Hematology Flashcards
How much blood is in our bodies?
About 6 quarts (5.5 Liters)
What percentage of blood volume is plasma?
50-55%
What percentage of blood is made up of water?
92%
- the other 8% consists of dissolved solutes
What is blood serum?
Serum is plasma that has been allowed to clot in the lab to remove fibrinogen and other clotting factors
What is albumin?
- Is about 60% of total plasma
- Is a carrier molecule (regulate the passage between water and solutes through capillaries)
Who would you typically look at albumin levels for?
- liver disease
- kidney disease
- dehydration
CNS Symptoms of Anemia
- fatigue
- dizziness
- fainting
Cardiac Symptoms of Anemia
- Low blood pressure
- Palpitations
- Rapid heart rate (or arrhythmia)
- Chest pain
- Angina
- Heart attack
Eye Symptoms of Anemia
Yellowing of the eyes
Skin Symptoms of Anemia
- Paleness
- Coldness
- Yellowing
Respiratory Symptoms of Anemia
Shortness of breath
Muscular Symptoms of Anemia
Weakness
Intestinal Symptoms of Anemia
Changed stool color
Complications of Anemia
- Severe fatigue
- Arrhythmias –> CHF
- Nerve damage (vitamin B12 is essential for healthy nerve function)
- Impaired mental function (a shortage of B12 can also affect cognitive status)
- DEATH
Diagnosis/Evaluation of Anemia
- History of symptoms
- Complete medical history
- History of anemia
- History of bleeding
- History of imaging (colonoscopy, CT scan, Xray, ultrasounds)
Laboratory Tests for Anemia
CBC to measure the cells contained in the blood (hematocrit is the volume of RBCs) and the hemoglobin is the molecule that fills up the cell and gives the cell its red color.
**Differential on a CBC will examine the blood cells under a microscope for size, shape, and color
Components of RBC Indices
- RBC
- WBC
- MCV
- MCH
- MCHC
- RDW
- Platelets
- MPV
- Hct
- Hgb
MCV
Mean Corpuscular Volume
- average volume of a RBC
- allows classification as either a microcytic anemia (low MCV), normocytic anemia (normal MCV), or macrocytic anemia (high MCV)
MCH
Mean Corpuscular Hemoglobin
- average hemoglobin content in a red blood cell
- hemoglobin contains iron, which gives blood its characteristic red color (hyper/hypochromic)
MCHC
Mean Corpuscular Hemoglobin Concentration
- is the average hemoglobin per RBC
RDW
is the red blood cell distribution which provides information regarding RBC size
Disorders of Microcytic RBCs
- Iron deficiency anemia
- Anemia of chronic inflammation
- Thalassemias
- Lead poisoning
Normocytic Anemias
- Hemolytic anemias
- Hypersplenism
- Acute blood loss
- Anemias of chronic disease
Disorders of Macrocytic RBCs
- Vitamin B12 deficiency
- Folic acid deficiency
- Liver disease
- Hypothyroidism
- Reticulocytes
Other Lab Tests for Anemia
- Iron (Fe)
- TIBC
- Ferritin
- B12 levels
- Folate
- MMA
- LDH
- Urinalysis (hematuria)
- Occult stool
Elevated Iron (Fe)
Consider:
1. pernicious anemia
2. thalassemia
3. lead poisoning
4. estrogens
5. excessive iron intake
Decreased Iron (Fe)
Consider:
1. iron-deficiency anemia
2. hypothyroidism
3. malignancy
4. chronic renal failure
TIBC
Total Iron Binding Capacity
Elevated TIBC
Consider:
1. iron-deficiency
2. liver damage
3. blood loss
4. progesterone birth control
Decreased TIBC
Consider:
1. hemochromatosis
2. hemosiderosis
3. thalassemia
4. hyperthyoidism
5. anemia of chronic disease
Ferritin
the storage protein for iron
- correlates with the total body stores of iron
Increased Ferritin
Consider:
1. liver disease
2. Infection
3. alcoholism
4. hyperthyroidism
5. iron overload
6. ESRD
Decreased Ferritin
Consider:
1. Iron-deficiency anemia
2. Hemodialysis
B12 Levels
- deficiency caused by significant loss of stomach mucosa (gastric bypass) that prevent absorption of B12, decreased intrinsic factor (common in elderly), or lack of B12 intake
Long Term B12 Deficiency
Results in dementia, peripheral neuropathy, megaloblastic anemia
Causes of Decreased Folate Levels
- Alcohol abuse
- Elderly
- Poor dietary intake of animal proteins, veggies, and fruits, vegetarian or fad dieters
- Pernicious anemia
MMA
Methylmalonic Acid is elevated in B12 deficiency and is more sensitive than testing vitamin B12 levels (especially in the elderly)
LDH
Lactate Dehydrogenase may identify RBC breakage due to fragility or destruction (artificial heart valves): can be seen with hemolytic anemia
Iron Deficiency Anemia Treatment
- Iron supplements and treating the underlying cause if the cause is blood loss
- Ferrous sulfate 325 mg (contains 60mg elemental iron) titrate from once daily to TID
- Ferrous gluconate 300 mg (contains 35mg elemental iron) titrate from once daily to 5 times daily
- Ferrous fumerate 325mg (contains 107mg elemental iron) titrate from once daily to BID
- Vitamin C helps absorption
- Should see moderate reticulocytosis in 5-7 days
- In the absence of bleeding, only replace iron for up to 6 months
Vitamin B12 Deficiency Treatment
- Vitamin B12 100-1000mcg IM once weekly for 4 weeks, then once monthly
- Loading doses of B12 1000-2000 mcg orally daily
- 500 mcg intranasally weekly for life
- Increase dietary B12 if malnourished and/or strict vegan diet
- Oral B12 has been shown to be equally efficacious as injectable, however, high doses given orally are needed because of the variable absorption of the oral B12 in doses of 500mcg or less
- Intranasal B12 resulted in faster absorption and sustained increase of baseline cobalamin concentrations
Folate Deficiency Treatment
- Typical dose of folic acid is 250 to 1000 mcg per day.
- For severe deficiency, 1000-5000 mcg per day is often used until corrected lab values
- For elderly, 400-800mcg daily
- For ESRD, 800-15,000 mcg daily
Causes of Folate Deficiency
- excessive alcohol deficiency
- malnutrition
Anemia of Chronic Disease Treatment
- treatment is based on the underlying disease
- if symptoms become severe, a blood transfusion or injections of synthetic erythropoietin may help stimulate RBC production and ease fatigue
Aplastic Anemia
- characterized by diminished or absent hematopoietic precursors in bone marrow
Aplastic Anemia Treatment
- blood transfusions to boost levels of RBCs
- bone marrow transplant
Hemolytic Anemia
- defined as anemia due to a shortened survival of circulating RBCs (typically less than 100 days)
Hemolytic Anemia Treatment
- if severe, blood transfusion or plasmapheresis
- short courses of treatment with steroids, immune suppressant medications, or gamma globulin can help suppress the immune system’s attack on the RBCs
- if the cause is an enlarged spleen, a splenectomy may be necessary
Sickle-Cell Anemia Treatments
- Administration of oxygen, pain relieving drugs, and oral/IV fluids to reduce pain and prevent complications
- blood transfusions
- folic acid supplements
- antibiotics
- a cancer drug hydroxyurea (Droxia, Hydrea) can be used to treat adults
Thalassemia
- characterized by the abnormal formation of hemoglobin, resulting in decreased oxygen transport
- Autosomal Recessive disorder
- Can be classified as Minor, Intermedia, or Major
Minor alpha and beta thalassemias
vast majority with alpha and beta minor are asymptomatic are diagnosed because of the presence of microcytic, hypochromic red blood cells, with or without anemia
Thalassemia Intermedias
are common throughout the world and may present with more than one hemoglobin mutation such as sickle-cell thalassemia
Beta Thalassemia Major
Is associated with life-long transfusion dependent anemia
Alpha Thalassemia Major
Is incompatible with extrauterine life
Beta Thalassemia Major Diagnosis
usually diagnosed within 6-12 months of birth
* hemoglobin eletrophoresis
Alpha Thalassemia Major Diagnosis
Difficult to detect and can only be made with DNA analysis
Leukemia
Is cancer of the body’s blood-forming tissues, including bone marrow and lymphatic system
- It usually starts in the WBCs causing the bone marrow to produce a large number of abnormal WBCs, which don’t function properly
Symptoms of Leukemia
- fever or chills
- fatigue, weakness
- frequent infections
- anorexia/weight loss
- swollen lymph nodes
- enlarged liver or spleen
- easy bleeding or bruising
- exertional dyspnea
- petechiae
- night sweats
- bone pain or tenderness
Speed of Progression of Acute Leukemia
Abnormal blood cells are immature blood cells (blasts) - they function normally and they multiply rapidly, so the disease worsens quickly
* Acute leukemia requires aggressive, timely treatment
Speed of Progression of Chronic Leukemia
Involves more mature blood cells which replicate or accumulate more slowly and can function normally for a period of time
* Some forms of chronic leukemia initially produce no symptoms and can go unnoticed or undiagnosed for years
Type of Cell Affected in Lymphocytic Leukemia
Affects the lymphoid cells or lymphocytes, which form lymphoid or lymphatic tissue
* This tissue is the main component of the immune system and is found in various places throughout the body, including the lymph nodes, spleen, and tonsils
Types of Cells Affected in Myelogenous Leukemia
Affects the myeloid cells
- the myeloid cell line includes cells that later develop into RBCs, WBCs, and platelet producing cells
Types of Leukemias
- AML
- ALL
- CLL
- CML
AML
Acute Myelogenous Leukemia
- most common type of leukemia
- it occurs in children and adults
- also called acute nonlymphocytic leukemia
ALL
Acute Lymphocytic Leukemia
- most common type of leukemia in young children and accounts for about 75% of all childhood leukemias
CLL
Chronic Lymphocytic Leukemia
- a common adult leukemia, individuals may feel well for years without treatment
- it is more common in Jewish people of Russian or Eastern European descent
- almost never affects children
CML
Chronic Myelogenous Leukemia
- mainly affects adults and is associated with a chromosome abnormality called the Philadelphia chromosome, which creates an abnormal gene called BCR-ABL
- the BCR-ABL gene produces an abnormal protein called tyrosine kinase that is believed to cause leukemia cells to grow and develop
- persons may be asymptomatic for months or years before entering a phase in which the leukemia cells grow more quickly
Leukemia Treatment
- Chemotherapy
- Biological therapy
- Kinase inhibitors
- Radiation therapy
- Bone marrow transplant
- Stem cell transplant
- Clinical trials
Diagnosis of Leukemia
- HPI
- Physical exam
- Lab Tests (CBC)
- Immunophenotyping
- Cytogenic analysis
Immunophenotyping
Helps determine whether an increased number of lymphocytes in the blood caused by a reactive process - such as a reaction to infection or inflammation - or a cancerous process
- this test helps distinguish chronic lymphocytic leukemia cells from other types of leukemia and lymphoma
Cytogenic Analysis
Detects changes in the chromosomes, including the presence of the Philadelphia chromosome
- bone marrow test is the definitive test to look for leukemia cell
