1/4 Anemia1 - Wondisford Flashcards

1
Q

interpreting CBC

RBC, WBC, platelets

what if all counts low?

A
  • RBC ~5mil/ul
  • WBC ~6k/ul
  • platelets ~200k/ul

all counts low → bone marrow issue

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2
Q

normal range of Hb (g/dL)

birth

childhood

adolescence

adult man

adult woman (menstruation)

adult woman (postmenopausal)

during preg

WHO def: anemia

A

birth: 17
childhood: 12
adolescence: 13

adult man: 16 +/- 2

adult woman (menstruation): 13 +/- 2

adult woman (postmenopausal): 14 +/- 2

during preg: 12 +/- 2 (bc of incr plasma volume)

WHO def: anemia is Hb level < 13 in men, < 12 in non-preg women

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3
Q

hematocrit normal values

what does it look like when…

  • normal
  • anemia
  • polycythemia
  • dehydration
A

mean hematocrit

  • adult male: 47%
  • adult female: 42%

less reliable indicator of anemia than hemoglobin due to changes in plasma volume and Hb conc

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4
Q

reticulocytes

  • what are they/how identified
  • normal count vs corrected count
  • how to use in anemia
A

immature RBCs which still have RNA in them

  • identified with methylene blue stain (hits RNA)

normal count: 1-2%, reflective of daily replacement of circ RBCs

corrected count: reliable measure of effective red cell production

10 days post onset of anemia,

  • IF epo/erythroid marrow responses are intact: RBC production rises to 3x normal
  • IF less than 3x normal? → inadequate marow resp
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5
Q

reticulocyte corrections

2 types

A

correction #1 for anemia:

  • absolute reticulocyte count = ret count (Hb/normal Hb)
    • can also use hematocrit (instead of Hb)

correction #2 for longer life of rematurely released reticulocytes in blood

  • reticulocyte production index = corrected ret count/2
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6
Q

anemia RBC sizes

  • microcytic
  • normocytic
  • macrocytic
A

microcytes assoc with poor cytoplasmic maturation (no Hb)

macrocytes assoc with poor nuclear maturation (more time to synthesize more Hb)

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7
Q

3 classes of anemia

  • RPI
  • bone marrow
  • RBC size
A

1. hypoproliferative (RPI < 2.5; bone marrow erythroid hypoplasia; normocytic)

  • 75% of all anemias are due to Fe def and inflammation (ACD)
  • causes
    • Fe deficiency (early)
    • inflammation (early)
    • marrow damage
    • decreased epo from kidney disease

2. ineffective erythropoeisis (RPI < 2.5, BM erythroid hyperplasia, macro/microcytic)

  • nuclear maturation defect (folate/b12 def; drugs)
  • cytoplasmic maturation defect (iron def - late, infl - late, thalassema, sideroblastic)

3. blood loss/hemolysis (RPI > 2.5, BM erythroid hyperplasia, normocytic)

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8
Q

chromasia

A

measure of amount of Hb

hyperchromic: more Hb than normal
hypochromic: less Hb than normal

*overlay with size (micro/normo/macrocytic)

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9
Q

pathologic RBC forms

diseases associated with…

  • acanthocyte
  • basophilic stippling
  • dacrocyte (teardrop)
  • bite cell
  • Burr cell
  • hereditary elliptocytosis
  • macro-ovalocyte
A
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10
Q

pathologic RBC forms

diseases associated with…

  • ringed siderblast
  • schistocyte
  • sickled cells
  • spherocytes
  • target cells
  • Heinz bodies
  • Howell-Jolly bodies
A
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11
Q

anemia chart

A
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12
Q

microcytic anemias

(TAILS)

A
  1. thalassemia [issue with GLOBIN SYNTH]
  2. anemia of chronic disease [issue with IRON]
  3. iron deficiency [issue with IRON]
  4. lead poisoning [issue with HEME SYNTH]
  5. sideroblastic anemia [issue with protoporphyrin/HEME SYNTH]

all issues with producing hemoglobin!

recall: three types of anemia → ineff erythropoeisis → cytoplasmic maturation defect

  • Fe def - late
  • infl - late
  • thalassemia
  • sideroblastic
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13
Q

microcytic hypochromic anemia

A

most common: Fe deficiency due to…

  • chronic bleeding
  • malnutrition
  • gastrectomy (acid promotes Fe+2 form, more easily abs)
  • incr demand (preg)
  • hookworm

sx:

  • decr iron and ferritin
  • incr TIBC
  • fatigue, conjunctival pallor, pica, spoon nails (koilonychia)
  • on periph smear: central pallor > 1/3 RBC diameter

*may manifest as Plummer-Vinson syndrome

  • triad of Fe def anemia, esophageal webs, atrophic glossitis
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14
Q

in microcytic hypochromic anemia,

why LOW FERRITIN and HIGH TIBC?

exception

A

when ferritin decreases in liver, transferrin (TIBC) synth increases in attempt to replenish iron stores

  • i.e. vary inversely with one another: one rises, the other falls and vice versa
    exceptions: OCP use, pregnancy
  • hepatic transferring synth is incr due to estrogen
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15
Q

lab values in anemia

serum iron, TIBC, ferritin, % transferring sat in…

  • iron deficiency
  • ACD
  • hemochromatosis
  • pregnancy/OCP use
A

iron deficiency: low Fe stores (ferritin), compensatory incr in TIBC

anemia of chronic disease: high iron stores (ferritin), low TIBC [bc issue is ACCESS to the iron stores in the cells]

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16
Q

summary1

A