1. ANEMIAS II: HEMOLYTIC ANEMIAS Clinical Medicine and Surgery I Pamela Jaffey MD

117. MCV<80 fL Iron Deficiency Chronic Disease Thalassemias Sideroblastic Anemias Lead intoxication MCV 80–100 fL  Reticulocyte >100 k/  L  Reticulocyte <100 k/  L Megaloblastic Hereditary Vit B 12 deficiency Folate deficiency Non-megaloblastic Schistocytes Autoimmune hemolytic anemia Malaria DIC TTP-HUS Prosthetic heart valves Acquired WBC PLT Normal Acute blood loss Early iron defic Chronic Dz Chronic renal failure Sickle cell anemia G6PD defic spherocytosis WBC &/or PLT Low Infection Medications Aplastic anemia Leukemia Hypersplenism Hypothyroidism Liver Dz Alcoholism Aplastic anemia Classification of Anemias by MCV MCV >100 fL No Yes

119. Work-up of Normocytic Anemias Absolute Retic Count < 100,000/  L IRON STUDIES SERUM FERRITIN  1 st then  Serum iron,  TIBC BONE MARROW BIOPSY RENAL FUNCTION TESTS normal or  ferritin  TIBC Find bleeding source early iron deficiency chronic disease HYPOCELLULAR VERY FATTY HYPERCELLULAR REPLACEMENT APLASTIC ANEMIA LEUKEMIA UA CHRONIC RENAL FAILURE ACUTE BLOOD LOSS

120. SERUM HAPTOGLOBIN  25 mg/dL  serum LDH,  total bilirubin, indirect bilirubin HEMOLYTIC ANEMIAS Hemoglobin electrophoresis Direct antiglobulin (Coomb’s) test HbS other hemoglobinopathies HbC, HbSC, HbD etc. sickle cell anemia NEG POS Peripheral blood smear autoimmune hemolytic anemia POS NEG platelets  nml G-6-P-D deficiency spherocytosis heterozygotes homozygotes Nml CBC NEG POS Sickle RBC PT, PTT, D-dimers  nml Prosthetic heart valve DIC TTP - HUS schistocytes Work-up of Normocytic Anemias Absolute Retic Count > 100,000/  L

122. TABLE 2: USE OF IRON STUDIES TO DIFFERENTIATE BETWEEN: Iron Deficiency Anemia - Anemia of Chronic Disease - Thalassemia Minor NL NL or  NL or  Thalassemia Minor  NL or   Anemia of Chronic Dz    Iron Deficiency Anemia TIBC FERRITIN SERUM IRON