Anemia Types and Key Lab Findings PDF

62 b. Hemoglobin C i& Chronic hemolytic disease ❖ Heterozygous - asymptomatic ~ Hb H (~4 ) ❖ Homozygous - mild chr011ic...

62 b. Hemoglobin C i& Chronic hemolytic disease ❖ Heterozygous - asymptomatic ~ Hb H (~4 ) ❖ Homozygous - mild chr011ic i& Hb Bar t's (Y4) present at birth anen11a w Hb H inclusions (h eiuz bodies) ❖ May see Hh C crystals (bar- ❖ 4 deleted a genes (- -I- -) shaped), and target cells w H y drops fetalis ❖ In SC disease, crystals appear as i& Non viable fetus "hand in glove" or "Washington monument" ❖ Confirm by electrophoresis ~ Cellulose a cetate - migrates with A2, E, 0 , and CHarlem ~ Citrate agar - (C separates @ Sexy REMEMBER! from others) 2. Decrea sed production of a or ~ chains Valine a. ~ thalassemia - t or absent produ ction of ~-ch ain s ❖ Microcytic, hypochromic anemia ❖ ,t. Hb Az and F, t or absent A t b. a thalasserma - production of Valine for Glutanuc Acid in Hemoglobin S a-chains ❖ 1 deleted a gene (- a/aa) - Silent carrier; n ormal CBC ❖ 2 deleted a genes (- al-a) or (- -laa) - Mild microcytic, hypochromic anemia ❖ 3 deleted a genes (- - I-a) - Hemoglobin Variants BD.d Hemoglobin H disease Electrophoretic Migrations Classification of Anemias Anemia--- "t Hb & Hct - MCV Normal (normocytic) PROBLEM WITH HEME * ANTIBODY DESTRUCTION MEGALOBLASTIC Iron Deficiency Hemolytic Disease of the Newborn MATURATION Sideroblastic Transfusion Reaction B12 Deficiency Chronic Disease/Inflammation Autoimmune Hemolytic Anemia Folate Deficiency Myeloproliferative Neoplasms PROBLEM WITH GLOBIN RBC MEMBRANE DEFECT Myelodysplastic Syndromes Thalassemias Hereditary Spherocytosis (HS) NON-MEGALOBLASTIC Hemoglobin E Hereditary Elliptocytosis (HE) MATURATION Paroxysmal Nocturnal Hemoglobinuria(PNH) ENZYME DEFICIENCY Liver Disease G6PD Pyruvate Kinase (PK) tPRODUCTION, LOSS Aplastic Anemia, Chronic Renal Disease Acute Blood Loss, BM infiltration HEMOGLOBINOPAT HIES Hb S, HbC OTHER EXTERNAL ACTIONS Physical Trauma, Chemicals, Organisms  63 Anemia Types and Key Lab Findings ANEMIA LAB FINDINGS M ICROCYTIC/H YPOCHROMIC Iron Deficiency t Serum Ferritin, t Serum Fe, +TIBC, t 0 10 Saturation Chronic Disease / Inflammation N-,f. Serum Ferritin, t serum Fe, tTIBC Lead Poisoning Basophilic Stippling, ,¼.Blood Pb, ,f.FEP Thalassemia Trait N Serum Fe, N TIBC, ,f.A2, ,f.F M ACROCYTIC B12 Deficiency t B12, t Retics, Pancytopenia, Oval Macrocytes, Hypersegmented Polys, Howell Jolly (HJ) Bodies ~ Pernicious Anemia (PA) 1-'l,> Anti-IF positive (Intrinsic Factor), ,f.MMA (methylmalonic acid), ,f.Homocysteine, ~ Malabsorption/ Dietary ~ t s12, Anti-IF negative Folate Deficiency tFolate levels, Anti-IF negative, t Retics, Oval Macrocytes, Hypersegmented Polys Liver Disease / Alcoholism ,¼.Liver Enzymes, Target Cells, Round Macrocytes NORMOCYTIC/N ORMOCHROMIC Antibody Mediated ,f.Bilirubin, t Haptoglobin, DAT+ ltiF PCH ,r;p Donath Landsteiner Ab (Anti P specificity) iW Cold Agglutinin Disease I& lgM Ab (Anti I specificity), Cold Agglutinin Titer+ e:w Warm Autoimmune l& lgGAb Hemolytic Anemia Membrane Defect llF Hereditary Spherocytosi~ 611" Spherocytes, ,f.MCHC, Abnormal Spectrin 1& Hereditary Elliptocytosis a- Elliptocytes (>15% to 100%), Abnormal Spectrin IIF PNH e:w CD55-, CD5~. FLAER Test positive Enzyme Deficiency 11F G6PD " t G6PD, Heinz Bodies _.., P vn 1v I(;""'"" /PK\ tri1'..PK II.In ~in7 R,-,,1;.,~ Decreased Production / Loss - Aplastic Anemia ,r;p "Dry Tap" Bone Marrow (BM), Hypocellular BM, t Retics, Pancytopenia - Acute Blood Loss 611" Normal BM, +Reties - Chronic Renal Disease - t EPO Hemoglobin Defects Definitive Poikylocytes on Smear (HbC crystals, Sickle Cells, SC crystals, etc.), Hb Electrophoresis REMEMBER! Trust in yourself. Your perceptions are often far more accurate than you are willing to believe - Claudia Black Correlate Lab Data to Determine Type ofAnemia