Anemia Part I Flashcards
Fundamentally, anemias are generally due to either (1) of red cells and these two major types can be distinguished by (2)
- decreased production or increased destruction
2. the reticulocyte count
Reticulocyte count in anemias of decreased production
low reticulocyte count
(1) are newly produced red cells and can be identified by their larger size or by stains that identify their (2)
- Reticulocytes
2. ribosomes.
The normal range for reticulocyte count changes based on age since newborns have (1)% reticulocytes in their blood whereas adults have (2)% reticulocytes in their blood.
- 2-6%
2. 1-2%
Laboratories often provide a reticulocyte index which is a derived value based on the (1) and the (2). It is based on the idea that there are fewer red blood cells in anemia so the percentage of reticulocytes (3) the number of reticulocytes.
- RBC count
- reticulocyte count
- underestimates
Reticulocyte count in anemias of increased destruction
elevated reticulocyte count
Red cell indices are measurements and derivations which describe the (1) of red blood cells (RBCs).
- size and color
The (1) is the measured number of particles of a specific size (bigger than (2) but smaller than (3) present in a microliter of blood measured by light scatter.
- RBC count
- platelets
- white cells
The (1) is the volume in femtoliters of blood per RBC and is directly determined by measuring the mean volume of cells based on light scatter.
mean corpuscular volume (MCV)
How is hematocrit determined?
Measure the MCV and the RBC count by light scatter
MCV = hematocrit/RBC count
hematocrit = MCV x RBC count
MCH =
mean corpuscular hemoglobin
MCH = Hb/RBC count
MCHC =
mean corpuscular hemoglobin concentration
MCHC = Hb/Hct
Microchromic
low MCH or MCHC
Normochromic
normal MCH or MCHC
Microcytic
low MCV due to low volume per cell
Macrocytic
high MCV due to high volume per cell
macrocytic anemias tend to be due to?
impaired bone marrow maturation
microcytic, microchromic anemias tend to be due to ?
problems with red cell production or synthesis
Patients with severe anemia due to any cause often have what s/s?
weakness
tire easily
DOE
pale skin and oral mucosa
Hypoxia as a consequence of anemia can also cause CNS problems including:
headache, blurry vision, and confusion or lethargy.
If the anemia is due to acute blood loss and is leading to hypovolemic shock (shock is a decrease in BP) than (1) can result as a consequence of ?
- oliguria or anuria
2. pre-renal azotemia.
Acute blood loss can rapidly lead to?
decreased intravascular volume, cardiovascular collapse and death
The initial evaluation of a bleeding patient requires an assessment of ?
vascular volume (BP predominantly)
How might an acute blood loss anemia lead to an iron deficiency anemia?
If the patient bleeds into tissues then the hemoglobin is recaptured. If the bleed is into the GI tract or outside the body then there will be iron loss.
The resulting reduction in oxygenation due to decreased blood delivery of oxygen induces the kidneys to produce erythropoietin which stimulates the proliferation of (1) within the bone marrow.
- CFUe (colonies of later erythroid progenitors)
Blood loss can also lead to (1) production along with increased secretion of (2) which will increase the number of (3).
- increased platelet
- adrenergic hormones
- white blood cells
measurements of Hb, Hct, or RBC count in initial acute blood loss
will be normal (there is less blood but it has the same concentration)
measurements of Hb, Hct, or RBC count in acute blood loss a few hours later
decreased hematocrit
due to hemodilution as blood volume is restored caused by shifting of water from interstitial fluid to plasma
Five to seven days after the bleed, the progency from the CFUe mature and appear as (1)
- reticulocytes.
Chronic blood loss outside of the body (including into the GI tract, respiratory tract, urinary tract, female reproductive tract) leads to (1) which must be viewed as a medical finding and not a specific diagnosis.
- iron deficiency anemia
Why is it important to be concerned about iron deficiency anemia in the elderly?
Many older patients with iron deficiency anemia have early cancers
(1) is a very common cause of GI bleeding and iron deficiency anemia in people over 50.
- Colon cancer
Iron deficiency anemia is ____cytic and ____chromic. Levels of MCV, MCH/MCHC, Hb, Hct, and RBC?
micro and micro
reduced MCV, MCH/MCHC, Hb, Hct, and RBC count
Iron levels and TIBC levels in iron deficiency anemia?
iron is reduced and TIBC (total iron binding capacity) is increased
Reticulocyte count in iron deficiency anemia?
low