Anemia Flashcards
hemoglobin range for anemia
men<14 women<12
Reticulocyte normal range, amount of time in bone marrow and peripheral blood, and RBC lifespan
normal 0.5-2%
3 days in marrow, 1 day in peripheral blood
120 days
causes of anemai
Decreased RBC production
- nutritional deficiencies (iron, b12/folate)
- chronic disease
- ineffective erythropoisis
Increased RBC destruction
-hemolysis
Blood loss
- menstrual
- GI
- Trauma
nomenclature for RBC size
and mean corpuscular volume MCV of each
- normocytic: normal size 80-100
- Microcytic= small <80
- Macrocytic=large > 100
what does MCH measure
mean corpuscular hemoblobin (content in RBC)
-chromic
what does MCHC measure
mean corpuscular hemoglobin concentration (concentration per RBC)
what is normal red cell distribution width? RDW
normal RDW 11-15%
Three main categories of anemia and their cause
- microcytic hypochromic: iron deficiency, thalassemia, sideroblastic anemia
- normocytic normochromic: hypothryroidism, liver disease, chronic disease
- macrocytic (megaloblastic): folate defieciency and vitamin B12 deficiency
Iron deficiency anemia IDA major causes
- blood loss- MOST COMMON
- decreased dietary intake-decreased iron absorption (upper GI) such as celiac celiac disease, bariatric surgery, H. pylori infection
Iron deficiency anemia diagnostic study key points
- decreased RBC
- microcytic, hypochromic
- decreased ferritin
- decreased serum Fe
- increase total iron binding capacity TIBC
- increase RDW
what is poikilocytosis
varying shapes of RBCs
what is anisocytosis
vary in RBC size
clinical manifestations of IDA
atrophic glossitis angular cheilitis koilonychia Pica (craving for ice) dysphagia esophageal webs : plummer-vinson syndrom restless legs sydrome
Treatment IDA
- treat underlying cause
- replace iron stores with oral ferrous sulfate 325mg TID on empty stomach
- appropriate response is increase rate of 2-4 g/dl every three weeks until baseline
- continue for 3-6 months
what is thalassemia
inherited hemoglobinopathy
can lead to ineffective erythropoiesis and hemolysis
- variable degrees of anemia and extramedullary hematopoiesis
- can lead to bone changes, impaired growth and IRON OVERLOAD
what is alpha thalassemia
deletion of one or more of the four a-globin chains
1-silent carrier
2- a-thalassemia minor; mild microcytic anemia
3- hemoglobin H disease; moderate microcytic anemia (chronic hemolytic anemia)
4- hydrops fetalis; usually fetal in utero
What is beta-thalassemia
reduced or absent beta-globin chain synthesis
minor: dysfunction of ONE b globin chain, asymtomatic, mild microcytic anemia
intermedia: less severe than major, non-transfusion dependent, chronic HEMOLYTIC anemai
Major: dysfunction of BOTH b-globin chains, transfusion-dependent, severe hemolytic anemia, if untreated 85% of children will die by the age of 5 years
Thalassemia lab eval key notes
- normal to increased RBC
- MCV is strikingly LOW
- RDW is normal
- retic count often elevated
- normal to increased ferritin and serum iron
- normal to decreased TIBC
- microcytic, hypochromic, target cells
-HEMOGLOBIN ELECTROPHOESIS helps with diagnosis
Thalassemia treatment
- folic acid supplementation
- AVOID IRON SUPPLEMENTATION
- hematopoietic cell transplantation
what is sideroblastic anemia
hereditary or acquired RBC disorder
abnormal RBC iron metabolism->diminished heme synthesis->iron accumulates in the cell
sideroblastic anemia presentation
Bone marrow
-RING SIDEROBLASTS: blue stained iron
peripheral smear: siderocytes with pappenheimer bodies
sideroblastic anemia causes
-aquired varient of myelodysplastic syndrome -chronic etoh -medications -copper deficiency
sideroblastic anemia diagnostic
- ring sideroblasts
- often elevated RDW
- normal to low retic count
- normal or elevated ferritin
- SYSTEMIC iron overload
sideroblastic anemia treatment
pt education refer to rheum treat underlying cause removal of toxic agents pyridoxine vit B6 transfulsion/mangment of iron overload
Anemia of chronic disease pathogenesis
a reduction in RBC production by the bone marrow, with a component due to mild shortening of RBC survival
- HEPCIDIN-INDUCED alterations in metabolism
- inability to increase erythropoiesis in response to anemia
- decreased erythropoietin EPO production
anemai of chronic disease lab findings
often mild anemia Hb 10-11
- MCV usually normocytic (normochromic)
- normal or increased serum ferritin
- retic: mildly decreased or normal
- serum fe and TIBC both decreased with inflammation
- treat underlying disease
- EPO may be of benefit
