Anemia Flashcards
physiologic understanding of anemia
- Hematopoiesis: production and turn over of RBC
- Erythropoiesis: the process of RBC production
- Iron: fuel of RBC , B12, folate: all have crucial roles in erythropoiesis
CBC
- wBC: leukocyte count
- Hemoglobin: blood ability to carry 02
- hematocrit: volume of RBC of volume of whole blood
- Platlet: thrombocyte count
- RBC indices:
a. MCV: the size of RBC
b. MCH: the amount of hemoglobin in RBC
C. MCHC: concentration of hemoglobin per unit volume
MCV meaning
MCV < 80 microcytic anemia
MCV > 80-100 normocytic anemia
MCV > 100 Macrocytic anemia
Microcytic anemia = smaller RBC, iron deficiency
Macrocytic anemia= B12 deficiency or folic acid deficiency , impaired DNA synthesis , RNA is unaffected
MCH vs MCHC
Mean corpuscular hemoglobin:
Quantifies Hgb per RBC
Normochromic 27-33
Hypochromic <26
Mean corpuscular Hemoglobin concentration:
Quantified HgB per unit
normal 32-36%
Reticulocytes : retic count measures how fast RBC or released
reticulocytes are immature RBCs to maturein body
elevated: hemolysis = hemolytic anemia, acute blood loss , nutrition defieciency that decreases red blood production.
Low = reflection of erythropoiesis in developing erythroblasts
Lactade dehydrogenase (LDH)
found in all body tissues
regenerate glucose, glycolysis
High= hemolytic anemia because of high regeneration
concentration of LDH in RBCs
Haptoglobin
plasma protein
binds free hemoglobin
clinical significance = low to absent is hemolytic anemia
Ferritin and Fe+
Ferritin: assess the level of iron stores
needed for cell growth and differentiation
Excess= toxicity and death
Iron deficiency = limits 02 delivery to cells
Transferrin , TIBC and % saturation
Transferrin: carries free iron(protein plasma takes free iron from food to liver, spleen, and bone marrow
TIBC: capacity to bind iron to transferrin
Anemia Causes
- blood loss
- poor nurtition
- bone marrow anemia
- iron deficiency anemia
- sickle cell anemia
- pernicious anemia
- aplastic anemia
- anemia of chronic disease
- aplastic anemia
- hemolytic anemia
- kidney disease
- thalassemia
- anemia r/t medications
- pregnancy
- alcohol-related anemia
- other
anemia & MCV differentials
Microcytic: iron deficiency, thalassemia, anemia of chronic disease, sideroblastic
Normocytic: Hemolytic, acute blood loss, anemia of chronic disease, aplastic anemia, chronic renal disease, autoimmune (CLL, SLE), hypersplenism, infection, trauma, enzyme deficiency, sickle cell
Macrocytic: vit B 12 deficiency, folate deficiency, myelodysplastic, liver disease , alcohol use, thyroid disease
Marrow production defects:
hypoperliferation
Red blood cell defects:
ineffecive erythropoiesis
Decreased red cell survival:
blood loss / hemolysis
Diagnosis:
MCV= determines micro, macro, or normal
Retic count= key to the classification of anemia, elevated hemolyzing, or hemorrhaging
Erythropoiesis: Macro or microcytosis is a maturation disorder of RBCs
hypoperliferative anemia
75% of all cases
low reticulocyte with normal morphology
reticulocyte production <2
Causes:
mild / mod Fe deficiency
marrow damage
inadequate EPO stimulation
impaired 02 needs r/t metabolic dx
Maturation anemia
key points: low reticulocyte with both macrocytic/microcytic, reticulocyte production < 2
Two categories:
1. macrocytosis ( nuclear maturation)
causes low B12, folate, drug damage, myelodysplasia
- Cytoplasmic maturation: microcytosis
causes: Fe deficiency, thalassemia, sideroblastic
Hemolysis anemia ( blood loss)
Key points: Increase in RBC production, reticulocyte > 2.5, hemolysis resulting in reticulocyte production 3 x normal, hemorrhagic less retic production dt limited Fe
Causes:
hemorrhage, , hemoglobinopathy, sickel cell and thalassemia, hemolytic : intravasculare vx extrvascular
