Exam 3 - Hem/Onc Flashcards
What is the definition of hematocrit?
Amount of space in the blood that is occupied by RBCs
What is the definition of MCV?
Average size of RBCs
What is the definition of MCH?
Average amount of hemoglobin in each RBC (color)
What does a reticulocyte count indicate?
Number of young RBCs → RBC production
- Higher reticulocyte count = more production
What does a red cell distribution width (RDW) indicate?
Measurement of variation in RBC size
- Higher RDW = more variation (young vs old RBC)
What is the definition of anemia? Is anemia a diagnosis?
Decreased RBC and hemoglobin or hematocrit
- NOT a diagnosis → s/s of an underlying disorder
- Identify source and treat it appropriately
Causes of anemia → RBC production disorders
- IDA
- Anemia of chronic disease (ACD)
- Vitamin B12 and folate deficiency
- Aplastic anemia
Causes of anemia → RBC destruction disorders
- Sickle cell anemia
- Hereditary spherocytosis and elliptocytosis
- G6PD deficiency
- Autoimmune hemolytic anemia
Causes of anemia → blood loss (acute or chronic)
Trauma, hemorrhage, menorrhagia, hematuria, GI bleeding
Normal RBC levels in men and women
Men: >13.6 g/dL
Women: >12 g/dL
Anemia clinical manifestations
- If healthy, few s/s until hemoglobin falls below 7.5 g/dL → Fatigue, malaise, HA, dyspnea, irritability, mild decrease in exercise tolerance
- Moderate to severe anemia: wide pulse pressure, midsystolic or pansystolic murmur, confusion, lethargy, brittle nails, glossitis, angular cheilitis, spoon shaped nails
- Pallor of mucous membranes, lips, conjunctivae, nail beds, palmar creases
- Forceful apical pulse, tachycardia with exertion, systolic murmur
Anemia diagnostics
- CBC w/ diff
- Reticulocyte count
- Peripheral blood smear
What diagnostic labs are most sensitive for anemia?
- Serum bilirubin
- Lactate dehydrogenase
What labs should be collected for suspected microcytic anemia or IDA?
Iron profile
What is the definition of microcytic anemia?
Small RBCs → less hemoglobin, less volume
- Due to iron deficiency (without iron RBCs cannot grow or be produced)
Microcytic anemia lab results
- Low MCH, low MCV
- Low/normal reticulocyte count (low RBC production)
- Increased RDW (newer cells are smaller than old cells)
- High TIBC (RBCs really want iron)
What is the definition of macrocytic anemia?
Large RBCs → more hemoglobin, more volume
- Due to folate or vitamin B12 deficiency (without either RBCs cannot divide/undergo mitotic division)
Macrocytic anemia lab results
- High MCH, high MCV
- Low/normal reticulocyte count (low RBC production)
- Increased RDW
- Normal TIBC (RBCs have enough iron)
Possible causes of normocytic anemias
- Congenital → sickle cell disease, G6PD deficiency
- Hemolysis
- Acute/large volume blood loss
- Anemia of chronic disease (ACD)
Types of microcytic anemia
- IDA
- Thalassemia
Types of macrocytic anemia
Megaloblastic (vitamin B12/folate deficiency)
IDA peripheral smear findings
- Hypochromia
- Microcytosis
- Mild anisocytosis
- Poikilocytosis
Are microcytic and macrocytic hypo proliferative or hyper proliferative?
Hypo proliferative = lack nutrient for proper RBC production
- Low reticulocyte count
Iron profile findings for IDA
- Low serum iron
- Low ferritin
- Low % transferrin saturation
- Elevated TIBC (looking for iron to bind to)