologic disorders), medications (NSAIDs, ASA, anticoagulants), family history (thalassemia) PHYSICAL chronic inflammatory states such as malignancy, infection and rheumatologic diseases → ↑ INF γ, TNF α, IL-1, IL-6, IL-10 → ↑ hepatic expression of hepcidin which inhibits duodenal absorption of iron, ↑ uptake and storage of iron into monocytes and macrophages, ↓ production of EPO → ↓ availability of iron for erythrocytes → anemia (microcytic or normocytic) Clinical Features HISTORY ↓ iron → ↑ TIBC → ↓ Hb → ↓ MCV → hypochromia ANEMIA OF CHRONIC DISEASE Hb <135 g/L, MCV <80 fL SEQUENCE OF IRON DEFICIENCY Pathophysiology DEFINITION OF MICROCYTIC ANEMIA I ron deficiency-blood loss (GI, GU, vaginal, trauma), iron-deficient diet, celiac disease, atrophic gastritis, renal failure on EPO, pulmonary hemosiderosis, intravascular hemolysis NEJM 2005 352:10 Differential Diagnosis ★TAILS★Ī nemia of chronic disease-infection, malignancy, inflammatory disorders 20), polycythemia vera (cytoreduction with hydroxyurea is preferable to phlebotomy target to keep hematocrit <0.45 in ♂ and <0.42 in ♀, ASA 81 mg PO daily prevents thrombosis-but watch out for bleeding) relative (hydration), CO hemoglobinemia (smoking cessation. Minor-WBC >12 × 10 3/μL, platelet >400 × 10 3/μLĭiagnosis-need absolute criteria plus one major or two minor criteria for the diagnosis of polycythemia rubra vera. Solid tumor workup-CT abd, MRI head (if tumors)īone marrow biopsy-rule out myelofibrosis and CMLĭiagnostic Issues CRITERIA FOR POLYCYTHEMIA RUBRA VERA (PRV)Ībsolute-↑ RBC mass, no secondary cause (normal PaO 2, EPO not elevated) Hypoxia workup-oximetry, ABG, CO-hemoglobin JAK2 mutation >95% sensitive for primary PRVĮPO level-low in PRV, high if secondary causes JAK2 mutation-JAK2 is a cytoplasmic tyrosine kinase activated by EPO binding to its receptor the V617F mutation activates JAK2 and thereby drives EPO-independent erythropoiesis. Labs-CBCD, lytes, urea, Cr, leukocyte alkaline phosphatase (LAP), vitamin B12, RBC mass (total blood volume × Hct, to rule out spurious causes), carboxyhemoglobin level, cortisol level, peripheral blood smear hypertension, oxygen saturation, facial plethora, conjunctival injections, engorgement of the veins of the optic fundus, abdominal mass, hepatomegaly, splenomegaly, excoriations, stigmata of a prior arterial or venous thrombotic event, gouty arthritis, and tophi Investigations BASIC hyperviscosity (headache, blurred vision, epistaxis), dyspnea, epigastric pain, early satiety, weight loss, fever, night sweats, pruritus, erythromelalgia, recent travel to high-altitude areas, past medical history (respiratory diseases, myeloproliferative disorders, myocardial infarction, stroke, pulmonary embolism, DVT, renal disorders, smoking), medications (androgens, EPO) PHYSICAL hematocrit >0.6 in ♂, hematocrit >0.5 in ♀ Related Topics Pathophysiology DEFINITION OF POLYCYTHEMIA R enal-polycystic kidney disease, hydronephrosis, post-transplant H ypoxia-obstructive sleep apnea, COPD, smoking, high altitudeĮPO- secreting tumors-renal, hepatoma, cerebellar, pheochromocytoma polycythemia rubra vera SECONDARY ★HERA★ ![]() stress (Gaisböck’s syndrome), decreased intravascular volume PRIMARY ![]()
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