2013-10-15 Anemia I

Question 1

Definition of anemia

Answer 1

Insuff RBC mass to adequately deliver O2 to peripheral tissues

Per WHO:
Hgb < 14gm/dL for men
Hgb < 13gm/dL for women

Question 2

What are the microcytic anemias?

Answer 2

1. Iron deficiency anemia (IDA)
2. Lead poisoning
3. Sideroblastic anemias
4. Thalassemias

Question 3

What are the normocytic anemias?

Answer 3

FIRST REVIEW RETIC COUNT.

WITH LOW RETIC COUNT
A. 2/3 Anemia of chronic disease (ACD)
B. Aplastic anemia
C. Myelodysplastic syndromes (MDS)
D. Misc. (Renal dz, Hypersplenism, Endocrine)

WITH HIGH RETIC COUNT
Hemoglobinopathies (e.g., Sickle cell)
Hemolytic states
—Autoimmune hemolytic anemias
—Drug-induced
—Hemolytic anemias
—Membranopathies (Paroxysmal nocturnal hemoglobinuria-PNH; Hereditary spherocytosis)
—Enzymopathies (G6PD deficiency; PK deficiency) —Hemoglobinopathies (e. g. , sickle cell anemia)
—Microangiopathic hemolytic anemias (MAHA)- T TP, HUS, DIC
Others: Traumatic, Infections, Transfusions, Hemolytic disease of the newborn

Question 4

What are the macrocytic anemias?

Answer 4

THINK EtOH!

Megaloblastic BM anemias
—abnl DNA metab: (B12 def, folate def, med assoc’d)
—herid. orotic aciduria

Non-Megaloblastic BM anemias
—Newborn
—s/p splenectomy
—reticulocytosis (shift of immat. cells)
—liver dz (lipid abnl'ty)
—MOA Unknown: hypothyr, MDS, AA, dyserythropoietic anemias,, Trisomy 21

Question 5

Hgb ref range

Answer 5

Adult men: 14-18gm/dL

Adult women: 12-16gm/dL

Question 6

Hematocrit ref range

Answer 6

Adult men: 40-54

Adult women: 37-47

Question 7

% retic ref range

Answer 7

Adult men: 1.6 +/- 0.5

Adult women: 1.4 +/- 0.5

Question 8

MCV ref range

Answer 8

80-96 fL

Question 9

MCH (mean cell hemoglobin)

Answer 9

28-33 pg/RBC

Question 10

MCHC (mean cell hemoglobin concentration)

Answer 10

33-36 g/dL

Question 11

RDW (red cell volume distriubtion width)

Answer 11

13.1% +/- 1.4

Question 12

Effect of DPG of O2/Hgb dissociation curve.

Answer 12

Increase DPG DECREASES affinity

Question 13

Bohr effect

Answer 13

low pH and high CO2 decrease affinity of Hgb for O2

Question 14

Haldene effect

Answer 14

O2 displaces CO2

Question 15

Layers of a tube of whole blood post-spin-down

Answer 15

55% - plasma (serum if clotted) which contains electrolytes, proteins, nutrients, hormones
<1% - buffy coat (plts, leukocytes)
45% - RBCs

Question 16

nl WBC count

Answer 16

4-10K

Question 17

nl platelet count

Answer 17

145-370K

Question 18

Hct definition

Answer 18

the proportion of blood volume (RBC+plasma) that is occupied by RBCs

Question 19

Hgb definition

Answer 19

the amount of hemoglobin in the blood, expressed in grams per deciliter

Question 20

estimate MCV?

Answer 20

compare RBC to nucleus of lymphocyte; should be about equal

Question 21

MCH vs MCHC

• -low?
• -high?

Answer 21

**think donut hole size

Mean corpuscular hemoglobin (MCH) is a measure of the average mass of hemoglobin per red blood cell

Mean corpuscular hemoglobin concentration (MCHC) is a measure of the concentration of hemoglobin in a given volume of packed red blood cell.

• -both low (large donut hole; hypochromic) in thalassemias or iron deficiency
• -MCH high (small/no donut hole; hyperchromic) in macrocytosis of any cause
• -MCHC high in SPHEROCYTOSIS

Question 22

anisocytosis

Answer 22

increased variability of RBC volume

Question 23

polychromasia

Answer 23

On the peripheral blood smear, the presence of reticulocytes is reflected by polychromasia, visible with Wright Giemsa stain= slightly larger, bluish/grey, with less central pallor