Heme Flashcards
Normal hgb
M: < 13 W: <12
Normal HCT
M < 40 W: <36
MCV
Blood cell size normal is 80-100
MCHC
Measures Color of RBC
Will be low in iron deficiency anemia
Normal in a/b thallasemia
Serum Ferritin
Most SENSITIVE test to detect iron deficiency anemia
< 15 = dx of IDA
Retic count
immature RBC, elevated in a few days to week after supplementation of iron /folate/ or B12
RDW
measures the differences in RBC sizes. Elevated in anemias and is an early indicator
TIBC
it is the measure of the transport protein in blood. Elevated in IDA
normal in thal
What will you see on a blood smear with a person with IDA
Microcytic hypocromic RBC’s
Poikilocytosis ( abnormally shaped)
Anisocytisis ( variability in size)
IDA S/S
May have a normal CBC in early phase,
Fatigue, pallor, leg cramps, angular stomatitis, cheilosis
PICA: cravings for clay, ice chips, dirt
Nails: Will see Koilonychia ( spoon-shaped nails)
How much iron is stored in the body
2500 mg
what is the treatment for IDA
- find cause
- replace with ferrous sulfate 325 TID for 6-8 weeks
- Correct diet
what are foods high in iron
spinach, red meat, liver, egg yolks
What labs would you see with IDA
decreased
- MCV
- Hgb
- HCT
- ferritin
- iron
Increased
- RDW
- TIBC
Normal
- Hgb Electrophoresis
What would you check to see the iron supplementation response
- retic count peak at 7-10 days
- order a CBC w/ retic in 4-6 weeks
- Hbg will rise in 6-8 weeks
Who is most effected with thalassemia A/B
Mediterraens ( italian, greek, arabs)
South east asians ( chinese, flininos)
Africians
Normocytic anemia levels
MCV 80-100
classic presentation for normocytic anemia
elderly w an autoimmune dx w/ malgiancy and signs and symptoms of anemia
What is the main problem with normocytic anemia
bone marrow is adversely affected
What are the two causes of macrocytic anemia
B12 or Folate
What is the first and second tests for macrocytic anemia
- CBC ( will see decresed H/H and increased MCV >100)
2. then order B12 folate , retic, peri smear
what will you see on a peripheral smear with someone with macro
macrocytes, megaloblastic RBC’s, hypersegmented neutrophils
B12 deficency what is it?
macrocytic, normochromic anemia
also a autoimmune dx called pernicious anemia
lacking intrinistic factor
what are high risk populations for B12 def
vegans, babies of vegans, bariatric surgery
PE findings for B12
decreased DTR ( ankle jerk reflex)
vibration sense and proproception - decreased
hand grip weak
B12 presentation
complains of generalized weakness with parasthesias of hands or feet, reporting lef stiffness, dropping objects
Folate Def Anemia, def and cause
Macrocytic, normochromic low intake of folate ( malnutrit, alcoholics) increased demand ( preg, lactation) impaired absoptions ( meds
What medications inhibit folate absobption
metformin, trimethoprin, triamterene (diuretic), methotrexate, phenobarb, phenytoin
Presentation of folate def
alcoholic or elderly with pallor, fatigue, diarrhea, no nuero symptoms, check medications
what foods are high in folic acid
cereals bread, fruits, non cooked leafy greens,
what are the risks for preg women with low folate?
neural tubal defects
should take 400 mcg daily
what is secondary polycythemia?
increases in RBC mass, increased H/H
overproduction of red blood cells. It causes your blood to thicken, which increases the risk of a stroke.
Caused by something else such as ,
dehydration can cause hct to become falsely high
increased production of erythropoietin secondary to aterial hypoxemia ( chronic smoking, copd, living at high alt) sleep apnea
what is thrombocytopenia?
defined as low platlet count < 150,000
s/s:
- petecchiae to purpura, easy brusing, hemmorahge,
