Hematology Flashcards
Anemia Definition
A reduction in the number of RBCs, the amount of hgb, or the hematocrit
Alternate term for WBCs?
Leukocytes
What does MCV measure?
The average RBC size
What does MCH measure?
The amount of Hgb per RBC
How long do RBCs live for in the body?
120 days
Where does O2 attach to the RBC?
To the heme binding sites on hemoglobin
These labs help define anemias by cell size and amount of Hgb
MCV and MCH
What does MCHC measure?
Concentration of hemoglobin
What does hematocrit measure?
Percentage of packed RBCs per deciliter of blood
What determines whether anemia is micro, macro or normocytic?
MCV
What is a reticulocyte?
An immature RBC without a nucleus
What could a high reticulocyte count with anemia indicate?
Potentially blood loss, hemolysis, kidney disease (with increased erythropoetin), or sickle cell.
What could a low reticulocyte count with pancytopenia indicate?
Aplastic anemia, bone marrow failure, cirrhosis of the liver, anemia d/t low iron/B12/folate, or CKD
What would a retic count of zero indicate?
Pure red cell aplasia
Normal reticulocyte lab values
0.5%-1.5%
Microcytic anemia is usually caused by
- Inadequate production
- ex: low iron, lead poisoning, thalassemia, or inflammation, anemia d/t chronic disease
Normocytic anemia is usually caused by
- blood loss
- could also be sepsis, chronic disease, kidney failure, or prosthetic heart valves
Macrocytic anemia is usually caused by
- destruction of RBCs (caused by chemo and vitamin deficiencies. DNA messed up)
- **Alcoholism has chronic macrocytosis
What is hemolytic anemia?
Anemia where RBCs are being destroyed. Often inherited.
General symptoms of all anemias
Yellowing of eyes, skin pale/cold/yellow, SOB, weakness, change in stool color, fatigue, dizziness/OH, low blood pressure, palpitations, tachycardia, spleen enlargement, decreased O2 sats, headache
Symptoms of severe anemia
Chest pain, angina, heart attack, murmers and gallops, fainting
Classification of Folic acid deficiency anemia
Macrocytic & lacking a substance
Causes of folic acid deficiency anemia
- Dietary deficiency (lacking in fruits and veggies)
- Malabsorption syndromes (crohns, celiac)
- Alcohol use/abuse
- Certain meds (bactrim, oral contraceptives, anticonvulsants, methotrexate)
Symptoms of folic acid deficiency
- may be without symptoms
- all of the usual anemia symptoms
- poor growth, especially of fetuses
- mouth sores
- swollen tongue
Role of folic acid
Aids in synthesis of DNA, production of RBCs, digestion and use of proteins, and neural tube formation
Is folic acid water soluble? How does this affect its storage in the body?
Yes, easily excreted because it can’t be stored in fat so the body has no folic acid reserves
Assessment items of folic acid def
- Diet recall
- Med list
- Hx of malabsorptive disorders
- Hair and nails (may be brittle)
- O2 sat, cap refill, skin color
Folic acid labs and tests
- Folic acid levels
- CBC
- MCV (high)
- Retic count (low)
- Vit B12 and Iron to compare or r/o
Treatment of folic acid def
- increase folic acid in diet
- folic acid supplements (400 mcg daily rec)
- treat long term alcoholism
- stop or monitor medications
- monitor labs over time (folate and RBCs)
- outcomes usually good with tx
Meds that can cause low folate levels
- phenytoin, methotrexate, sulfasalazine, triamterene, pyrimethamine, trimeth-sulfameth (bactrim), barbiturates
Good sources of folic acid
- Fruits and veggies
- specifically green leafies, citrus, beans and nuts.
Vitamin B12 Deficiency - classification
Macrocytic
Role of Vitamin B12
Needed to transport folic acid into cell, aid in DNA replication
Common causes of B12 Def
- Dietary deficiency (vegan/vgtrn)
- Failure to absorb B12 d/t:
- Partial gastrectomy, pernicious anemia, malabsorption syndromes, alcohol use, immune system disorders, LT use of acid reducing drugs, gastritis
Symptoms of B12 Def
- may be without symptoms
- all the typical anemia sx
- Easy bruising, bleeding
- mouth sores, bleeding gums
- swollen red beefy tongue
- upset stomach or diarrhea
- paresthesia, neurological changes (numbness/tingling)
Nerve damage may be permanent with this type of anemia
B12 Deficiency
B12 Labs
- B12 levels
- CBC
- MCV (high)
- Retic count (low)
- Folic acid and iron to compare or r/o
A subtype of B12 deficiency anemia caused by a lack of intrinsic factor in gastric secretions
Pernicious anemia
Role of intrinsic factor
Necessary for absorption of vitamin B12
Causes of pernicious anemia
Chronic gastritis or gastrectomy, autoimmune conditions, DM I, thyroid disease, family Hx
Treatment of pernicious anemia
- B12 injections, oral or nasal spray B12
Symptoms of B12
- All the norms plus…
- Red beefy tongue, mouth sores, bleeding gums, fissured/ cracked tongue
- fatigue
- paresthesias
This type of deficiency has been linked to alzheimer’s, CAD, ADHD, and autoimmune diseases
Vitamin B12
Foods that contain B12
- Meat, dairy
- not found in plant foods
Causes of normocytic anemia
- chronic infections or inflammation (cancer, renal failure, liver disease…)
- iron stays in stores and is not used adequately d/t chronic inflammation blocking it
Where is erythropoetin (EPO) produced? What stimulates its production?
In the kidneys, the cells release more EPO in response to low blood oxygen levels
Pt may will adapt to lower RBCs and physicians may choose not to treat in anemia of this type
Anemia of chronic illness
Is iron replacement recommended for anemia of chronic illness?
No! They are not low in iron, it’s just being blocked.
Treatment of chronic illness anemia
- Possible blood transfusion
- Possible epoetin injections (esp. if CRF or CKD related)
- May not treat
- Monitor labs
Aplastic anemia classification
Normocytic
Causes of aplastic anemia
- production shut down of WBCs, RBCs and PLTs
- meds like Bactrim
- Ratiation, chemo, virus, autoimmune disease, exposure to pesticides and benzene
Dx of aplastic anemia
Bone marrow biopsy
Aplastic anemia symptoms
The usual plus Infection and bleeding
Labs for aplastic anemia
- WBC (low)
- Platelets (low)
- watch retic count to check for formation of RBCs
Aplastic anemia treatment
- immunosuppresant meds
- corticosteroids
- blood transfusions
- stem cell transplant
- bone marrow transplant
- splenectomy
Rationale for using immunosuppresants with aplastic anemia
- suppresses activity of immune cells that may be damaging bone marrow
- gives the bone time to recover and generate new blood cells
What is the most common cause of anemia?
Iron deficiency
Where is iron stored?
2/3 in hgb, 1/3 in bone marrow/spleen/muscle stores
Most common cause of iron deficiency anemia?
GI bleed
Classification of iron def anemia
Microcytic
Symptoms of iron def anemia
- The usual plus…
- Pika
- RLS
- GI bleeding if that is the cause
- may show no sypmtoms
Iron Def Anemia Labs
Ferritin, total iron, TIBC, Serum Iron, RBC studies, MCV is LOW
Treatment of Iron Df. Anemia
- iron supplements, increase in diet
- locate source of bleed and treat
- monitor labs, check over 2-6 mos of tx
Sickle cell disease classification
Hemolytic
Cause of sickle cell disease
Genetic condition in which abnormal hgb causes their RBCs to form a sickle shape
Treatment of sickle cell anemia
- Blood transfusions
- Pain control
- Prevention of clots
- Watch for MI, CVA, kidney infarct
- O2
Classification of G6PD anemia
Hemolytic
What causes G6PD anemia?
- defect in G6PD enzyme production
- hereditary
- can also be caused by meds and some foods
- is episodic
How does G6PD deficiency affect cells?
It is a protective enzyme, so being deficient makes cells more susceptible to damage
Drugs that can cause G6PD problems
Sulfas, ASA, thiazides, macrodantin
Assessment for G6PD
- drug hx
- spleen enlargement
- diet assessment for fava, soy
- travel assessment (occurs with malaria)
- jaundice
- all other signs of anemia
G6PD labs
- increased bilirubin
- retic count elevated
- dark urinex
- CBC - hgb and haptoglobin
G6PD tx
- Avoid cause
- episodic, should spont. resolve in 7-12 days
- counsel to avoid giving blood
- monitor labs
- mannitol may be needed to help w/ kidney excretion
- may need a transfusion if kidney fx is normal
Leukemia pathology
Overproduction of a specific WBC type usually at an immature stage, because of shut down in production of normal bone marrow
Risk factors for Leukemia
- Previous cancers, environmental exposure to toxins, family hx, genetics
Diagnostic for Leukemia
Bone marrow biopsy
Prognosis for leukemia
70-80% go into complete remission when under age 60
Symptoms of acute leukemia
fatigue, fever, bleeding, infection, joint pain, pancytopenia, 90% blasts in peripheral smear
This type of leukemia is more common in people over 50 yrs
Chronic Lymphocytic Leukemia (WBCs over 20,000)
Most common leukemia throughout the life span
Acute myelogenous leukemia (AML)
Rarest type of leukemia
Chronic lymphocytic leukemia
Most common leukemia in children
Acute lymphocytic leukemia
Leukemia Treatment
- Bone marrow transplant
- Chemotherapy
Syngenetic transplant
From an identical twin
Allogenic transplant
From family or unrelated donor
Autologous transplant
Self donation
Where does lymphoma occur?
Blood related cancer of many organs, wherever lymph system/blood travels
Lymphoma is characterized by…
- lymphocytes (T cells/ B Cells) becoming malignant/going rogue. these cells can accumulate into tumors
- enlarged lymph nodes in the absence of infection
Where all does the lymph system exist/travel?
Lymph nodes, liver, lungs, bone marrow, spleen, bone, skin, mucosal linings
Lymphoma Dx
Biopsy of lymph nodes
Lymphoma Tx
- Targeted therapy - substances that attack cancer cells without harming normal cells
- Chemo, radiation, biologic therapy (boosts body’s ability to fight)
- therapy that removes proteins from the blood
- may do watchful waiting if there are no symptoms
Symptoms of lymphoma
- night sweats
- enlarged lymph nodes w/out other signs of infection
- fever
- wt loss
What are the most common types of lymphoma?
Hodgkins and non-hodgkins
Non-Hodgkins arises most frequently from this type of cell
B cells
Function of T cells
Help kill foreign invaders directly
Function of B cells
Produces antibodies that neutralize foreign invaders
What is the difference between Hodgkin’s and non-Hodgkin’s lymphoma?
- Non-Hodgkin’s has no Sternberg cells unlike Hodgkins
- Non-Hodgkin’s is more common
Symptoms of non-Hodgkins
- painless, swollen lymph nodes
- abd pain/swelling
- chest pain, coughing, or dyspnea
- fatigue, fever, night sweats, wt loss
Risk factors for non-hodg
- Immunosuppressive meds (organ transplant)
- infection with certain viruses and bacteria (HIV, Epstein barr, H pylori)
- Chemicals
- Older age
Indolent phase
Slow growing
Stage I lymphoma
Single lymph node region
Stage II lymphoma
Two or more lymph node regions on same side of diaphragm
Stage III lymphoma
Lymph node involvement on both sides of the diaphragm, may include spleen
Stage IV lymphoma
Diffuse extralymphatic disease
Platelet deficiency
Thrombocytopenia (several types)
