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HEMATOLOGY AND

INFECTIOUS DISEASE

AGENDA



Anemias

 Interpreting RBC, Hgb and RBC indices

 Microcytic Anemia

 Macrocytic Anemia

 Normocytic



WBC interpretation



Infectious Mono

 Influenza

 Lyme Disease

ANEMIA



Not a disease but a sign/symptom of an

underlying disorder



Defined by low Hgb (<12 g/dl in women, <14 g/dl

in men



decreased RBC production, increased RBC

destruction, and blood loss

 Important to identify underlying condition or

cause

MCH – MEAN CORPUSCULAR

HEMOGLOBIN



Amount of Hgb in RBC

 27 – 34 pg

 Hypochromic anemia



Hyperchromic anemia

MCV - MEAN CORPUSCULAR

VOLUME



Size of average RBC

 Categorizing anemia

 Microcytic < 80 (80-100 fl)

 Fe deficiency

 Thalassemia

 Anemia of Chronic Disease (ACD) - occasionally



Normocytic < 80 – 100

 Acute blood loss

 ACD – including renal failure



Macrocytic >

 Megaloblastic anemia – B12 or folate deficiency

CASE STUDY 1

 M.B. is a 42 year old Caucasian female who

presents to the office for an annual physical. She

offers no specific complaints other than lack of

energy and feeling fatigued at the end of the day

for the past 3 – 4 months. She attributes it to

being a busy mom and working full-time but

admits to feeling worse in the past few months.



Meds – none



Allergies - none



PMH – C-section 2014

 FH – father HTN, mother A&W

PE

 (^) Ht – 5’6” Wt – 140 lbs.  (^) BP =126/68 HR =88 RR = 16 Temp =98.  (^) General – well-groomed, skin smooth, dry intact  (^) HEENT – normocephalic, PERRLA, conjunctiva slightly pale, oral membranes moist, neck supple, thyroid non palpable  (^) Lungs – eupneic, CTA bil  (^) CV – S1S2 RRR, no edema  (^) Abd – soft, non-distended, non –tender, + BS  (^) MS – full ROM 5/5 strength, no swelling or deformities  Neuro – AAO x 3

CLINICAL PRESENTATION



May not have any symptoms until anemia is

severe (Hgb < 6 g/dl)



Iron Deficiency anemia (IDA) – can cause

symptoms with Hgb <11 g/dl



Most common presentation – fatigue, mild

dyspnea and mild exercise intolerance

 Moderate to severe anemia – marked dyspnea,

activity intolerance, pallor, tachycardia



Elderly patients may present with exacerbation of

comorbidities – dementia, chest pain, HF

IRON DEFICIENCY ANEMIA (IDA)



Most common cause of anemia

 Most common nutritional deficiency

 Most common cause is chronic blood loss

 Menorrhagia, GI bleed – NSAID/ASA

 In women, include menstrual hx – menorrhagia or

pregnancy?



Also caused by:

 inadequate diet

 Malabsorption – celiac, H. pylori, gastric bypass

 increase iron requirements – pregnancy

 Extreme athletes

QUESTION



In a patient with Iron-Deficiency Anemia, which

blood work would indicate the earliest

abnormality to confirm the diagnosis?

A. Transferrin

B. Total Iron binding capacity

C. Serum Iron

D. Ferritin

FERRITIN



Iron stores

 Earliest lab abnormality

 Most accurate test to diagnose IDA



Women – 12- 150 ng



Men - 15 – 300 ng



Decreased – IDA

 Increased - ACD, sideroblastic anemia



In chronic states of inflammation - <50ng is

considered IDA

OTHER TESTS

Usually not necessary:

 Reticulocyte count – new immature RBCs (1%)

 decreased

 Peripheral smear – provides information of count and

morphology

 Bone marrow – rare

Other tests:

o Stool OB – r/o GI beed

o HCG test

DIFF DX - THALASSEMIA

Labs:

 RDW – normal

 Retic count – increased

 Ferritin – normal

 high-performance liquid chromatography (HPLC)/

Hgb electropheresis – diagnostic standard

 Globin gen – diagnostic confirmation

 Pre-conception and pre-natal testing and counselling

 ACD

 Non- anemia diff dx

 Hypothyroid

 Pregnancy

 Uterine fibroid