Anemia & Labs Flashcards
describe the trends in Hgb/Hct levels throughout the lifespan for both M/F
At birth high. Childhood drops, increases in adolescents at which stays same for females, but increases for males. During pregnancy gets lower. Postmenopause slightly higher.
What indicates anemia based upon RBC count, Hct, Hgb readings
Men < 14 & <4.2
how would you measure the mean cell volume (MCV) for a RBC indices
Hct/RBC count
what is a normal range for MCV
80-100
which anemia type would be classified <80 otherwise known as microcytic anemia
iron deficient
which anemia type would be due to a MCV > 100
Vit. B12 def. & Folate
the terms hypochromic and hyperchromic refer to:
concentration of Hgb in RBC’s (MCH/MCHC) typically range 32-36 or 26-34
which test would you order to check reticulocyte counts
blood smear
which types of d/o would result in +schistocyte’s on a peripheral b. smear
Anything with trauma fragmenting the RBCs such as: MAHA (TTP), HUS, DIC
What is the mainstay treatment for one with sickle cell anemia
hydroxyurea; along with oxygen, hydration, & pain control…
what does hydroxyurea do
triggers bone marrow to make more Hgb F (fetal) subsequenctly lowering Hgb S
This is the only anemia that has an increased MCHC
hereditary spherocytosis
What is the main diagnostic test for hereditary spherocytosis?
osmotic fragility test.
How would you treat hereditary spherocytosis
Daily folate, splenectomy is prime tx.
This type of anemia presents with difficulty to swallow cold, a positive Coombs test & acrocyanosis
IgM/Complement (cold)
This anemia presents with (triad) sudden onset hemolysis, jaundice, & enlarged spleen and a positive coombs test
IgG (warm)
The G6PD deficiency is most prevalent in which population
African or Mediterranean descent that is x-linked recessive
what is pernicious anemia
autoimmune disease where intrinsic factor is not produced
in which anemic state would you see neuropathy
vitamin B12 deficiency
The schilling test measures if body is absorbing vitamin B12 for PA. What is the more common test…
EGD, Biopsy for atrophy of gastric parietal cells/increased infiltration of goblet cells, & **measure anti-parietal cell antibodies
at what rate would you look to the Hct decline for an indication of anemia or blood loss
3% per week or more
A pt’s Hct has fallen 1% in the last week. Does this indicate anemia?
No, must be 3% or more per week
what Reticulocyte index would you look for as a sign of acute blood loss or anemia
> 2.5
In general, why do pts with sickle cell anemia eventually develop organ failure?
the sticky, viscosity of the RBC due to an influx of Ca and release of K changes the membrane to stiff- unable to pass capillaries, adhere to small venules making an ischemic state
why are pt’s with sickle cell most likely at increased risk for infections from encapsulated organisms
the spleen is frequently lost w/in first 18-36 months of life.
what other complications can you see from Sickle cell anemia due to the vaso-occlussive property
retinopathy, MI/Strokes, kidney failure, bone/jt-osteomyelitis & avascular necrosis. *Lungs-acute chest syndrome with cough/fever/sob/pain
Distinguish why the electrophoresis is better than the sickle-dex test
the sickle-dex test doesn’t help differentiate btw a carrier or someone who has the disease…
what percent of Hgb S will appear on electrophoresis btw a carrier and disease
Someone with the trait will have 40% whereas w/ disease >85%
this pt presents with aplastic crisis (fatigue, pallor, etc) and has been known to possess sickle cell dz…what is a likely pathogen
parvovirus B19
if someone is infected with salmonella develops osteomyelitis; why would you think sickle cell dz
spleen is impaired and can’t rid body of encapsulated organism.
what would u tx a patient with who is having a sickle cell crisis
ER, oxygen, hydrate, pain control (morphine)
what would you tx a chronic sickle cell pt with primary
hydroxyurea
This anemia is predominant in northern europeans
hereditary spherocytosis
How would you visualize the presence of increased bilirubin due to hereditary spherocytosis
pigmented gallstones.
this type of autoimmune d/o is often associated with SLE (lupus) and others like leukemia or lymphoma
IgG mediated (warm)
this autoimmune HA most often affects extravascular organs like spleen. liver, etc
IgG (warm)
this autoimmune HA affects intravascular structures like blood vessels themselves
IgM (cold)
This is the only type of anemia that presents with pruritis as a symptom
polycythemia vera
If you were to find a pt with an anemia who complains of itching, what else are you likely to find:
HA, dizziness, tinnitus, blurred vision, fatigue, dyspnea, abd pain
in addition to the splenomegaly and hepatomegaly in pts with polycythemia vera, this unique findings may be present
gout
what are some of the main treatments for polycythemia vera
*prevent thrombosis due to hyperviscosity. maintain Hct <45% myelosuppression with hydroxyurea. anagrelide 4 thrombocythemia, allobutrinol for hyperuricemia, antihistamine for pruritis splenectomy
this anemia presents with pancytopenia
aplastic anemia
café au lait spots and short stature is often associated with this:
Fanconi’s anemia
this disorder is often characterized by bone marrow failure which results in pancytopenia & replacement of fat into the cavity & is acquired in a bimodal prevalence pattern
Aplastic anemia
what are some treatments of aplastic anemia
bone marrow transplant BEST therapy for young when HLA-match; immunosuppressants (better w/ cyclosporin), red blood cell transfusions
Describe the RDW & what its normal range should be? What is indicated above the range?
RBC distribution width, normal 11-15% and anything > 15% should indicate a variety of sizes aka anisocytosis (this is seen in microcytic anemia)
Howell Jolly bodies on a smear can indicate this
absence of a spleen or leaving b.marrow while incompletely mature
acanthocytes such as spur cells or burr cells indicate
liver dz and renal failure respectively
rouleaux formation on a blood smear indicates plasma globulin causing RBCs to adhere to another looking stacked-what dz is this prevalent in
multiple myeloma
what reticulocyte count # would indicate the B. marrow is compensating for anemia? Hypoproliferative?
> or equal to 2 compensated vs. <2 hypoproliferative
where is iron distributed throughout the body?
65% Hgb, 4% myoglobin, 30% stored as Ferritin in liver/spleen/b.marrow and rest is in serum bound to apotransferrin
how would you expect the total bilirubin and LDH to change in event of hemolysis, liver dz, and leukemia
It would be raised. (unconjugated w/ hemolysis; conjugated-liver dz)
Sxs of PICA, glossitis, spooning of fingernails, anglular cheilosis, plummer-vinson syndrome would all indicate?
iron def. anemia
what r some causes of iron def anemia
GI loss/trauma pregnancy, breast feeding, malnutrition, celiac, crohns gastric surgery
what is the tx for iron def anemia
ferrous sulfate 325 mg BID/TID checking CBC 2-3 months, continuing supp. 3-6 mnths…. if GI upset give gluconate, furonate, or parenteral IV iron
what are some common causes of tx failure in iron def anemics
compliance or misdiagnosis
what are the lab results for pts with anemia due to chronic dz
ferritin normal/high with low serum Fe and TIBC
how would u treat anemia due to chronic dz
purified recombinant erythropoiten (SQ)
how many genes for alpha hemoglobin would you expect to be defected in a pt with Hgb H dz
3
in a pt with one missing or defective alpha hemoglobin gene would you expect to see signs/sxs?
no
what is the most likely prognosis for a pt with hydrops fetalis or Barts Hgb?
death, stillbirth
which deficiency is most likely in a pt who was born in SE asia or china
alpha thesssalemia
what is indicated with a Mentzer index < 13
thessalemia
what is indicated with a Mentzer index > 13
iron def anemia
how would you distinguish btw alpha thess. minor/trait vs .Hgb H dz?
trait would only have mild exercise intolerance vs. Hgb H or Barts would have pallor splenomegaly, more pronounced lab lowering on Hct (22-32%) low MCV, b. smear with poikulocytes and an increased reticulocyte count.
how would you treat HGb H
Folic acid, regular trasnfusions + deferoxamine, splenectomy, allogenic BM transplant, *Avoid oxidative drugs
how would you describe beta thessalemia intermediate
chronic HA, mild bony deformities, most live into adulthood, but need transfusions only after post-stressors
what is indicated by Cooley’s anemia
beta thessalemia major
what are some sings/sxs of cooleys anemia (Beta thessalemia major
growth failure, remarkable bony deformities, jaundice, ineffective erythropoietin
hemosiderous refers to what complication often seen in beta thessalemia major pts/
iron overload
what complications from beta-thessalemia major cause pts to die in their 30s
heart failulre, cirrhosis, endocrinopathies
with Hgb less than 10 what are pts at an increased risk for developing in beta–thess. major
bony deformities
what do you want to avoid giving pts with beta-thess major/cooley’s anemia
iron supplements b/c they are already at an increased risk for iron overload (hemosiderous)
what are the tx modalities for a pt with cooley’s anemia/ beta-thess major
folic acid, transfusion dependent, splenectomy, allogenic BMT,
describe the epidemiology for beta-thess
greeks/mediteraneans
how would you distinguish btw alpha-beta thessalemia? which test would you order
electrophoresis would be normal for alpha but variable in beta with increased Hgb A2 and F
describe the hemoglobin subtypes
adult hemoglobin 96-98% (2a2b) adult2 (1.5-3.2%)(2a2delta) fetal .5-.8 (2a2gamma)
describe plummer vinson syndrome & what anemia is it associated with
pt w/ trouble swallowing b/c of tissue blocking some of the esophagus often associated with iron def. anemia
what is an increased level of ZnPP (zinc protoporphyrin) a sign of
iron def. anemia
what are some causes of aplastic anemia
inherited, idiopathic >50% medications/chemicals/chemotherapy (benzene, insecticides); infections radiation
