Anemias Flashcards
Anemia definition
CBC looks at
Anemia = reduction in the quantity of hemoglobin or # of RBCs –> decreased O2 carrying capacity
CBC looks at: number, size, shape, color of RBC
Hb levels reflecting total amount in RBCs
Hematocrit levels in deficit
When deficits occur for both Hb and hematocrit
Hemoglobin:
Women deficit = <120 g/L
Men deficit = <140 g/L
Occurs during: PEM, hemorrhage and other anemias
Hematocrit:
Women = <37%
Men = <40%
Occurs during: hemorrhage and water overload
Levels increase during dehydration
Other tests for anemia besides Hb and Hct
Other tests:
RBC count
Mean corpuscular volume (MCV): average size of RBC
Mean corpuscular hemoglobin (MCH): Hb concentration in RBC
Mean corpuscular hb concentration (MCHC) = hb/hct %
Depletion of Fe progression and labs tests that reflect it at each stage
1) Storage Fe ↓ from liver, bone marrow, spleen
Serum Ferritin ↓ in early deficit
2) Transport Fe ↓
1st transferrin remains saturated but serum Fe ↓
2nd transferrin unsaturated/levels ↑ while serum Fe continues to ↓
TESTS: Serum Fe (Fe bound to transferrin), Total Fe Binding Capacity (TIBC) for saturation ability of transferrin, Transferrin saturation
3) Essential Fe ↓ from RBC, myoglobin and enzymes
TEST: Erythrocyte protoporphyrin ↑ in later deficiency limiting Hb production
Lab tests for folate deficiency
Serum folate: ↓ in early deficiency
RBC folate: ↓ as deficiency progresses
Folate deficiency: low serum + low RBC folate + megaloblastic + macrocytic RBC (+ normal B12)
Lab tests for B12 deficiency
↑ Methylmalonic acid (involved in B12 cycle) during early B12 deficiency
↑ homocysteine during B12 deficiency
Serum B12 ↓ in progressing deficiency state
Causes megaloblastic, macrocytic RBC + serum B12 ↓
Describe trends for Fe stores, RBC Fe, serum ferritin, transferrin saturation, free erythrocyte protoporphyrin and [Hb] over time in progressing Fe anemia
Excellent sources of heme and non-heme iron >3.5mg
Risk factors for poor Fe status
Heme: Clams, oysters and liver
Non-heme: cooked legumes, seeds, fortified cereals and tofu
Risk factors: low Fe intake, low vit C intake, low fortified foods (infants), ↑ tea/coffee (tannins/polyphenols), ↑ phytates/oxalates, regular aspirin use, menorrhagia, 3+ blood donations, pregnancy/multiple gestation/parity
Fe supplementation recommendation
Ferrous sulfate (200mg TID x 6 months)
- better absorption to ↑ Hb 1g/L per week
Liquid or tablet
Take on empty stomach with liquid unless side effects
Deficiencies which may cause anemias
Fe: microcytic, hypochromic
Folate: macrocytic, megaloblastic
Vitamin B12: macrocytic, megaloblastic (delayed maturation)
Vitamin C and E
Anemia of chronic diseases (normochromic/cytic)
