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Hematology > 10.08.18 Approach to Anemia > Flashcards

10.08.18 Approach to Anemia Flashcards

1
Q

an automated test to give us information about red cells

A

Complete Blood Count (CBC)

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2
Q

Is hemoglobin calculated or directly measured?

A

Directly measured

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3
Q

Volume of red cells per total volume of blood, given as a percentage

A

Hematocrit

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4
Q

Is hematocrit calculated or directly measured?

A

Calculated

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5
Q

Direct measurement of the number of red cells

A

RBC

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6
Q

Direct measurement of red cell volume

A

MCV

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7
Q

Calculated value, based on Hb and RBC

A

MCH

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8
Q

Calculate value, based on Hb, MCV, and RBC

A

MCHC

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9
Q

coefficient of variation of the MCV; how much “spread” there is in the MCVs of all the different red cells in the patient’s body

A

RDW

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10
Q

How does the distribution of RDW look in iron deficiency

A

Widened

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11
Q

a decreased hemoglobin/hematocrit below the normal range for gender and age; manifestation of disease not a final diagnosis

A

Anemia

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12
Q

What does the clinical manifestation of anemia depend on?

A
  1. Reduction of oxygen carrying-capacity
  2. Change in whole blood volume (acute-less, chronic-more)
  3. Rate of change of Hb
  4. Cardiopulmonary compensation
  5. Manifestation of illness that caused anemia
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13
Q

What are most symptoms of acute hemorrhage related to?

A

Hypovolemia

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14
Q

What are they symptoms of acute hemorrhage

A
  1. Hypotension
  2. Orthostatic changes
  3. Syncope
  4. Shock
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15
Q

What are symptoms of tissue hypoxia

A
  1. Fatigue
  2. Shortness of breath
  3. Cognitive difficulties
  4. Ischemic pain
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16
Q

How does the body respond to anemia with an increased cardiac output?

A

Increased heart rate

17
Q

What reflex does acute blood loss and hypovolemia trigger?

A

Vasoconstriction

18
Q

What are chronic changes associated with the body’s response to anemia?

A
  1. Kidneys retain salt/water (transfusion require diuretic)
  2. Increased 2,3DPG leads to right shift in O2 disassociation –> increased O2 delivery to tissues
  3. Renal mesangial cells sense decreased O2 delivery and increase erythropoietin synthesis
19
Q

What are the mechanisms of anemia?

A
  1. Hemorrhage
  2. Hemolysis
  3. Decreased RBC production
20
Q

How is anemia classified?

A
  1. Erythropoietic response (reticulocyte count- hyperproliferative or hypoproliferative)
  2. RBC size and Hb concentrantion (microcytic/hypochromic, macrocytic, normocytic/normochromic)
21
Q

On Wright-Giemsa staining these cells are polychromatophilic (grayish blue)

A

Reticulocyte

22
Q

Retic count x Hct/ideal Hct x 0.5

A

Reticulocyte index

23
Q

Retic (%) x RBC

A

Absolute reticulocyte count

24
Q

On supravital staining how are reticulocytes differentiated?

A

Have RNA “reticulated” remnants

25
Q

What does retic index <2% or absolute retic count <75000 suggest?

A

RBC production problem; –> hypoproliferative abnormality

26
Q

What does retic index >2% or absolute retic count >100000 suggest?

A

Good marrow response, so anemia is either hemorrhage (blood loss) or hemolysis (RBC destruction)

27
Q

Tends to reflect a problem with Hb synthesis

iron deficiency, thalassemia, lead poisoning, anemia of chronic disease, and sideroblastic anemias

A

Microcytic anemia

28
Q

What lab value classifies microcytic anemia?

A

low MCV (<80)

29
Q

Megaloblastic- impairment of DNA synthesis

Non-megaloblastic- variety of other causes

A

Macrocytic anemia

30
Q

What lab value classifies macrocytic anemia?

A

high MCV (>100)

31
Q

Either the marrow isn’t working well, there is a mixed problem, or there is a very acute problem

A

Normocytic anemia

32
Q

What are the 2 approaches to treat anemia?

A
  1. Treat the underlying cause

2. Transfusion

33
Q

How do you decide whether to transfuse?

A
  1. How symptomatic is the patient?
  2. Can we reverse the underlying cause?
  3. Do we have enough time to treat the underlying cause?
34
Q

What are the general indications that determine you need a blood transfusion?

A
  1. Cardiovascular compromise (CHF, shock, angina)
  2. Hypoproliferative anemia with no or prolonged recovery
  3. Anemic patient is going to surgery now- blood loss potential

Hematology (23 decks)

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