Anemia and the CBC Flashcards
anemia
is a symptom, not a disease
decrease in RBC mass or Hg - decreased O2 carrying capacity
anemia measure
<2.5 percentile value of reference range
anemia lab values
2 standard deviations away
95% of population within 2 SDs
erythrocytosis polycythemia
high RBC count
severe anemia
fainting
chest pain
angina
heart attack
conjunctiva
is pale in anemic patients
jaundice
seen in anemia
hemolytic process occuring
3 reasons to be anemic
blood loss
hemolysis
decreased RBC production
blood loss
acute
chronic - menstruation, GI bleed
hemolysis
genetic defects - inherited or acquired
Ab- mediated destruction
microangiopathic hemolytic anemia
infection
toxic/chemical injury
deficient DNA synthesis
B12 and folate deficiency
deficient hemoglobin synthesis
iron deficient anemia
parvovirus B19
infection of RBC progenitors
MCV
mean cell volume
80-100
microcytic 100
microcytic anemia
iron deficient
thalassemias
sideroblastic
normocytic anemia
anemia of chronic disease
blood loss
BM suppression
macrocytic anemia
B12 folate deficiency
ethanol consumption
anemia of chronic disease
normocytic anemia
ethanol abuse
macrocytic anemia
MCHC
mean cell Hg concentration
chromaticity
33-37
range of MCHC
33-37
reticulocytes
immature RBCs
has rough ER - form net in cytoplasm
remnant RNA stains blue with methylene blue**
macrocytic
MCHC values are invariably low
relative Hg production not increased at greater rate than cell increase in size
normal reticulocyte
larger than mature RBC
circulate 2-3 days
usually 2% of cell population
rate of production and release of RBCs by marrow into peripheral blood
retic count
pediatric retic count
3-7%
adult retic count
0.5-1.5%
reticulocytosis
increase in retic count
3-4 days after episode of acute hemorrhage
peak 6-10 days - 6-8%
corrected retic count
to adjust for decreased existing number of red cells in peripheral blood
retic index = retic count x patient Hct / 45%
common causes of reticulocytosis
acute blood loss
acute hemolysis
hemolytic anemia
response to therapy
impaired globin synthesis
alpha and beta thalassemia
microcytic anemia
decreased/abnormal synthesis protoporphyrin-heme
lead intox anemia
sideroblastic anemia
microcytic anemia
abnormal Hg
hemoglobin C disease
microcytic anemia
microcytic anemia with low ferritin
iron deficient
Hg electrophoresis
assess for thalassemia
acquired microcytosis with microcytic anemia
anemia of chronic disease
microcytic anemia low ferritin high TIBC low serum iron high sTfR
iron deficiency anemia
serum ferritin
50-170
TIBC
250-400
soluble transferrin receptor
2-5
ferritin
20-250
microcytic or normocytic anemia high ferritin low TIBC low serum iron sTfR normal
anemia of chronic disease
microcytic anemia high ferritin low TIBC high serum iron low sTfR
sideroblastic anemia
first check with normocytic anemias
retic count
-if high - hemolysis or blood loss
high retic count
hemolytic anemia
positive coombs test
hemolytic anemia
IgG coating RBCs
low haptoglobin
hemolytic anemia
binds free Hg - so less of it
HgB A2 and F
hemolytic anemia - thalassemia
Hgb S
hemolytic anemia - sickle cell
elevated bilirubin
with hemolytic anemia
high RDW
variation in size of RBC - anisocytosis
hemolytic anemias
measure of variable size of RBCs
RDW
direct coombs test
patient RBCs are washed and incubated with antihuman Abs (coombs reagant)
ethanol abuse
folic acid deficiency
macrocytic anemia with high retic count
bleeding
recent tx with B12 or folate
hemolytic anemia
labs for macrocytic anemia
retics
peripheral smear
B12/folate level