Heme 1 Flashcards
a high WBC can indicate what?
infection
leukemia
a low WBC can indicate what?
acute leukemia
first line of defense in a patient
neutrophils
release histamine
seen in patients w/ allergies
eosinophils
basophils
what carries the oxygen in the RBCs?
hemoglobin
normal hemoglobin in men
13-18
normal hemoglobin in females
12-16
normal hematocrit in males
45-52
normal hematocrit in females
37-48
tells you the size of the red cells
MCV
normal is 80-100
Average amount of hgb in average red cell
MCH
Average concentration of hgb in given volume of red blood cells
MCHC
variability of red cell size and shape
RDW-Red Cell Distribution Width-
what is the cutoff for low platelet count (start to get concerned)
50,000
normal platelet count
150,000-450,000
decrease in one or more of major RBC measurements from a CBC
anemia
Hct is usually ___X’s the hgb
3
Erythropoeisis occurs in the____________
bone marrow
who can you see elevated RBC levels in?
higher elevation
athlete
smoker
what is the life of a RBC
110-120
Reticulocyte count __% of total circulating cells.
1%
with an acute episodes leading to anemia what symptoms will you have?
exertional dyspnea dyspnea at rest fatigue boudning pulse palpitations 'roaring in ears' leg pain
what are the 3 mechanisms in the kinetic approach?
decreased RBC production
increased RBC destruction
blood loss
low levels of what hormones can lead to decreased RBC production
lack of TSH
lack of testosterone
lack of EPO
with aplastic anemia what will be seen?
low level of all counts (RBC, WBC)
what cause macrocytic anemias (MCV>100)
Folate, B12 deficiency
Abnormal RBC maturation
Alcohol Abuse, liver disease
what can cause microcytic anemia
Decreased iron content within RBC (MCH)
Decreased iron availability
Decreased heme synthesis
Decreased globin production
what are the 3 most common causes of anemia?
IDA, thalassemia, anemia of chronic disease.
what poisonings can interfere w/ RBC production
lead and copper
what other levels are affected with IDA?
Decreased ferritin, increased TIBC, decreased iron concentration
what will be normal with anemia of inflammation?
ferritin (or can be increased (artificial)
what is seen with bone marrow supression
differences in white count and platelets as well as RBC s
Main cause of VIt B12 deficiency?
people who have undergone gastric bypass
what OTC products should you ask someone w/ anemias about?
NSAIDs (affects the kidneys and gastric ulcers)
a new onset of neuropathy w/ anemia is probably due to what?
B 12 deficiency (can also cause pancytopenia)
if you see Schistocytes what is going on?
hemolysis somewhere
cells are torn apart
infection with what can cause chronic hemolysis and blunt erythropoiesis?
parvovirus
how do you treat chronic hemolysis?
steroids (need to cover w/ PPI to prevent more anemia)
are bone marrow biopsies usually indicated in anemia?
no
who is iron deficiency anemia seen more in?
women and children
what does absolute iron deficiency mean?
Iron stores absent in BM, liver and spleen
what is ferritin used for?
iron deficiency anemia
causes of iron deficiency
Blood loss-overt or occult
Decreased iron absorption (celiac, gastritis)
Foods and medications can impair iron absorption
Hemodyalysis
Gastric Bypass
Congenital Iron deficiency
what is pica for ice?
pagophagia
symptoms of iron deficiency?
Headache, weakness, irritability, fatigue, exercise intolerance, PICA
Many are asymptomatic
Glossal pain, decreased salivation, dry mouth
normal ferritin levels
18-200
Preverted appetite for substances not fit for food
Pica
what is an Excellent picture of iron stores
serum ferritin (but can be falsely elevated)
Girls ages 12-18, nonpregnant women of childbearing age, screen for anemia every how many years?
5-10 years
pregnant women should be on how much iron each day?
30 mg/day
Patients with hgb <__ should be referred onto hematologist
9
if a person takes an antacid when can they take their iron?
2 hours before or 4 hours after
how much elemental iron do people w/ IDA need?
120-150 mg of elemental iron
indications for IV iron
Indicated for excessive blood loss
Inflammatory disease
Chronic Kidney disease
what is one of the biggest iron infusions that can cause anaphylaxis
Infed (Iron Dextran)
pretreat w/ bendaryl
what is an IV iron that is magnetic. Can interfere w/ MRI results
Feraheme
what will be seen on a peripheral smear w/ B12 and folate deficiencies
hypersegmented neutrophils on smear
causes of a folate deficiency?
nutritional; substance abuse; depressed patients, nursing homes; celiac disease; inflammatory bowel disease; short bowel syndrome; pregnancy/lactation; medications
causes of a B12 deficiency?
Pernicious anemia; bariatric surgery; gastritis; Chrons disease; tapeworm; pancreatic insufficiency; vegans; medications
what meds can cause a B12 deficiency
neomycin
metforminn
PPI and H2
what drugs can cause a folate deficiency?
methotrexate
trimethoprim
ethanol
phenytoin
what lab do you need for pernicious anemia
parietal cell antibody test
what are metabolic intermediates w/ B12 and folate anemias
MMA and homocysteine
tx for folate deficiency
Folate-1-5 mg/day orally for 1 to 4 months
tx for B12/ pernicious anemia
1000 mcq SQ daily X 1 week, q week X 4, then monthly
when does Hgb rise w/ B12 and folate deficiency?
rises in 10 days, returns to normal in 8 to 10 weeks.
when do neuro problems w/ b12 or folate deficiencies resolve?
3 months
are blood transfusions usually indicate in Vitamin B 12 and folate def?
no
if anemia in the older adult usually severe or mild?
mild, usually sits above 10
causes of anemia in older adults
1/3 nutrition
1/3 CKD or chronic disorders
1/3 is unknown
median age of anemia of the older adult
> 65
what do you need to dx myelodysplasia
bone marrow biopsy
A hemoglobinopathy which manifests as a chronic hemolytic anemia occuring almost always in people of African origin
sickle cell anemia
what is there an increased risk of w/ sickle cell anemia?
stroke intracrnail hemorrhage neurocognitive decline cardiac complications restrictive and obstructive lung dz renal failure
what is the RBC of sickled cells?
17 days
what level will be elevated w/ sickle cell anemia?
LDH
how do you diagnose sickle cell dz?
Hb electrophoresis (HbS is elevated generally)
how do you treat sickle cell dz?
analgesics and IV
may need transfusions
Rx- hydroxyurea (fetal Hb), folate
splenectomy
what type anemia is often seen with sickle cells?
normocytic hemolytic anemia
with hemolytic anemias what is retic count increased to?
Normal retic count increased to 4 to 5 %
Anemia due to shortened survival of RBC
hemolytic anemia
Intracorpuscular Defects that can lead to hemolytic anemia
membrane injuries
unstable or missing RBC membrane proteins
PNH (paroxysmal nocturnal hemoglobinuria)
Extracorpuscular factors causign hemolytic anemia
Antibodies directed against RBC membrane components. Stasis, trapping of RBCs in spleen
what other random things can cause hemolytic anemias?
valves, ventricular assist devices, DIC, TTP
malaria
snake bites, insects, thermal burns
certain strain of C Diff
why is haptoglobin decreased in a hemolytic anemia?
Release of hgb, binds to haptoglobin, resulting in hgb-haptoglobin complex that is removed by the liver,
what will you see w/ someone in hemolytic anemia?
jaundice
splenomegaly
abnormal cells on smear (schistocytes, tear drop)
tx for hemolytic anemia
glucocorticoids 1mg/kg
next move to Cytoxan, Rituxan, splenectomy
immunosupressives and cytoxic agents (1 months for effect)
Hgb >16.6 in women, >18.5 in men
polycythemia
what is the median age for polycythemia?
60
Acquired or inherited mutation leading to an abnormality within RBC progenitors
primary polycythemia
symptoms of polycythemia
Pruritis Erythromelalgia Thrombosis Visual Disturbances GI complaints
what do people w/ secondary polycythemia look like a lot
smokers, overweight, sleep apnea
how to approach polycythemia
Confirm with second test H & P Pulse oximetry CBC, urinalysis LFTs CXR
concern w/ polycythemia
burnout of the bone marrow
can move into myelofibrosis
or a type of leukemia
causes of secondary polycythemia
Living at high altitudes Intracardiac or intrapulmonary shunts Renal transplant Family history of PC Medications Smoking Volume depletion Carbon Monoxide
what mutation causes primary polycythemia?
JAK2 mutation
is EPO increased in secondary or primary polycythemia
secondary
what can polycythemia transform into?
AML/MDS
tx for polycythemia?
phlebotomy to keep hct <42
if someone w/ polycythemia has a high risk of thrombosis what do you give them?
hydrea
ASA
