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Normocytic Anemia (Dx: CBC (MCV (:check:Normocytic anemia confirmed…
Normocytic Anemia
Dx: CBC
MCV
:check:Normocytic anemia confirmed (destruction/production(cancer))
Look for hemolysis
LDH
Haptoglobin
bilirubin
smear
:check:Hemolysis
high
LDH
low
haptoglobin
high
bilirubin
Smear
SCD
sickled cells
Adult managment
Path: Sickling cells, HgbSS (AR gene in AA people)
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G6PD
bite cells :watermelon: & Heinz bodies
Path: G6PD def, (AA people)
oxidative stress destroys cell
Pt:
AA man exposed to oxidative stress.
Dapsone, TMP-SMX, Nitrofurantoin(why would a man be on this?!)
no intervention needed
Mediterranean person eating fava beans
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Hereditary Spherocytosis
spherocytes
Path: RBC membrane problems
Spectrin Ankyrin Pallidin
Pt: Hemolysis w/ spherocytes
no characteristic history
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Autoimmune Hemolytic Anemia
spherocytes
Dx: Coombs test
Smear: sphereocytes
IgM positive
Cold Autoimmune Hemolytic Anemia
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IgG positive
Warm Hemolytic Anemia
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Paroxysmal Nocturnal Hemoglobinuria
no characteristics
Path: Deficiency of PIG-A gene
Complement forms MAC and eats RBC
Pt: Paroxysmal nocturnal hemoglobinuria :waxing_crescent_moon::bed:
must reach a complement threshold
at night, hypoxemia/acidosis w/ less breathing
more complement fixation
increased bilirubin in pee
(not a real hemoglobinuria)
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:green_cross:Normal?
Suspect Hemorrhage
Tx: Plug hole & give blood
chances are w/o bleed: CKD
Toy:
EGD or colonoscopy :telescope:
Check for NSAID abuse
Coagulopathies: PT/PTT
Cancer :crab:
:check:smear, but normal labs
:crab:Malignancy
MDS
blasts (leukemia)