Anemia Flashcards
How are blood oxygen levels managed?
Negative feedback loops
What is the sequence of events when blood oxygen levels are low?
- Stimulus - hypoxia (due to low RBC count, low amount of hemoglobin, or decreased availability of O2)
- Tissues in the kidney sense low O2 and release Erythropoietin (EPO)
- EPO stimulates bone marrow to produce more RBCs
* B12 and folate are necessary in order to produce blood iron
What is the factory for the production of RBC’s?
Bone marrow
What detects low O2 and releases EPO to stimulate bone marrow?
Healthy kidneys
What “ingredients” are necessary for RBC’s to be built?
B12 and folate in the gut
What are some causes of anemia?
- Bone marrow disfunction –> cancer, chemo, radiation, aplastic anemia
- Renal disease –> often tx with exogenous EPO
- Malabsorption/malnutrition –> B12, folate deficiency from diet
- Consumption –> bleeding, hemolysis
Anemia is a ______ not a _______
Symptom, Disease
If a pt has Hgb <12 and MCV <80 what test should you order? (MCH <26)
Iron panel
Microcytic hypochromic
What are the two most important values on an iron panel in terms of diagnosing anemia?
Ferritin and TIBC (total iron binding capacity)
What are abnormal values of ferritin and TIBC that would cause you to diagnosis someone with iron deficiency anemia?
LOW ferritin and HIGH TIBC
If an iron panel comes back normal for a pt with Hbg <12 and MCV <80 what test should you now order?
Gel electrophoresis
Once you’ve ordered gel electrophoresis, what is the most likely diagnosis?
Thalassemia
What do RBC’s look like in microcytic hypochromic anemia?
Target cells (think the target logo)
What does total iron binding capacity (TIBC) measure?
The amount of proteins available for binding iron (in healthy individuals, you want to see low TIBC because it means you have enough iron to bind to all the proteins)
What are long term iron stores called?
Ferritin (want high long term stores)
What is treatment for iron deficiency anemia?
Start with iron supplementation (oral or IV) which searching for a cause
What is the number one cause of iron deficiency anemia in the world?
Parasitic disease
What is the intense craving for nonfood items?
Pica
What is the craving for ice and when is it commonly seen?
Pagophagia. Commonly seen in the iron-deficient state
If a pt has Hgb <12 and MCV 80-100 what lab should you order?
Reticulocyte count
What does a high reticulocyte count indicate in a patient with normocytic anemia?
There is a bleed somewhere internally and you need to find it, next step = peripheral blood smear
What does a low reticulocyte count indicate in a patient with normocytic anemia?
Abnormally functioning bone marrow, next step = bone marrow biopsy
What are schistocytes?
Helmet shaped cells or fragments of RBCs that have been lysed
What should you order if schistocytes are present?
Haptoglobin (decreased in times of lysis <50) and LDH (elevated >200)
