Anemic Patient Flashcards
CBC
complete blood count 7 components 1. RBC 2. Hemoglobin 3. Hematocrit 4. RDW 5. MCH 6. MCHC 7. MCV
RBC
direct measurement of number of red cells
hemoglobin
concentration of hemoglobin, directly measured
hematocrit
volume of red cells per total volume of blood, percentage
MCV
mean corpuscular volume direct measurement of red cell volume, size
RDW
red cell distribution width how much spread there is in the MCVs of all the different red cells in the patients body
anemia
decreased hemoglobin/hematocrit below normal range for gender and age
worldwide _____ of the population is anemic
1/3
anemia is the _______ of disease and not a final diagnosis
manifestation
hypovolemia
acute loss of blood which leads to low blood volume or hypovolemia
how does the rate of change of hemoglobin affect symptoms?
increased rate leads to increasingly dramatic symptoms
symptoms of acute hemorrhage related to hypovolemia
- hypotension - syncope (blood pressure goes down, heart rate goes up, faint) - shock - orthostatic changes - symptoms of tissue hypoxia
symptoms of tissue hypoxia
fatigue shortness of breath cognitive difficulties ischemic pain (angina or claudication)
chronic anemia
- increased fluid retention leading to increased blood volume due to kidneys retaining salt and water - increased erythrocyte 2,3- DPG leading to right shift in O2 dissociation curve leading to increased O2 delivery to tissues - mesangial cells sense decreased oxygen delivery and increase erythropoietin synthesis
body’s response to anemia
increased cardiac output mainly from increased heart rate
acute blood loss and hypovolemia trigger a reflex for
vasoconstriction
mechanisms of anemia
- hemorrhage 2. increased red cell survival (hemolysis) 3. decreased red cell production
classification of anemia
- erythropoietic response 2. MCV- red cell size
erythropoietic response
- Hyper-proliferative: plenty of reticulocytes 2. Hypo-proliferative: not enough reticulocytes
reticulocytes
young red blood cells immediately released by the bone marrow as the end result of erythropoiesis
wright-giemsa staining
stain reticulocytes a blue color, polychromatophilic RNA remnants
reticulocyte index
(reticulocyte count x hematocrit) / (ideal hematocrit x 0.5)
absolute reticulocyte count
reticulocyte percentage x RBC
polychromatophilic cells on wright giemsa staining
reticulocyte staining using supravital staining
reticulocyte index is < 2% or absolute reticulocyte count is < 75,000
anemia is likely due to red cell productoin errors
reticulocyte index is > 2% or absolute reticulocyte count is > 100,000
anemia is likely due to hemorrhage or hemolysis
classifications of anemias by RBC size
- MICROCYTIC ANEMIA
- MACROCYTIC ANEMIA
- NORMOCYTIC ANEMIA
MICROCYTIC ANEMIA
low MCV < 80
tends to reflect a problem with hemoglobin synthesis
- iron deficency
- thalassemia
- lead poisoning
- anemia of chronic disease
- sideroblastic anemia
- hemoglobin C
macrocytic anemia
high MCV > 100
- impairment of DNA synthesis
1. aplastic anemia
2. antiviral therapy
3. liver disorder
4. thyroid disorder
5. MDS- myelodysplastic
6. b12/folate deficiency
7. chemotherapy
8. elevated reticulocyte count
treatments of anemia
- blood transfusions
- treat underlying cause
indications for blood transfusions
- cardiovascular compromise
- congestive heart failure
- angina
- shock - hypoproliferative anemia with no or prolonged recovery
- anemic patient is gong to surgery and potential for further blood loss
