Anemic Patient

Question 1

CBC

Answer 1

complete blood count 7 components 1. RBC 2. Hemoglobin 3. Hematocrit 4. RDW 5. MCH 6. MCHC 7. MCV

Question 2

RBC

Answer 2

direct measurement of number of red cells

Question 3

hemoglobin

Answer 3

concentration of hemoglobin, directly measured

Question 4

hematocrit

Answer 4

volume of red cells per total volume of blood, percentage

Question 5

MCV

Answer 5

mean corpuscular volume direct measurement of red cell volume, size

Question 6

RDW

Answer 6

red cell distribution width how much spread there is in the MCVs of all the different red cells in the patients body

Question 7

anemia

Answer 7

decreased hemoglobin/hematocrit below normal range for gender and age

Question 8

worldwide _____ of the population is anemic

Answer 8

1/3

Question 9

anemia is the _______ of disease and not a final diagnosis

Answer 9

manifestation

Question 10

hypovolemia

Answer 10

acute loss of blood which leads to low blood volume or hypovolemia

Question 11

how does the rate of change of hemoglobin affect symptoms?

Answer 11

increased rate leads to increasingly dramatic symptoms

Question 12

symptoms of acute hemorrhage related to hypovolemia

Answer 12

• hypotension - syncope (blood pressure goes down, heart rate goes up, faint) - shock - orthostatic changes - symptoms of tissue hypoxia

Question 13

symptoms of tissue hypoxia

Answer 13

fatigue shortness of breath cognitive difficulties ischemic pain (angina or claudication)

Question 14

chronic anemia

Answer 14

• 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

Question 15

body’s response to anemia

Answer 15

increased cardiac output mainly from increased heart rate

Question 16

acute blood loss and hypovolemia trigger a reflex for

Answer 16

vasoconstriction

Question 17

mechanisms of anemia

Answer 17

1. hemorrhage 2. increased red cell survival (hemolysis) 3. decreased red cell production

Question 18

classification of anemia

Answer 18

1. erythropoietic response 2. MCV- red cell size

Question 19

erythropoietic response

Answer 19

1. Hyper-proliferative: plenty of reticulocytes 2. Hypo-proliferative: not enough reticulocytes

Question 20

reticulocytes

Answer 20

young red blood cells immediately released by the bone marrow as the end result of erythropoiesis

Question 21

wright-giemsa staining

Answer 21

stain reticulocytes a blue color, polychromatophilic RNA remnants

Question 22

reticulocyte index

Answer 22

(reticulocyte count x hematocrit) / (ideal hematocrit x 0.5)

Question 23

absolute reticulocyte count

Answer 23

reticulocyte percentage x RBC

Question 24

Answer 24

polychromatophilic cells on wright giemsa staining

Question 25

Answer 25

reticulocyte staining using supravital staining

Question 26

reticulocyte index is \< 2% or absolute reticulocyte count is \< 75,000

Answer 26

anemia is likely due to red cell productoin errors

Question 27

reticulocyte index is \> 2% or absolute reticulocyte count is \> 100,000

Answer 27

anemia is likely due to hemorrhage or hemolysis

Question 28

classifications of anemias by RBC size

Answer 28

1. MICROCYTIC ANEMIA 2. MACROCYTIC ANEMIA 3. NORMOCYTIC ANEMIA

Question 29

MICROCYTIC ANEMIA

Answer 29

low MCV \< 80 tends to reflect a problem with hemoglobin synthesis 1. iron deficency 2. thalassemia 3. lead poisoning 4. anemia of chronic disease 5. sideroblastic anemia 6. hemoglobin C

Question 30

macrocytic anemia

Answer 30

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

Question 31

treatments of anemia

Answer 31

1. blood transfusions 2. treat underlying cause

Question 32

indications for blood transfusions

Answer 32

1. cardiovascular compromise - congestive heart failure - angina - shock 2. hypoproliferative anemia with no or prolonged recovery 3. anemic patient is gong to surgery and potential for further blood loss