Approach to the Anemic Patient Flashcards
hemoglobin is a measurement of
- concentration of hemoglobin
hemoglobin type of measurement
- direct measurement
hematocrit is a measurement of
- volume of red cells per volume of blood
- given as a percentage
hematocrit type of measurement
- calculated value
- Hit = RBC x MCV
height of red cells divided by total height of the liquid in the tube
hematocrit compared to hemoglobin
- generally Hct is 3x hemoglobin
RBC type of measurement
- direct measurement
MCV is a measurement of
- red cell volume
- how big the red blood cells are
MCV type of measurement
- direct measurement
RDW measurement of
red cell distribution of width
- how much spread there is in MCVs of different red cells in patient’s body
iron deficiency cells change in RDW
- RDW gets wider
microcytic cells then transfusion - change in RDW
- RDW gets wider
anemia definition
- a decreased hemoglobin/hematocrit below the normal range for gender and age
anemia (manifestation of disease versus final diagnosis)
- anemia is a manifestation of disease not a final diagnosis
anemia leads to
- reduction of oxygen carrying capacity
acute blood loss leads to
- low blood volume
chronic, longstanding anemia leads to
- fluid retention
- increased blood volume
faster rate of change of hemoglobin will lead to
- more dramatic symptoms
if an anemic person is volume overloaded, but needs a transfusion, what do you do?
- give a diuretic first
most symptoms of acute hemorrhage in anemia related to
- hypovolemia
symptoms of hypovolemia
- hypotension
- orthostatic changes
- syncope
- shock
symptoms of tissue hypoxia
- fatigue
- shortness of breath
- cognitive difficulties
- ischemic pain
cardiac response to anemia
- increased heart rate
- increased cardiac output
vascular response to anemia due to acute blood loss and hypovolemia
- vasoconstriction
kidney response to chronic anemia
- retain salt and water to expand intravascular volume
erythrocyte 2,3-DPG response to chronic anemia
- increased
- right shift in O2 curve
- increased O2 delivery to tissues
renal mesangial cells response to chronic anemia
- sense decreased oxygen deliverty
- increase erythropoietin synthesis
mechanisms by which anemia can occur
- hemorrhage
- decreased red cell survival
- decreased red cell production
ways to classify anemia
- by erythropoietic response
- by red cell size and hemoglobin concentration
erythropoietic response
- hyperproliferative
- hypoproliferative
hyperproliferative
- plenty of reticulocytes
- problem due to loss or destruction of reticulocytes
hypoproliferative
- not enough reticulocytes
red cell size and hemoglobin concentration classification
- microcytic, hypochromic
- macrocytic
- normocytic, normochromic
reticulocyte definition
- young red cells immediately released by the bone marrow as the end result of erythropoiesis
reticulocyte on Wright-Giemsa staining
- polychromatophilic (grayish blue)
reticulocyte composition
- RNA remnants on supra vital staining
- reticulated
absolutely reticulocyte count formula
- retic (%) x RBC
if reticulocyte index is <2%
or absolute reticulocyte count <75,000
- problem with red cell production
- HYPOPROLIFERATIVE ABNORMALITY
if reticulocyte index > 2%
or absolute reticulocyte count > 100,000
- good marrow response
- anemia due to blood loss (HEMORRHAGE) or red cell destruction (HEMOLYSIS)
microcytic anemia MCV level
- MCV <80
microcytic anemia tends to reflect a problem with
- problem with hemoglobin synthesis
macrocytic anemia MCV level
- MCV > 100
macrocytic anemia types
- megaloblastic
- non-megaloblastic
megaloblastic anemia cause
- impairment of DNA synthesis
normocytic anemia cause
- marrow not working well
- mixed problem
- acute problem
two approaches for treatment of anemia
- treat underlying cause
- transfusion
whether or not to transfuse
- how symptomatic is the patient?
- can we reverse the underlying cause?
- do we have enough time to treat the underlying cause?
hemoglobin value that should be a trigger in every patient for transfusion
- NO ABSOLUTE VALUE
general indications for transfusion
- cardiovascular compromise
- hypo proliferative anemia with no or prolonged recovery
- anemia patient going into surgery now and may lose blood
cardiovascular compromise conditions
- CHF
- shock
- angina
