TY  - CHAP
M1  - Book, Section
TI  - Most Common Hematology Questions
A1  - Rowe, Julie H.
A1  - Gonzalez, Anneliese O.
A1  - Jafri, Syed H.
A1  - Cen, Putao
A1  - Kanaan, Zeyad
A1  - Amato, Robert J.
A1  - Rios, Adan
A1  - El-Osta, Hazem
A1  - Mohlere, Virginia
PY  - 2019
T2  - Hematology-Oncology Clinical Questions
AB  - Table  Graphic  Jump  Location|Download  (.pdf)|PrintKey  conceptAnemia  is  defined  in  clinical  practice  as  a  hemoglobin  level  <13.5  g/dL  in  men  and  <12  g/dL  in  women.  Symptoms  of  anemia  correlate  with  the  degree  and  rate  of  development.  An  underlying  abnormality  should  always  be  explored  in  an  anemic  patient.Clinical  scenarioA  69-year-old  man  with  a  history  of  an  Escherichia  coli  urinary  tract  infection  treated  8  days  ago  with  ceftriaxone  presents  to  the  emergency  room  with  symptoms  of  fatigue  and  jaundice.  Physical  examination  reveals  pallor  and  icteric  sclerae.  Laboratory  evaluation  reveals  a  hemoglobin  level  of  7.9  g/dL,  elevated  lactate  dehydrogenase  (LDH),  low  haptoglobin,  indirect  hyperbilirubinemia,  and  reticulocytosis.  Review  of  the  peripheral  smear  shows  increased  reticulocytes,  anisocytosis,  and  spherocytic  red  blood  cells  (RBCs).  A  direct  antiglobulin  test  (DAT)  is  positive  for  IgG.  The  patient  is  managed  with  supportive  measures  and  recovers  spontaneously  after  7  days.Action  itemsProduction  of  RBCs  requires  the  interaction  of  several  elements  and  catalysts,  including  functional  bone  marrow,  erythropoietin,  iron,  vitamins,  and  cytokines;  deficiency  in  any  of  these  can  lead  to  anemia.A  systematic  approach  in  narrowing  down  the  cause  of  anemia  should  be  taken  to  ensure  an  accurate  diagnosis  and  avoid  unnecessary  testing.DiscussionIn  approaching  a  patient  with  anemia,  the  initial  work-up  should  delineate  whether  the  cause  is  a  result  of  marrow  underproduction  or  peripheral  destruction  or  sequestration.  This  should  be  followed  by  a  focused  work-up  of  the  suspected  cause.  Apparent  or  occult  blood  loss  should  be  excluded,  after  which  the  pathogenesis  can  be  categorized  as  follows.Underproduction  anemiasAnemia  plus  corrected  reticulocyte  count  <2%  Corrected  reticulocyte  count  =  reticulocyte  %  ×  patient’s  hematocrit/normal  hematocrit1Select  examples1:Microcytic  RBCs:  disorders  in  heme  or  globin  synthesis  (eg,  iron  deficiency,  congenital  sideroblastic  anemia,  thalassemia)Normocytic  RBCs:  anemia  of  chronic  disease  (can  be  microcytic),  chronic  kidney  disease,  or  compound  deficiencies  (eg,  iron  and  folate  deficiency)Macrocytic  RBCs:  deficiency  of  vitamin  B12  or  folate,  or  liver  diseaseAnemia  secondary  to  increased  RBC  destruction  (hemolytic  anemia)Intravascular  hemolysis:  hemoglobinemia,  hemoglobinuria,  hemosiderinuria,  decreased  haptoglobin,  or  elevated  LDH2Extravascular  hemolysis  (spleen,  liver):  no  release  of  hemoglobin  in  the  blood;  no  hemoglobinemia,  no  hemoglobinuria,  no  or  minimal  consumption  of  haptoglobin,  and  LDH  can  be  normal  Recycled  hemoglobin  in  the  spleen  or  liver  can  result  in  indirect  hyperbilirubinemia  and  bilirubinate  gallstones2Select  examples1,2See  Table  below  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - hemonc.mhmedical.com/content.aspx?aid=1162981169
ER  -