Anemias Flashcards
What is on a CBC
WBC differential RBC Hgb Hct MCV MCH MCHC Plt
What is normal RBC count
M: 4.7-6.1
F: 4.2-5.4
Normal lifespan: 120 days, then spleen eats them
RBC carry Hgb
What does Hgb do
bind and transport oxygen
M: 14-18
F: 12-16
What is the Hct
measure of % of total blood volume that is made up of RBC
Should be 3x the Hgb
What is the MCV
Volume determining average volume (size) of RBC
Normal: 80-100
Tells you micro vs macro vs normocytic
What is the MCH/MCHC
Avg mass of Hgb per RBC in a sample of blood. Less Hgb = less red. more Hgb = more red
Tells you hyper vs hypochromic
What is RDW
Red cell Distribution Width AKA measure of variation in size of RBC’s
Normal is 11-15%
What is anisocytosis
Increased variation in size of RBC
Increased RBC count can indicate
Dehydration
COPD (chronic hypoxemia)
Polycythemia vera
Decreased RBC count can indicate
Anemia 2/2: bleeding iron deficiency B12, folate deficiency hemolytic cirrhosis bone marrow failure pregnancy
What is anemia
Reduction in 1+ of major RBC measurements
What are reticulocytes
Immature RBC
Takes 1-2 days to mature
Indicate the bone marrow is producing RBC!
Normal: 1-2%
What is a pearl about recognizing reticulocytes in a peripheral smear
Lots of blue means Lots of new
Reticulocytes have a blue tint, and are larger than normal RBC
What are some causes of anemia
Impaired RBC production: iron, B12, folate deficiency, chronic disease, insufficient erythropoiesis
Increased RBC destruction: hemolysis
Blood loss: menses, GI, trauma, post-op
What are the characteristics of the different types of anemia*
Microcytic: small size, low MCV. Iron deficiency or Thalassemia
Normocytic: nl size, nl MCV. chronic disease
Macrocytic: large size, high MCV. Folate or B12 deficiency
How does anemia present clinically
Varies based on age, underlying condition, etiology, severity, and onset
Acute may have Sx even if mild
Chronic often doesn’t show Sx until Hgb <7!
S/Sx of anemia are
Fatigue weakness light headed/ syncope dyspnea palpitations pallor tachy hypotension orthostatic changes \+/- heme in stool
Late signs of anemia are
Glossitis (big tongue)
Chelitis
Jaundice
Koilonichia
What is your differential for Microcytic anemia
Iron deficiency (MC) Thalassemia Sideroblastic Lead poisoning -All with MCV <80
Common etiologies of iron deficiency anemia are
Menstrual blood loss
GI blood loss
Decreased iron absorption (celiac, bariatric surgery, H pylori infx)
Increased iron requirement (pregnancy)
Labs for Iron deficiency anemia will show
Microcytic (MCV <80) MCHC is low RDW increased Ferritin <12 (low stores) Serum Fe is low TIBC is high Rarely need marrow Bx, but if you got it, it'd show absence of iron stores
What is Ferritin
an indicator of iron storage! If low, iron stores are depleted
Also an acute phase reactant! Will falsely elevate with acute illnesses
Clinical findings in iron deficiency anemia are
Glossitis, chelitis, koilonychia
Pica (cave ice, clay, dirt)
Dysphagia 2/2 esophageal webs (plummer vinson syndrome)
Restless leg syndrome
How do you treat iron deficiency anemia
ID and Tx cause**
R/o underlying occult malignancy
Replace iron stores (Ferrous sulfate 325 mg BID-TID until anemia corrects + 3-6 months after)
Blood transfusions (depending on Hgb), but not for iron replacement