Anemia 101- Case Studies. Peter A. Kouides MD Associate Professor of Medicine, University of Rochester School of Medicine Attending Physician, The Rochester General Hospital. Anemia classification based on the mechanism. Kinetic Classification (based on retic count)
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Peter A. Kouides MD
Associate Professor of Medicine,
University of Rochester School of Medicine Attending Physician,
The Rochester General Hospital
2. If decreased production, narrow down the causes in terms of the MCV-
3. If the the reticulocyte count is increased-
4. Look at the peripheral blood smear to confirm/support the diagnosis
What is the MCV ??
Renal vs. Liver vs. Endocrine vs. Anemia of Inflammation
Other: sideroblastic anemia (meds,PB,Zn excess,Cu def)
What is the result of a Coomb’s test ??
Intrinsic red cell defect
Extrinsic red cell defect
1. Stool guiacs x 3
2. If the MCV is low, then prescribe iron
3. If the MCV is high, then check a folate level and vitamin B12 level
Case #1-A 67-year-old man is referred for evaluation of dyspnea. The hematocrit is 28%, white blood cell count 4500/mm3, platelet count 550,000/mm3, and reticulocyte count 4%. The MCV is 78 and the blood smear reveals basophilic stippling and a small population of hypochromic microcytic red cells. Serum Fe 225, TIBC 260, Ferritin 490
Anti-Tb drugs= Sideroblastic Anemia
Chloramphenicol, Valproic acid= Pure Red Cell Aplasia
AZT, Dilantin= Macrocytic Anemia
Increased Destruction (Hemolytic):
Qunidine, PCN, Aldomet= Auto-immune Hemolytic Anemia
Primaquine,Nitrofurantoin, Dapsone, Pyridium= G6PD Deficiency
A 21-year-old woman with sickle cell anemia has had a fever and severe pain in the right shin for 3 weeks. The painful area is hot, swollen, tender and indurated.