Anemia I Flashcards
anemia
decrease in circulating RBC mass
volume of packed RBC
Hematocrit
usual ratio of Hgb to Hct
Hgb:Hct = 1:3
RBC life span
120
- old RBCs are removed by the spleen
reticulocyte count
indication of bone marrows production of RBC
- normal 1-2%
polychromasia
reticulocytosis
- except to see lots of blue on peripheral smear
- “lots of blue means lots of new”
nomenclature for RBC size
- normocytic: normal size RBC
- microcytic: small than normal
- macrocytic: larger than normal
Mean corpuscular volume. List MCV values for Micro, Normo, and Macro
- calculated value to determine average volume of RBC
- Microcytic: < 80 fL
- Normocytic: 80-100 fL
- Macrocytic: > 100 fL
mean corpuscular hemoglobin concentration
a measure of the concentration of hemoglobin in a given volume of packed red blood cells
- normochromic vs hypochromic
anisocytosis
variation in size of RBC
red cell distribution width
measurement of variation in the size of RBC
symptoms often occur when Hgb drops below
7 g/dL
What conditions falls under microcytic, hypochromic
- iron deficiency
- thalassemia
- sideroblastic
What conditions falls under normocytic, normochromic
- Hypothyroidism
- liver disease
- chronic disease
What conditions falls under macrocytic (megaloblastic)
- folate defiency
- vitamin B12 deficiency
Presentation
- MCV low <80
- Low Fe
- High TIBC
- low ferritin
- iron deficiency: determine cause
Presentation
- MCV low <80
- Low Fe
- Normal or low TIBC
- normal or high ferritin
- anemia of chronic disease
- infection
- inflammation
- malignancy
Presentation
- MCV low <80
- normal to high Fe
- any TIBC
- normal to high ferritin
- sideroblastic anemia
OR
- alpha or beta thalassemia
Which test is most sensitive for iron defiency
decrased ferritin: depletion of iron stores occurs first
TIBC. High or low in iron deficiency anemia
total iron binding capacity
- measures transferrin (what serum iron binds to in the body)
- transferrin will increrase to maximize the low iron available
IS RDW increased or decreased in iron deficiency anemia
increased: variation in RBC size
Clinical presentation
- glossitis, cheilitis, koilonychia
- pica
- dysphagia
- restless leg syndrome
iron deficiency anemia
treatment of iron deficiency anemia
- **treat underlying cause
- replace iron stores
- oral ferrous sulfate 325 mg BID-TID until anemia corrected + 3-6 months
- blood transfusions (select patients)
what is considered a low ferritin level
< 12 ng/mL
Alpha thalassemia is a deletion of
one or more of the four alpha globin chains
normal Hb genetic makeup
aa/aa + B/B
list number of deletions of a-globin chains and manifestation in alpha thalassemia
- 1 deletion: silent carrier (-a/aa + B/B)
- 2 deletions: alpha-thalassemia trait
- mild microcytic anemia
- 3 deletions: hemolytic anemia
- 4 deletions: hydrops fetalis
- not compatible with life
beta thalassemia
reduced or absent beta-globulin chains
list number of deletions of b-globin chains and manifestation in beta thalassemia
- dysfunction of one B-globin chain -> thalassemia minor
- asymptomatic
- microcytic, hypochromic anemia
- severe dysfunction of both B globin chains -> thalassemia major (cooley anemia)
- patients die before age 30
poikilocytosis
abnormal shaped RBC
RDW is normal or elevated in thalassemia
normal
diagnosis of thalassemia
Hgb electrophoresis
peripheral smear of thalassemia
- target cells
- teardrop red cells
- poikilocytosis
treatment of thalassemia
- folic acid supplementation
- regular transfusion schedule (severe cases)
- hematopoietic cell transplantation (severe Beta-T)
- Avoid iron supplementation**
presentation
- MCV normal to decreased
- Serum FE normal to decreased
- TIBC: normal to decreased
- Ferritin: normal to increased
anemia of chronic disease/inflammation
What is Myelodysplastic syndromes
- acquired disorder to hematopoietic stem cells
- ineffective blood cell production
Myelodysplastic syndromes can progress to what conditions
- marrow failure
- leukemia
What is Sideroblastic anemia
- hereditary or acquired RBC disorder
- abnormal RBC iron metabolism -> diminished heme synthesis
- bone marrow produces ringed sideroblasts
what are sideroblasts
- normally found in bone marrow of healthy people
- nucleated RBC precursors (erythroblasts)
- contains iron-containing granules in cytoplasm
- **abnormal form: ringed
sideroblastic anemia is most often a subtype of what condition
myelodysplastic syndrome
Presentation
- MCV varied
- moderate anemia (Hct 20-30%)
- normal or elevated ferritin
- marked anisocytosis and poikilocytosis
- systemic iron overload
sideroblastic anemia
what are some other causes of sideroblastic anemia
- chronic alcoholism
- lead poisoning
- medications
- chronic infection or inflammation