Amemia- Johns Flashcards
Anemia
Reduction in a major RBC measurement:
- Hemoglobin concentration
- hematocrit
- RBC count
Two ways you become anemic?
Not enough production or you are losing/destroying RBC too fast.
Reticulocyte
RBC precursor
- If you are losing cells too quickly then reticulocytes are booted out of marrow and into blood.
- If you aren’t making enough RBCs then reticulocyte level =normal
Biologic/kinetic approach
Increased retics = blood loss and hemolytic processes
-25% of hemolytic anemia will have normal retics
When are retic counts most helpful?
if extremely low or greater than 3%
** must be adjusted for patient’s hematocrit
Morphology approach:
big vs. little ==MCV (mean corpuscular volume
MCV>100 (norm 80-100)= macrocytic
B12, folic acid deficiency
Drugs that impair DNA synthesis
Anemia with MCV 80-100 = Normocytic
Types?
AOCD
Mixed deficiencies
Renal failure
MCV
- Iron deficiency
- Thalassemia trait
- AOCD (30-40%)
- Sideroblastic anemias
Macrocytic anemia = B12/folate Deficiency
B12 & folate are needed for DNA synthesis deoxyuridate to thymidylate
b12 def
Folate def
B12: usually decreased gastric secretion of INTRINSIC FACTOR = cant absorb B12
Folate: poor dietary intake
-alcohol,
increased demand in pregnancy
B12/Folate Def Dx:
Smear: Macrocytic (High MCV) RBCs
- hypersegmented neutrophils
- modest neutrophenia
Long term B12 deficiency?
Subacute combined degeneration of dorsal and lateral spinal columns :(
Reasons for iron deficiency?
Increased iron requirements (blood loss, GI disorders, prego, lots of blood donations)
Inadequate iron supply (poor intake, malabsorption, gastric bypass)
Iron def lab testing
- decreased hemoglobin
- microcytic MCV
- decreased serum iron
- increased/normal TIBC
- Decreased iron saturation
- Fe/TIBC ratio will be low
