Craving for ice equals anemia.

Flow murmur is a systolic murmur I-II/IV

Anemia in CCS do General, !!"#, CVS, c$est and e%tremities.
&a's( C)C wit$ *eri*$eral smear, retic, $a*toglo'in, &+, 'ill #,+, Iron studies, folate and )-.,
#S and F#/, urine wit$ microsco*y ---- For $emolysis do( $a*toglo'in, &+, 'ill #,+, and retic.
0eds( *$ysiological anemia in new'orns and infants( term 'a'ies ' nadir 12--- gm/dl3 at -. wee4s
due to eryt$ro*oitin su**ression at 'irt$. "o 5% is needed. 0reterm( nadir 16-2 gm/dl3 at 7-8 wee4s
and may require transfusion.
9icrocytic is #ICS
Iron( $ig$ 5+:, low ferritin and Fe. $ig$ #I)C
0eds( new'orns $ave sufficient iron stores to meet requirments for /-8 mont$s. Iron in 'reast mil4 is
less t$an foemulas 'ut more readily a'sor'ed. &ow iron in diet will result in anemia at 2-./ mont$s.
5%( oral ferrous salts and continue it for at lease ; wee4s after values normali<e, limit cow mil4.
Anemia of c$ronic disease( $ig$ ferritin, low #I)C and Fe. If due to !S5+ give eryt$ro*oitin
#$alassemia( very small 9CV. 9ent<e inde% = 9CV/5)Cs > -7, family $%, no res*onse to iron.
!lectro*$oresis()eta( $ig$ 'A.1al*a., delta.3, $ig$ 'F1al*$a., gama.3. Al*$a( normal if .
alleles. If 7 t$en ' 1'eta/3 will s$ow low 9CV and $ig$ retic. / alleles will die
Al*$a t$alassemia needs +"A sequencing to diagnose.
#reat wit$ transfusion and c$elation, folate and do allogenic trans*lant.
0eds( ) t$alassemia ma?or 1Cooley anemia3 *resents at age of . m wit$ *rogressive anemia
$y*ers*lenism and cardiac decom*enssation 1' > / gm/dl3, !%*annding of medullary s*ace leading
to large face and s4ull, !%tramedullary $emato*oisis, $e*atos*lenomegaly.
)I test and msot s*ecific( ' electro*$oresis will s$ow $ig$ 'F, varia'le increase of 'A. and low
or a'sent 'A 1$ig$ al*$a ca$ins --@ al*$a tetramer form --@$ig$ 'F3. C)C will s$ow sevver
anemia, low reticulocytes, $ig$ nucleated 5)Cs, microcytosis 19CV AA-;B3, :ill s$ow increased
ma4ers of $emolysis 1$ig$ indirect 'ill, &+, decreased $a*toglo'in3, $ig$ ferritin and transferrin
saturation 1low #I)C3
5%( transfusion to maintain ' @ 2 gm/dl, iron c$elation( defero%amine t$at usually starts 'efore ;
yrs C vitamin C. S*lenectomy( needed de to $y*ers*lenism and usually defered until age of A.
5outine care( folate C *neumococcal vaccine C )V vaccine C daily *enicilline *ro*$yla%is C
growt$ $ormone as e%cess iron leads to decreased G. )9 trans*lant is curative.
Sidero'lastic( Alco$ol, I"D, lead. ig$ Fe, 0russian 'lue stain. 9inor give *yrido%ine, ma?or remove
to%in.
0eds( &ead *oisoning( consider it w$en( $y*eractivity, aggression, im*aired growt$, consti*ation,
mental let$argy. )I is 'lood lead at -. and ./ mont$s in $ig$ ris4 c$ildren 1acc*ta'le u* yo A mcg/dl3
&a's( microcytc $y*oc$romic anemia, $ig$ eryt$rocyte *or*$yrins 10!03, 'aso*$ilic sti**lings.
5efer to $ealt$ de*artment if level @ -A mcg/dl. )egin c$elation if level @ /A mcg/dl
#$alassemia and s*$erocytosis( $ig$ 9CC
low 9CV C $ig$ retic = ', it is t$e only microcytic anemia wit$ $ig$ retic
low 9CV C $ig$ iron = sidero'lastic
$ig$ 5+:= iron def
"eurological *ro'lems due to )-. def( anyt$ing, most common is *eri*$eral neuro*at$y, least
common is dementia, reversi'le if it is only s$ort time. 9etformin 'loc4s )-. a's.
9acrocytic C $y*ersygmented neutro*$ils 1average num'er of lo'es @/ 1normal 7.A3 or more t$an
AE wit$ @ A lo'es3 ---@ megalo'lastic
9acrocytic in CCS( do 'ill and &+ usually $ig$. do retic w$ic$ will 'e low. do smear to find oval
cells and may'e $y*ersigmented neutro*$ils. +o )-. and folate. if )-. is normal do met$yl malonic
acid w$ic$ will 'e $ig$ in )-. def. omocysteine will 'e $ig$ in 'ot$.
If )-. def is diagnosed t$en do anti*arietal cells A) 1Cve in *ernicious anemia3 and anti-intrinsic
factor A).
5e*lace )-. and folate 'ut watc$ for $y*er4alemia. Fn re*lacing )-. reticulocytes will im*rove
'efore neurological deficits. Folate will correct 'lood *ro'lems in )-. def 'ut will worsen
neurological deficit.
"ormocytic( low *roduction, 'lood loss or $ge, $emolysis
"ormocytic C $ig$ retic C normal $emolysis la's ---@ ge
"ormocytic C $ig$ retic C Cve $emolysis la's 1$ig$ indirect 'ill and &+, low $a*toglo'in3 ---@
emolysis, IV $emolysis s$ows sc$istocytes
"ormocytic C low retic ---@ early c$ronic d< anemia
Sic4le cell anemia( *ain everyw$ere 1c$est, 'ac4, t$ig$3. do com*lete *$ysical, retinal inf, flow
murmur due to anemia, s*lenomegally in c$ild and a'sent in adult, c$est infection or infarcted lungs,
s4in ulcers, ase*tic $i* necrosis, stro4es.
Give F., continuous "S, *ain meds, if fever is *resent t$en give ceftria%one, levo or mo%i 1most
urgent ste*3.In CCS wit$draw cultures and give A) 'efore results. Also do C)C wit$ smear, retic,
GA, CH5.
!%c$ange transfusion( retinal inf, *ulm inf wit$ *leuritic *ain and a'normal H ray, *ria*ism or stro4e.
Sic4le cell wit$ sudden dro* of C# --@ )-2 or folate def. all *atients need folate all time.e is on
folate t$en )-2. +o 0C5 of *arvovirus, do transfusion C IVIG.
All will need folate, *neumococcal vaccine, $ydro%yurea if @ / times a year.
emoglo'in SC disease and sic4le cell trait( a mild version wit$ renal manifestations --@ $ematuria,
isost$enuria, G#Is
0eds( sic4le cell d<( 9CC of deat$ in *eds( -- infections 1autos*lenectomy at A3 --@ s.*neumoniae,
.infuen<ae, ".meningitidis. .- acute c$est syndrome. 7- se*sis /- acute s*lenic swequestration 1*ea4
incidence 8 m - 7 yrs3 +%( $' electro*$oresis is used in new'orn screening. 0renatal d% for *atients
wit$ trait( c$orionic villous sam*linng at -B--. wee4s, amniocentesis at -/--; wee4s. 5%( transfuse if
sym*tomatic anemia 1SF) or C03. +o e%c$ange transfusion in life t$reatening com*lications li4e
1stro4e, acute c$est, s*lenic crisis3 or 'efore $ig$ ris4 surgery. Give aggressive A) for infecctions.
Give $ydro%yurea to increase 'F( if 7 or more crises a year, sym*tomatic anemia or life t$reatening
com*lications. It doesnIt decrease ris4 of stro4e.
5outine care( *enicilline *ro*$yla%is at 7 mont$s to A years of age, daily folate.
Immuni<ations( regular including *neumococcal at . m C influen<a at 8 mont$s t$en yearly C
meningococcal at . yrs.
)9 trans*lant is t$e only defenitive 5% and $as mortality rate of -BE.
5ecurrent *ainful crises is not an indication for transfusion.
' C( variation of ) c$ain gene causes mild c$ronic $emolytic anemia.
Autoimmune $emolysis( autoimmune d< in $%, C&& in $%, &ym*$oma in $%, 9eds as *enicilline,
sulfa, al*$a met$ydo*a, quinine. $ig$ $emolysis la's, retic and may 'e low $a*toglo'in. S*$erocytes
may 'e seen in smear, *ositive coom's, give *rednisone, if recurrent consider s*lenectomy. if severe
or not res*onsive to steroids and transfusion t$en give IVIG
Cold agglutinins $emolysis( 9yco*lasma or !)V in $%, coom's negative and com*lement *ositive,
"o res*onse to steroids, s*lenectomy or IVIG. Give ritu%ima'.
emolysis( G80+ deficiency( sudden and may 'e severe onset. H lin4ed, o%idant stress mcc is
infection, o%idi<ing meds as sulfa, *rimaquine, da*sonand also fava 'eans.
)est initial( $ein< 'odies is o%idi<ed $' under mem' and if removed 'y s*leen will see 'ite cells---
9ost accurate( G80+ level 'ut only after . mont$s of t$e attac4.--- avoid t$e cause
$owell ?elly 'odies are in sic4le cell
emolysis( *yruvate 4inase def triggers $emolysis due to un4nown trigger.
emolysis( $ereditary s*$erocytosis( $ig$ 9CC.0eri*$eral smere will s$ow s*$erocytes w$ic$ is
also seen in autoimmune $emolysis so coom'Is test is required to rule out autoimmune $emolysis.
9ost accurate test is osmotic fragility.
Clinically( recurrent e*isodes of $emolysis wit$ 'ill gall stones and s*lenomegaly and $ig$ 9CC.
do s*lenectomy and donIt forget to give vaccines.
GS and ##0( B-A6(6 in $% or meds as ticlo*idine t$at triggers ##0.
GS( IV $emolysis, 4idney failure, low 0&# --- ##0( add fever and neurologic issues
9ost cases resolve s*ontaneously, if severe give do *lasma*$aresis, no steroids, no anti'iotics, no
0&#
emolysis( 0" *aro%ysmal nocturnal $emoglo'inuria( FIT 1flow citometry to d% and loo4 for
C+AA and C+ A2 anti'ody 4nown as decay accelerating factor/ IV $emolysisand *resents wit$
*ancyto*enia and dar4 urine in morning/ t$rom'osis of large v.eins is 9CC of deat$3 Can transform
into a*lastic anemia or A9&. treat wit$ steroids and if transfusion de*endant give eculi<uma'.
!&&0( $emolysis, elevated liver en<ymes and low 0&#, diff from +IC 'y normal coag., deliver
'a'y.
9et$emoglo'inemia( SF) for no reason, clear lungs, clear H ray. ' is o%idi<ed due to e%*osure
1nitroglycerin, amyl nitr, nitro*russide, da*son, any anest$etic wit$ caine even if to*ical anaest$etic
for mucous mem'3 loo4 for 'rown 'lood and give met$ylene 'lue.
#ransfusion reactions( #5A&I( A) against donors :)Cs, infiltrates t$at resolve in ./ $ours, SF)
t$at resolves in ./ $ours and needs only su**ortive measures.
IgA def( ana*$yla%is so in future use 'lood from IgA deficiant donor or was$ed 5)Cs.
A)F( accute $emolysis w$ile tansfusion is going 1$y*otension, tac$ycardia, dar4 urine, $ig$ &+,
'ill and low $a*toglo'in3
9inor g*( delayed ?aundice wit$ no t$era*y
Fe'rile non$emolytic reaction( small rise in tem* due to reaction against donor :)Cs Ag, can 'e
*revented 'y using filtered 'lood to remove Ag
0eds( t$rom'ocyto*enia is 9CC of 'leeding in c$ildren. )# evaluates 0&# and v:+. 0t e%trinsic
*at$way, 0## intrinsic *at$way. 0## is .-7 times $ig$ in $emo*$ilia A and ). V:+ $as $ig$ )#
and 0##. IF a case of well ontrolled $emo*$ilia *resents wit$ sudden 'leeding *ro'lem consider
coagulation factor in$i'itor and so order mi%ing study 1usually factor VIII in$i'itor3.
Von :ille'randIs( *lt 'leeding C $ig$ *tt in ABE of *ts C normal *lt count. e*ista%is is *lt 'leeding,
worse wit$ anti*lt.
9ost accurate test( 5istocetin cofactor assay and von wille'rand factor level. if t$e level is normal
5istocetin test will tell if it is wor4ing *ro*erly.
5%( minor 'leedign needs +esmo*ressin or ++AV0 to release su'endot$elial stores of V:F and
VIII, ma?or 'leeding needs VIII re*lacementas it $as V:F wit$ it.
Factor ty*e 'leeing is $emart$rosis or $ematoma/ GI# 'leeding
I#0( *lt 'leeding if num'er 'elow AB,BBB. +%(/anti*lt A), GS for s*leen si<e, )9 '% s$ows $ig$
num'er of mega4aryocytes, anti'odies to II'/III a rece*tor. give *rednisone even 'efore doing tests if
minor 'leeidng and *lt > ./,BBB. if @ AB,BBB do not$ing, if > .B,BBB and serious 'leeding give/IVIG
or 5$ogam 15$oJ+K Ig3. do s*lenectomy if recurrent. give 5omi*lostim/ eltrom'o*ag if no res*onse
to s*lenectomy.
I#0 in *eds *resents usually 'etween - - / yrs and usually following viral illness +% 'y e%clusion.
Always do *eri*$eral smear to ruule out ##0 or GS. 5% is 'ased on 'leeding and not 0&# count.
9ost 4ids will recover 0&# count wit$in 8 mont$s. If 5% is needed( -st c$oice is *rednisone, .nd
c$oice is IVIG, -B-.BE of *atients will develo* c$ronic I#0 and will need immunce t$era*y
1ritu%ima'3 or s*lenectomy.
"ote t$at t$e only a'normality in I#0 is ecc$ymosis. If $e*atos*lenomegally is found t$en consider
ot$er conditions li4e leu4emia.
Gremia induced *lt dysfunction( normal *lt count and tests for V:F def C *lt ty*e of 'leeding. give
desmo*ressin.
to diff factor def from factor A) do mi%ing study w$ic$ will fi% t$e factor def.
Any factor ty*e 'leedign do mi%ing study and if it s$ows deficiency t$en do s*ecific factor levels.
Factor VIII 1$emo*$ilia A3( male c$ild wit$ $emart$rosis, if > -E of activity give factor VIII if
minor def give ++AV0. 0eds( use desmo*ressin and aminoca*roic acid or trane%amic acid to
minimi<a fi'inolysis 1given 'efore oral surgical *rocedures. If ma?or 'leeding li4e 'leeding in ?oint,
ilio*soas 'leeding or any large 'leeding t$en give fctor VIII.
Factor IH 1$emo*$ilia )3( same *resentation 'ut less common, re*lace IH for minor or ma?or
'leeding.
Factor HI( rare 'leeding wit$ trauma or surgery, give FF0 for 'leeding.
Factor HII( no 'leeding and no treatment
If 'leeidng doesnIt correct wit$ mi%ing study t$en it is A) to factor( 9CC is factor VIII A), will
*resent wit$ *rolonged a0## t$at doesnIt correct wit$ mi%ing study
I#( at least ABE dro* of *lt after using $e*arin allergic reaction so dose doesnIt matter, *resents
mainly wit$ t$rom'osis w$ic$ is usually venous, sto* $e*arin and use direct t$rom'in in$i'itor.
+%( *lt factor / A), e*arin induced-anti*lt A)
y*ercoagula'le states( lu*us anticoagulant or anticardiol*in A)( venous t$rom'osis, $ig$ a0##,
normal 0#, S*ontaneous a'ortion, false *ositive V+5&. +o mi%ing study. 9ost accurate is 5ussel
vi*er venom test. give $e*arin t$en warfarin.
y*ercoagula'le states( 0rotein C def( s4in necrosis wit$ warfarin, do *rotein C level, give $e*arin
t$en warfarin
y*ercoagula'le states( Anti t$rom'in def( *resents as a *atient t$at ta4es 'olus IV $e*arin wit$ no
c$ange of a0##, do level of antit$rom'in III, give large amounts of $e*arin or direct t$rom'in in$
followed 'y warfarin
y*ercoagula'le states( Factor V leiden mutation( 9CC of t$rom'o*$ilia and diagnosed 'y factor V
leiden mutation test, give $e*arin t$en warfarin
+IC( give *lt, *rotein C concentrate or cryo**t to re*lace fi'rinogen, give FF0 to re*lace *lasma. +o
C)C wit$ smear, a0##, 0#, F+0, +-dimer, solu'le fi'rin monomer com*le%.
Acute leu4emia( fatigue and infections, )lasts on *eri*$eral smear, *rognosis is detected 'y
cytogenetics, t$ose w$o will rela*se need )9 trans*lant as soon as c$emo induces remission.
#reatment( c$emo 1A9&( IC Idaru'icin/donoru'icin and cytosine ara'inoside31A09& - 97( add
A#5A31A&&( add intrat$ecal met$otre%ate3. Give allo*urinol.
0t wit$ :)Cs a'ove -BB,BBB and *resents wit$ SF), confusion, 'lurry vision( t$at is leu4ostasis due
to $ig$ :)Cs, do leu4a*$aresis and give $ydro%yurea. #$is $a**ens wit$ acute leu4emia and is rare
wit$ C&& as lym*$ocytes are smaller and never occludes vessels.
&ym*$adeno*at$y, s*lenomegally and C"S involvement are common in A&& and not A9&
Auer rods --@ A9&
97 is A09&( associated wit$ +IC
)9( @.BE 'lasts ---@ leu4emia, >.BE 'lasts ----@ myelodys*lastic syndrome
9yelodys*lasia 19+S3( !lder wit$ 1*ancyto*enia, $ig$ 9CV wit$ normal )-., low retic,
9acroovalocytes3... 9acroovalocytes are s*ecial neutro*$ils wit$ . lo'es and called L0elger-uet
cellL. )9 will s$ow 'lasts >.BE so canIt 'e leu4emia.
Consider it as mild *rogressive *releu4emia and it may *rogress to acute leu4emia.
9CC of deat$ is infection or 'leeding. +o su**ortive measures and transfusion
9+S( s*ecific t$era*y is a<acitadine. Gse lenalidomide n Aq minus syndrome
9yelo*roliferative disorders 1C9&, C&&, $airy cell leu4emia, myelofi'rosis, 0CV, essential
t$rom'ocytosis3 of all of t$ese, untreated C9& $as t$e $ig$est ris4 to transform into Acute leu4emia3
C$ronic myelogenous leu4emia 1loo4 for elevated :)Cs wit$ neutro*$ils *redominance3,
s*lenomegally is frequent. 9ost accurate test( 0$yladel*$ia C$r. )est initial test is &A0 to rule out
reactive $ig$ :)Cs due to infections
C9&( 'est initial is imatini' 1gleevec3 w$ic$ leads to 2BE remission. If not res*onsive t$en try
dasatini' and nilotini' 1tyrosine 4inase in$i'itors3. )9 trans* is t$e only curative measure
)usulfan can only 'e t$e answer to Lw$at causes *ulmonary fi'rosisL. I"F and $ydro%yurea are
wrong answers to C9&,.
C&&( @ AB yrs, $ig$ lym*$ocytes t$at loo4 normal. )est initial test is smear ---@ Smudge
cells1ru*tured lym*$ocytes nuclei3. Stages( B $ig$ :)Cs only, - large &", . large s*leen, 7 Anemia,
/ low 0&#
#reatment( Stage B , - no t$era*y, . - / fludara'ine w$ic$ is t$e most li4ely t$era*y to increase
survival in advanced stages. Com'ine it wit$ ritu%ima'.
C&&( c$loram'ucil is not very effective, Alemtu<uma' is 'etter 1anti C+A. agent3
airy cell leu4emia( ) lym*$ocytes, 9iddle age 1ABs3, *ancyto*enia, massive s*lenomegaly.
9ost accurate is #5A0 1tartrate resistant acid *$os*$atase3, smear wit$ $airy cells, +ry )9 ta*. ---
treat wit$ cladri'ine 1.-C+A3
9yelofi'rosis( Same *resentation as $airy cell( massive s*leen and *ancyto*enia 'ut normal #5A0
level. #eardro* cells on smear. !%tramedullary $emato*oiesis leads to $e*atos*lenomegally. )9
trans* can 'e curative. )est initial lenalidomide or t$alidomide
0olycyt$emia Vera( $eadac$e, 'lurry visio, di<<iness, fatigue, *ruritus after $ot s$ower due to release
of $istamine from 'aso*$ils, s*lenomegaly is common. ig$ C# wit$ no $y*o%ia, low
eryt$ro*oitin and 9CV. MAN. mutation.
0CV( C)C will s$ow $ig$ C#, order A)G to rule out $y*o%ia, in CCS Oorder eryt$ro*oitin level
and $ematology consultation. Also order nuclear red cell mass test, test for MAN. mutation. &A0 and
)-. will 'e $ig$ 1order t$em3P
0CV( do *$le'otomy, give $ydro%yurea, daily as*irin. If t$e *atient $as $ig$ *lt give anagrelide.
!ssential t$rom'ocytosis( mar4edly $ig$ *lt, *resentation( $eadac$e, visual distur'ances and *ain in
$ands 1eryt$romelalgia3. +eat$( 'leeding or more commonly t$rom'osis. 5%( $ydro%yurea,
Anagrelide w$ic$ is not as strong as $ydro%yurea, As*irin
0lasma cell disorder( 99, 9GGS, waldenstromIs macroglo'ulinemia, A*lastic anemia.
99( )one *ain, renal failure, infections. Fsteoclastic lesions --@ $ig$ Ca, S0!0 $ig$ monoclonal
A) and usually it is IgG, G0!0 )ence Mo$nIs, Smear - @ roulau% of 5)Cs.
99( *resents wit$ *at$ological 'one Q. 9CC of deat$ is infections as t$ey are immunodeficient or
due to 5F. S4eletal surver --@/osteoclastic lesions, if osteo'lastic t$in4 of *rostate cancer.+o
)G"/Cr. 9ost s*ecific test is )9 )% -@ @-BE *lasma cells. )eta . microglo'ulin is a *rognostic
indicator
99( 5%( -- mel*$an and steroids, .- you may add t$alidomide 1#"F in$i'itor as effective as
c$emot$era*y3, lenalidomide or 'orte<omi'. 9ost effective is autologous stem cell )9
trans*lantation, reserve t$is for > 6B yrs and advance d<. +F"I# FF5G!#( treat $ig$ Ca
1)i*$os*$onates3, 5F 1Fluids3, Anemia 1!ryt$ro*oietin3, Give vaccines 1Flu, *neumova%, tetanus3
9GGS( Aym*tomatic $ig$ IgG on S0!0 w$ic$ is usually requested to assess $ig$ total *roteins in an
elder, usually @ 6B yrs, "o 5%
:aldenstromIs macroglo'ulinemia( *resents wit$ $y*erviscosity due to $ig$ Ig9 1$eadac$e, 'lurry
vision, confusion3, large &" and s*leen are found. C)C will s$ow not$ing. )est initial is serum
viscosity level, S0!0 will s$ow $ig$ Ig9.
)est initail 5% is *lasma*$aresis. Agents of C&& can 'e used 1Fludara'ine, c$loram'ucil3
A*lastic anemia( *ancyto*enia of un4nown itiology, If *t is > AB yrs and $as a matc$ t$en 'est
t$era*y is )9 trans*lant. If @ AB or no matc$ t$en give antit$ymocyte glo'ulin or cyclos*orine.
) sym*toms( means more wides*read lym*$oma 1fever, wt loss, nig$t sweating3
&ym*$oma( !nlarged &", + starts in nec4 and s*reads centrifugally and usually *resents at I or II,
"& wides*read and usually *resents at III or IV.
Stages( I one g*, II more t$an one g* 'ut at same side of dia*$ragm, III 'ot$ sides of dia*$ragm, IV
wides*read
+H( e%cisional &" )% t$en imaging for staging 1CH5, C# scan wit$ contrast for c$est, a'domen,
*elvis and $ead3, )9 )%, +o Anti-C+.B Ag to decide 'est regimen in "&.
5%( I and II wit$ no ) symtoms( radaition. more advanced -@ c$emot$era*y.
+( A)V+ 1Adriamycin Ldo%oru'icinL, 'leomycin, vinlastine, dacar'a<ine3
"&( CF0 1Cyclo*$os*$amide, $ydro%yadriamcycin, oncovin 1vincristine3, *rednisone3, If anti-
C+.B antigen *ositive t$en add ritu%ima' as it will increase efficacy.
C$loram*$enicol can cause *ancyto*enia
Ferritin and )-. are acute *$ase reactants
Continue 5% after values normali<e to re*lenis$ stores
#$rom'ocytosis is common wit$ iron def anemia
Nee* ' @ 6 g/dl or ; gm/dl in CA+
ig$ 9CV @ -BB( folate or )-. def, liver d<, $y*ot$yroidism, alco$ol a'use, myelodys*lasia,
reticulocytosis. If @ --B t$en usually folate or )-. def is t$e cause.
Sc$istocytes and $elmet cells are seen in microangio*at$ic $emolytic anemia due to s$eering of
5)Cs in coagulated ca*illaries