Hematology: Red Blood Cell Disorders Flashcards
1
Q
Transferrin
A
carries iron to bone marrow where Hgb synthesized
2
Q
What do the liver and spleen do to the old RBCs?
A
phagocytize (ingest) andTota
3
Q
Reticulocyte count
A
shows if bone marrow is working
4
Q
Hemoglobin
A
protein that delivers oxygen to the cells
5
Q
Mean Corpuscular Hemoglobin (MCH)
A
average amount of hemoglobin found in RBC in body
6
Q
Erythropoietin
A
made by kidneys, stimulates the proliferation of red blood cells
7
Q
stage of Reticulocyte in RBC
A
last immature stage of RBC
8
Q
what is the most reliable measure of RBC production
A
Reticulocyte count
9
Q
what is a good indicator of bone marrow function?
A
Reticulocyte count
10
Q
Hematocrit
A
% of RBC
11
Q
what happens to MCV, MCH and vit B12 levels with iron deficiency anemia?
A
everything is low
12
Q
anisocytosis description and cause
A
abnormal size, caused by severe anemia
13
Q
poikilocytosis description and cause
A
abnormal shape, caused by severe anemia
14
Q
Target cells description and cause
A
cells dark center + periphery & clear ring inbetween, caused by liver disease
15
Q
sickle cell description and cause
A
cresent-shaped red blood cell, caused by sickle cell anemia
16
Q
lysis
A
cell destruction
17
Q
macrocytic
A
large RBCs (Increased MCV)
18
Q
normocytic
A
normal size RBCs
19
Q
microcytic
A
small RBCs (decreased MCV)
20
Q
hyperchromic
A
too much Hgb
21
Q
Normochronic
A
normal amounts of Hgb
22
Q
hypochromic
A
too little Hgb (decreased MCHC)
23
Q
Production defect
A
lack of necessary building blocks to make RBCs
24
Q
Destruction defect
A
bone marrow destruction or hemolysis
25
genetic defects in Hemoglobin
sickle cell anemia
26
Anemias caused by Red cell production disorders
Deficiency of essential elements, bone marrow disease, nutritional deficiencies
27
Anemias caused by an excessive loss of RBCs
chronic blood loss, acute blood loss, excessive cell lysis
28
examples of excessive cell lysis (destruction)
hemodialysis, hypersplenism, hemoglobinopathies, intravascular hemolysis
29
what is the normal response of a reticulocyte count to be in the presence of anemia?
high
30
Iron deficiency anemia labs
MCV decreased
MCHC decreased
Hgb decreased
Normal/increased RDW
31
average amount of Fe in diet
10-20 mg
32
how much of Fe is absorbed in intestines?
1-2mg
33
500-1500mg of Fe is stored as what?
- Ferritin in liver, spleen and bone marrow
| - Myoglobin in muscle
34
what is iron necessary for?
hemoglobin production
35
what does a serum iron test measure?
iron bound to transferrin
36
what is the gold standard for iron stores?
bone marrow exam
37
a low serum ferritin rules in or out iron deficiency anemia?
rules in
38
a high serum ferritin essentially rules in or out iron deficiency?
rules out **only in the absence of inflammatory condition
39
is ferritin levels affected by blood transfusions?
no
40
how long does it take to increase ferritin levels with iron supplements?
2-3 weeks po and 24 hours IV
41
what affects transferrin?
inflammation, loss of protein, nutritional status and liver disease
42
Transferrin concentration
globulin in the blood that binds and transports iron. 1/2 life = 1 week
43
Transferrin saturation and is this increased of decreased with iron deficiency anemia?
the sites on transferrin that are attached to iron. This is decreased in iron deficiency anemia because there isnt alot of iron to go around since its deficient
44
normal transferrin saturation
20-50%
45
Iron deficiency anemia cause
- impaired production of RBC
- low iron intake
- problems with iron absorption
- chronic blood loss
46
poorly understood s/s of iron-deficiency anemia
brittle nails,, glossitis (smooth red sore tounge), web in upper esophagus, pica
47
key sign of iron-deficiency anemia
hypoxemia
48
what will labs look like in iron deficiency anemia?
Decreased:
MCV, MCHC, serum ferritin & transferrin saturation
Increased:
serum transferrin & total iron binding capacity
49
Megaloblastic Anemias
impaired synthesis of DNA resulting in enlarged RBC (Macrocytic)
50
megaloblastic anemias are most often d/t what?
vit B12 deficiency or folate deficiency
51
Are megaloblastic anemias RBcs small or large?
large with a decreased lifespan and few in number
52
where is vit B 12 absorbed
terminal ileum
53
Vit B 12 is only absorbed when in complex with what?
intrinsic factor which is secreted by parietal cells of gastric mucosa
54
large store of vit B 12 is located where
liver
55
are MMA and homocysteine increased or decreased with vit B 12 deficiency?
increased
56
which is more specific MMA or homocysteine in vit B 12 deficiency?
MMA
57
causes of Vit B12 deficiency
pernicious anemia, total gastrectomy (removes intrinsic factor), atropic gastritis, vegetarian diet, chronic alcoholism, sprue & celiac disease, resection of ileum
58
what deficiency is seen with myeloproliferative disorders, liver disease & bacterial overgrowth syndrome?
Vit B12
59
normal vit B12
100-700pg/ml
60
pernicious anemia
inadequate production of intrinsic factor
61
the presence of antiparietal cell antibodies does not rule in what?
do not rule in pernicious anemia
62
s/s of vit B12 deficiency
hypoxemia, premature grey hair, vitiligo, low BP, lemon colored skin, low grade fever, yelloe-blue color blindness
63
early neurologic signs of vit B12 deficiency
inability to preform fine movements, Loss of vibratory sense
64
progressive neurologic signs of vit B12 deficiency
paresthesias (numbness & tingling), weakness, uncoordination, ataxia, personality changes
65
late neurologic signs of vit B12 deficiency
urinary/fecal incontinence, spastic paralysis, confusion psychosis
66
vit B 12 deficiency lab values
macrocytic (increased MCV), normochromic (normal amount of Hgb), decreased B12
67
folic acid deficiency causes
alcohol use, pregnancy, certain folic acid antagonists
68
folic acid deficiency lab values
macrocytic (increased MCV), normochromic (normal amount of Hgb), decrease in serum folate
69
do you have neurologic symptoms with folic acid deficiency?
no
70
treatment for folic acid deficiency
1mg daily for 1-4 months
71
what else do you test when looking at folate (folic acid)deficiency
B12 deficiency
72
causes of aplastic anemia?
radiation, chemo, tumor cells, myelodysplatic syndromes
73
normocytic anemia
anemia in which RBC are normal
74
Normocytic anemia examples
aplastic, cut blood loss, anemia of inflammation, hemolytic anemia, hemoglobinopathies
75
s/s of aplastic anemia
hypoxemia, decreased bone marrow, decreased WBC & PLT
76
what is most important treatment for chronic anemia?
treat the cause!
77
anemia with inflammation (normocytic anemia example) is seen with what problems?
malignancy, chronic infection or inflammation
78
therapy for anemia of inflammation?
no known therapy
79
what other diseases are associated with anemia of inflammation?
renal insufficiency, liver disease, chronic inflammation, Endocrinopathies, acute bacterial infection, ICU pts
80
Hemolytic anemia ( Normocytic anemia example) that is inherited causes
sickle cell, thalassemia, G6PD
81
Hemolytic anemia (Normocytic anemia example) that is acquired causes
drugs-sulfas, infection, transfusion rxn
82
s/s of Hemolytic anemia (normocytic anemia example )
hypoxemia, jaundice, splenomegaly, organ damage, hepatomegaly
83
treatment for hemolytic anemia (normocytic anemia example)
increase fluids, steroids, remove spleen, oxygen therapy
84
what does a direct coombs test looks for?
antibodies attached to RBCs
85
what is a direct coombs test used for?
to confirm a diagnoses of hemolytic anemia
86
what does an indirect coombs test look for?
presence of antibodies in the patients serum
87
what is a indirect coombs test used for?
to screen for Rh factor
88
Hemoglobinuria definition and when is it elevated?
excretion of free hemoglobin in urine--its elevated if hemolysis is intravascular
89
Bilirubin
made from hemoglobin which is carried to liver to be excreted
90
sickle cell anemia is what kind of genetic order
| (recessive/dominant?
autosomal recessive disorder
91
autosomal
any chromosome other than the sex (X& Y)
92
sickle cell anemia has what kind of abnormal hemoglobin?
hemoglobin S
93
life span of a sickle cell
15-20 days
94
what makes a sickle cell anemia pt symptomatic?
hypoxia
dehydration
acidosis
95
Hgb F in sickle cell pts
don't have a problem with sickling until 6 months of age
96
why is sickle cell anemia painful?
blood vessels become occluded
97
sickle cell anemia complications
```
stroke
splenic sequestration
avascular necrosis
aplastic crisis
cardiomegaly(enlarged heart)
```
98
aplastic crisis in sickle cell anemia
bone marrow shuts down and pt becomes anemic
99
what is used to confirm sickle cell anemia?
hemoglobin electrophoresis, increase in bilirubin
100
hemoglobin electrophpresis
looking for hemoglobin S
101
Hereditary Spherocytosis anemia is what kind of genetic disorder? (recessive or dominate?
autosomal dominate hemolytic anemia
102
s/s polycythemia vera
purplish skin, mucous membranes very red, bloodshot eyes, splenomegaly (huge spleen)
103
treatment for polycythemia vera
bloodletting, radiation
104
polycythemia vera
overproduction of RBCs
105
If Iron stores are decreased what happens to Transferrin levels?
increase
106
If Iron stores are increased what happens to Transferrin levels?
decreased
107
Total Binding Capacity
The amount transferrin in the blood, this is increased because your body tries to compensate by making more iron carrying capacity
108
Serum ferritin and will this be increased or decreased in iron deficiency anemia?
iron stores; decreased
109
RBC
cytotic
110
Hgb
chromic
