Anemia 1 Flashcards
Anemia definition?
↓ in circulating RBC mass
Normal Anemia Values:
Women
Men
Hgb:Hct
women: Hgb < 12 - 16 g/dl, Hct < 35 - 45%
men: Hgb < 14 - 18 g/dl, Hct < 40 - 50%
1: 3
Hct =
Hct = vol of packed RBC
RBCs removed by what organ?
spleen
Steps in Development of RBCs
Erythropoiesis
Pluripotent Stem Cell > Erythroid Colony Forming Unit (CFU-E) > Proerythroblast > Nomoblast > Reticulocyte > Erythrocyte (RBC)
What is a Retic Count?
count of reticulocytes,
indication of RBC production,
retics stain blue (lots of blue = lots of new)
Value of normal retic count?
0.5 - 2.5%
Retics take how long to mature into RBCs once released into blood stream?
1 - 2 days
3 causes of anemia?
1) ↓ RBC production
(iron, B12, folic acid deficiencies, chronic dx)
2) ↑ RBC destruction (hemolysis)
3) Blood loss (bleeding)
3 RBC sizes?
normoblast
microblast
macroblast
Mean Cell Volume (MCV) is?
calculated value used to determine average RBC size
MCV =
hct / red cell count
Normal MCV values?
80 - 100 fl
Microcytic MCV value?
< 80 fl
Mean Cell Hemoglobin (MCH) and
Mean Cell Hgb Concentration (MCHC) test what?
amount of hgb in RBCs
MCH =
normal value =
MCH = hgb / RBC
normal = 26 -34
MCHC =
normal value =
MCHC = hgb / hct
normal = 32 -36
Red Cell Distribution Width (RDW) is?
indicator of degree of variation in size of RBC
Normal RDW =
11 - 15%
Anisocytosis?
variation in size of RBC > 15%
Standard lab tests for anemia eval? (4)
CBC
RBCs (MCV, MCH, MCHC, RDW)
Retic Count
Peripheral smear
Signs/sxs of anemia U not noticeable until Hgb of what?
< 10
Anemia sxs? (6)
fatigue/weakness, lightheaded/syncope (U) w/ orthostatic ∆s, dyspnea OE, palpitations, HA, Pica for ice, clay, starch
Anemia signs?
pallor, ↑ pulse, ↓ BP w/ ortho, systolic murmur, hyperdynamic impulse, heme in stool (if blood loss)
Anemia late signs? (3)
glossitis
cheilitis
koilonychia
3 categories of Anemia?
1) Hypochromic/Microcytic
2) Normochromic/Normocytic
3) Macrocytic
Hypochromic/Microcytic caused by?
iron deficiency
thalassemia
sideroblastic
lead poisoning
Normochromic/Normocytic caused by?
hypothyroidism
liver dx
chronic dx
Macrocytic caused by?
folate, B12 deficiencies
Fe Deficiency Anemia (IDA) caused by? (4)
(U) menstrual
↑ requirements w/ pregnancy
GI blood loss
↓ absorption
IDA typical Labs Results:
MCV
Color/size
RDW
MCV = normal in EARLY IDA
Hypochromic/microcytic
RDW = high (high variation of size)
IDA Special Labs Results:
Serum Ferritin (Fe storage protein)
Serum Fe
TIBC
Bone Marrow
Serum Ferritin = ↓
(first measure to fall in IDA, if low then diagnostic)
Serum Fe = ↓ to < 50 µg/dl
TIBC = ↑ to > 450 µg/dl
**order Serum Fe and TIBC together
Bone Marrow = absent Fe stores
What is diagnostic test for IDA?
Ferritin below 10 ng/dl (or 10 mg/ 100 mL)
↓ Ferritin U precedes other signs of Fe deficiency
First move in treating IDA?
Identify cause
IDA tx?
1) tx cause
2) replace Fe
3) blood transfusion if cerebrovascular or cardiopulmonary sxs
Fe replacement med?
oral ferrous sulfate 325 mg BID - TID
until corrected and + 6 add’l months
IV if can’t absorb
Thalassemias are?
Result in?
(C) in what ethnicities?
inherited Hgb production disorders
↓ prodxn of α- or β- globulin chains
Mediterranean, African, Mid Eastern, Indian, Asian
Normal Hgb genes?
αα/αα + β/β
α-thalassemia results in?
↓ in 1 α =
↓ in 2 α =
↓ in 3 α =
↓ in 4 α =
↓ fxn of any of the α-chain genes:
↓ α-1 = mild microcytosis
↓ α-2 = mild hypochromic/microcytic
↓ α-3 = hemolytic anemia, splenomegaly
↓ α-4 = hydrops fetalis (stillbirth)
β-thalassemia results in?
dysfxn of 1 β-globulin chain =
dysfxn of both β-globulin chains =
↓ or absent β-globulin chains:
1 β = Thalassemia Minor
(asymp; hypo/micro)
2 β = Thalassemia Major (Cooley’s)
(U) death < 30 yo
Thalassemia typical Lab Results:
MCV
color/size
RDW
shape
will also see
MCV = low
color/size = hypo/micro
RDW = normal (all RBC are small)
shape = Poikilocytosis (abn shapes)
Target Cells
Nucleated RBCs
Thalassemia tx? (2)
Goal of tx?
1) transfusion (1-2 units/month)
2) Fe chelation (for Fe overload from transfusions)
Goal = Hgb > 9 g/dl
(prevent skeletal issues)
2 kinds of Microcytic Anemia?
1) IDA
2) Thalassemias
Testing Summary for Microcytic Anemia
1st and 2nd tests
1st test: Serum Ferritin
if low = IDA
otherwise >
2nd tests: Serum Fe and TIBC
Anemia of Chronic Dx (ACD) common result of?
inflammatory dx, malignancy, autoimmune dx, chronic infections
ACD typical Lab Results:
color/size
Ferritin
may also see
color/size = Normo/Normo
Ferritin = normal or ↑
may also see microcytes
NO diagnostic test
ACD tx?
Treat underlying dx
(P) erythropoetin
Myelodysplastic Syndrome is?
Results in?
May progress to?
Acquired hematopoietic stem cell disorder
refractory anemia
bone marrow failure or leukemia
Myelodysplastic Syndrome etiology?
idiopathic or
2º to radiation, chemo or toxins
Sideroblastic Anemia is?
heterogeneous disorders w/ abnormal RBC Fe metabolism
Sideroblastic Anemia etiology?
hereditary or
acquired from toxins, malignancy, chronic inflamm or infections
Sideroblastic Anemia typical Lab Results:
MCV
Serum Fe
Bone marrow
may also see
MCV = ↑, ↓, or normal
Serum Fe = normal or ↑
Characteristic bone marrow findings
Anisocytosis
Poikilocytosis
Ringed sideroblasts
Fe deposits
Sideroblastic Anemia tx?
tx underlying cause
supportive
DDX Process for Anemias:
Fe, TIBC and Ferritin
Fe ↓ and TIBC high
Ferritin ↓ (Fe/TIBC < 16%) = ID
Fe, TIBC and Ferritin normal = Fe deficiency is unlikely
Fe and TIBC ↓ = (P) ACD
Ferritin normal or ↑
Fe ↑ and TIBC normal = (P) Thalassemia
Ferritin ↑
