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Hematologic Disorders Flashcards

1
Q

When does anemia occur

A

when the insult is bad enough to disturb normal homeostatic mechanisms and exceed reserves

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2
Q

4 things needed for RBC formation

A

erythropoietin
DNA synthesis
Hgb synthesis
intact marrow

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3
Q

Erythropoietin comes from

A

renal 90%
hepatic
diminished with renal failure starting with GFR <49

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4
Q

DNA synthesis can be impaired by

A

chronic inflammation conditions
(lupus, RA, and chronic inflammation)
can reverse with tx of inflammation

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5
Q

Hgb defined

A

iron-containing oxygen transport protein

from iron, vit B, C and protein

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6
Q

Heme =

A

iron

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7
Q

globin =

A

protein

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8
Q

Component of intact marrow

A

reticularcytes (young RBCs)
with anemia the anticipated response is for reticulocytosis to increase so there are increase in RBCs i the body “reticking”

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9
Q

Causes of anemia

A

blood loss: acute or chronic
reduced RBC production
premature destruction

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10
Q

Acute blood loss cause in anemia

A

need >1L of blood loss before lab shows
hemorrhage
rule out by history and physical

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11
Q

Chronic blood loss cause in anemia

A

erosive gastritis
menorrhagia
GI malignancy
RBCs can’t be recycled with this type of blood loss

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12
Q

Normal blood volume in women

A

4800

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13
Q

Normal blood volume in men

A

5600

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14
Q

Causes of reduced RBC production

A
  1. nutrition
    (vit b12, folic acid, iron deficiency)
  2. anemia of chronic disease
  3. bone marrow suppression
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15
Q

Premature destruction of RBCs

A

hemolysis

can be part of anemia of chronic disease

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16
Q

normal RBC life span

A

90-120 days

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17
Q

Normal Hgb to Hct ratio

A

1:3
or 30%
so if Hgb 10, Hct 30

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18
Q

Normal Hgb and Hct for women

A

12g/dl : 36%

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19
Q

Normal Hgb and Hct for men

A

15g/dl: 45%

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20
Q

MCV =

A

size of cell

“mean corpuscle volume”

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21
Q

Different sizes of cells

A

Microcytic: small
Normocytic: normal
Macrocytic: large

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22
Q

Normal cell size according to MCV

A

80-96

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23
Q

Hgb content of RBC determines its

A

color

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24
Q

Color of RBC =

A

chromic

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25
Q

Value of what shows color/hgb content

A

MCH: mean cell Hgb
MCHC: mean cell Hgb concentration

26
Q

2 types of color or hgb content

A

Normochromic: normal in color MCHC 31-37
Hypochromic: pale in color MCHC < 31

27
Q

RDW in anemia

A

a value given based on the variation in size of RBCs

>15% shows that cells are either smaller or larger than other cells

28
Q

One of the earliest lab indicators of an evolving micro or macro cytic anemia

A

RDW

29
Q

Reticulocyte percentage

A

normal is about 1-2 %
in response to anemia it is >2%
marked reticulocytosis can cause RDW increase

30
Q

Types of anemia

A 
Normocytic normochromic anemia
Microcytic hypochromic with elevated RDW
Microcytic hypochromic with normal RDW
Macrocytic normochromic with elevated RDW
Drug inducted macrocytosis
31
Q

Normocytic normochromic anemia etiology

A
  1. acute blood loss
  2. anemia of chronic disease
    “normal size, normal color”
32
Q

example of Normocytic normochromic anemia

A

72 year old man with acute GI bleed

32 year old female with newly dx systemic lupus

33
Q

Lab values that would be affected with normocytic normochromic anemia

A 
Hgb decreased
RBCs decreased
MVC normal (size)
MCHC normal (color)
RDW or "reticking" normal because body may still be in shock and not attempting to accomodate
34
Q

Macrocytic hypochromic with elevated RDW etiology

A

iron deficiency anemia

“small and pale with new cells smaller than old cells (elevated RDW)

35
Q

Lab values that would be affected with macrocytic hypochromic anemia

A 
Hgb decreased
RBCs decreased
MCV (color) decreased
MCHC (size) decreased
RDW elevated: body trying to compensate or "retick"
36
Q

Examples of macrocytic hypochromic anemia

A

68 year old man with erosive gastritis

48 year old woman with menorrhagia

37
Q

Microcytic hypochromic anemia with normal RDW etiology

A

Genetic anemias
alpha thalassemia minor: Asian, African
beta thalassemia minor: African, Mediterranean, Middle Eastern

38
Q

Microcytic hypochromic anemia with normal RDW described

A

This is their normal so RDW with be normal because their body does not see a need to compensate
The cells are small and pale

39
Q

Lab values that would be affected with microcytic hypochromic anemia with normal RDW

A 
Hgb decreased
RBCs normal to elevated
MCV (size) decreased
MCHC (color) decreased
RDW normal
40
Q

Macrocytic normochromic anemia with elevated RDW etiology

A

B12 def
pernicious anemia
folate deficient anemia

41
Q

Macrocytic normochromic anemia with elevated RDW desribed

A

large cells with normal hgb content and new cells are larger than old cells

42
Q

Lab values that would be affected with macrocytic normochromic anemia

A 
Hgb decreased
RBC decreased
MCV (size) increased
MCHC (color) normal
RDW elevated and born "big"
43
Q

Example of macrocytic normochromic anemia

A

72 year old with untreated pernicious anemia

44
Q

Drug induced macrocytosis described

A

cells are just big due to medication use
no anemia occurs
reversible if drug d/c’d

45
Q

Drugs that cause macrocytosis

A 
carbamepine
zidovudine (AZT)
valproic acid
phenytoin
alcohol
46
Q

Lab values that would be affected with macrocytosis

A 
Hgb normal
RBC normal
MCV (size) elevated
MCHC (color) normal
RDW normal
47
Q

Interventions for anemia

A

treat the cause
replace nutrients as needed: needs increase with reticking
epoetin alfa: can be given for severe anemia or with advancing renal failure

48
Q

Most common type of anemia in child

A

iron

49
Q

Most common type of anemia in pregnancy

A

iron

50
Q

Most common type of anemia in women of reproductive years

A

iron

51
Q

Most common type of anemia in elderly

A

chronic

52
Q

Most important source of body’s iron supply

A

recycled iron content from aged RBCs

53
Q

A person that is vegan should supplement their diet with

A

vit B12

54
Q

Symptoms in history and physical that could indicate anemia

A

fatigue

spoon shaped nails

55
Q

Cause of macrocytic hypochromic anemia with elevated RDW in 78 year old c/o fatigue and spoon shaped nails

A

gastrointestinal blood loss

56
Q

In evaluating person with microcytic anemia the next lab to order would be

A

ferritin b/c it tells you the iron storage in the liver

57
Q

The best way to take an Fe supplement is

A

on an empty stomach or with light meal

no milk because Ca and Fe will fight

58
Q

68 year old female presents with peripheral numbness and oral irritation. Exam shows pale conjunctiva, grade 2/6 systolic murmur and smooth red tongue. Hemagram shows Macrocytic normochromic anemia with elevated RDW. What could be her cause of anemia?

A

Vit B12 def

59
Q

The grade 2/6 murmur in exam above could indicate

A

“hemic” murmur or a murmur caused by something else such as pregnancy, fever, anemia, infection or thyroid storm

a systolic murmur can be pathologic or physiologic
a diastolic murmur can only be pathologic

60
Q

65 year old with RA with a hemogram showing normocytic normochromic anemia would have

A

anemia of chronic disease

61
Q

Cooley anemia =

A

beta thal MAJOR

very serious

62
Q

Primary care of person with alpha thal minor would include

A

genetic counseling prior to pregnancy

don’t tx with Fe because they will get over loaded

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