Anemia 1

Question 0

Define hematocrit.

Answer 0

• ratio of the volume of RBCs to that of whole blood

- 3x[Hb] approximately

Question 1

4 components of peripheral blood.

Answer 1

-RBC, WBC, platelets, plasma

Question 2

MCV vs. RDW

Answer 2

• MCV: mean cell volume; average volume of red cell in specimen
• RDW: red cell distribution; measure of the variation of the RBC volume in specimen

Question 3

Parameters of microcytic, normocytic, and macrocytic.

Answer 3

-micro: MCV100

Question 4

What does it mean if a RBC is hypochromic?

Answer 4

-increased central pallor so that it is greater than 1/3 of the RBC diameter

Question 5

T/F: A reticulocyte has a nucleus while an erythrocyte does not.

Answer 5

-False, neither have nuclei. The reticulocyte is slightly larger and blue-er because it still contains rRNA

Question 6

Define anemia and give its overall result.

Answer 6

• decrease in the # of RBCs or less than the normal quantity of Hb in the blood
• overall reduction in O2 carrying capacity of the blood, leading to tissue hypoxia

Question 7

3 general mechanistic categories of anemia.

Answer 7

1. decreased production
2. increased destruction
3. loss due to bleeding

Question 8

What does a high or low reticulocyte count suggest about an anemia patient?

Answer 8

• high: destructive problem or bleeding problem; marrow is appropriately trying to compensate for reduction in O2-carrying capacity by making more RBC
• low/normal: suggests production problem; marrow is not responding appropriately to the low O2-carrying capacity, so suggests it is the cause of problem

Question 9

An anemic patient’s MCV came back to be <80, what is on your differential diagnosis? Do the same for normocytic and macrocytic anemias.

Answer 9

Micro: iron deficiency anemia, thalassemia, anemia of chronic disease, sideroblastic anemia
Normo: hemolytic anemia, hemorrhage/blood loss, sickle cell disease, anemia of chronic disease, aplastic anemia
Macro: megaloblastic anemia ( due to meds, B12/folate deficiency), liver disease, alcohol, toxins, myelodysplastic syndrome

Question 10

Who is at risk for iron deficiency anemia? What will their blood smear look like? What is the follow up for these patients?

Answer 10

• toddlers, adolescent girls, women of childbearing age, older adults with occult blood loss
• microcytic, hypochromic anemia, high RDW; can see pencil cells occasionally
• iron studies and bone marrow (usually not needed but will show decreased iron stores)

Question 11

How will thalassemia appear on a blood smear? How can you tell this apart from other smears with potentially the same characteristics?

Answer 11

• microcytic, hypochromic anemia like iron deficiency anemia BUT often has VERY low (<70) MCV and not as high of a RDW
• target cells seen

Question 12

What type of anemia can Hereditary Spherocytosis cause? What does its peripheral smear look like?

Answer 12

• hemolytic anemia due to tendency for hemolysis in spleen

- normochromic, normocytic anemia with high retic count and spherocytes are present

Question 13

What does a spherocyte look like?

Answer 13

• RBC that has lost membrane and taken on spherical shape

- lack of central pallor

Question 14

Describe the surface area: volume ratios of normal RBCs, spherocytes, and target cells.

Answer 14

• Normal is baseline
• Spherocytes is low SA:V
• Target cell is high SA:V

Question 15

Megaloblastic anemia is on the differential for what RBC size? Give 3 things that can cause it.

Answer 15

• macrocytic: most common type of macrocytic anemia

- B12 deficiency, folate deficiency, medications

Question 16

Give 2 characteristics seen on peripheral blood smear from someone with megaloblastic anemia.

Answer 16

• macrocytic RBCs

- hypersegmented neutrophils

Question 17

Common causes of global anemias

Answer 17

• iron deficiency
• other nutritional deficits like Vit A, B, folic acid
• infectious disease: malaria, hookworm, HIV/AIDS, TB
• congenital causes: hemoglobinopathies

Question 18

4 consequences of anemia

Answer 18

• increased risk of maternal and child mortality
• adverse effects on cognitive and physical development of children
• decreased work productivity
• increased postoperative morbidity

Question 19

3 things mature RBCs lack.

Answer 19

-nucleus, mitochondria (only glycolysis), ribosomes (no longer makes Hb)

Question 20

How many hemes does a molecule of Hb contain?

Answer 20

-4; one on each a2B2 subunit

Question 21

If one were to classify an anemia off of mechanistic approach vs. a morphologic approach, what would they analyze for either approach?

Answer 21

• mechanistic: retic count

- morphologic: MCV

Question 22

Reticulocyte count vs. corrected reticulocyte count.

Answer 22

• RC: % of circulating RBCs which appear to be reticulocytes
• CRC: in anemia, the total RBC is low and therefore, we need to be a correction to judge the actual number of retics being made by BM; = % retics x (actual HCT)/(ideal HCT)

Question 23

4 categories of decreased RBC production

Answer 23

1. lack of building blocks: Fe, folate, B12 deficiency
2. inability to use iron: anemia of chronic disease
3. EPO deficiency: renal disease
4. Lack of RBC precursors: aplastic anemia, toxins, immune-mediated

Question 24

3 categories of blood loss leading to anemia.

Answer 24

• obvious acute bleeding: gun shot wound
• occult bleeding: colon cancer
• induced bleeding: constant and repeated testing; excessive blood donations

Question 25

Signs and symptoms of anemia

Answer 25

• fatigue, decreased exercise tolerance, light headedness, pallor of skin, nail beds, conjunctivae; due to low O2 delivery
• rapid, bounding pulse, dyspnea, eventually heart failure; cardiovascular response