icr: ANEMIA Flashcards
pancytopenia
decrease in RBC, WBC, and platelets
normal HB
12-16 for female; 14-18 for males
normal HCT
37-47 female; 40-54 male
African American hb and hct is…
lower than caucasians
leukopenia
decreased WBC
thrombocytopenia
decreased platelets
aerobic exercise tends to _____ hb and hct
lower
by increasing plasma volume and increasing erythrocyte 2,3DPG synthesis
in pregnancy, what increases? what falls?
plasma volume, RBC mass increase
MCV and Hb fall
O2 delivery =
cardiac output x O2 carrying capacity
symptoms of insufficient oxygen delivery
fatigue, irritability, confusion, poor focus, dyspnea on exertion, angina, mental status changes, pallor,(all indicate anemia)
if MCV is increased…
large RBC = nuclear problems
megaloblastic anemia, myelodysplastic anemia, chemo induced
if MCV is low ..
small RBCs = cytoplasmic problem
iron deficiency anemia, abnormal Hb
HCT
the percentage of blood occupied by RBC
CALCULATED, NOT measured
what is the best measure of oxygen carrying capacity?
Hemoglobin
MCV
size of individual RBC; allows categorization of macrocytic, normocytic, or microcytic
high RDW means…
there is more than one population of RBCs
saturation %
iron/transferrin ratio
iron deficiency vs chronic disease vs pregnancy
distinguished by transferrin
increases in iron deficiency, decreases in anemia of chronic disease, and slightly increased in pregnancy
iron is increased
in hemolytic anemia; when serum iron turnover is fast
reticulocytes (ARC)
slightly blue due to residual RNA;
hypo 100,000
HIGH reticulocytes means
acute blood loss or RBC destruction
causes of iron deficiency anemia
iron malabsorption
transferrin deficiency
loss of iron
ferritin vs transferrin
f stores iron; t transports it
symptoms of iron deficiency
headache glossitis pica leg cramping somatitis
B12 deficiency
via lack of intake(meat/dairy) or impaired absorption (r binder, intrinsic factor from parietal cells)
marrow arrested in S phase –> increased RBC size
***inverse relationship of severity of anemia and neurologic disease
SYmptoms: anemic signs, glossitis, dementia, ipersonality change, loss of vibratory and position sense
larger MCV, oval, hypersegmented neutrophils
B12 is necessary for
DNA synthesis
normal B12 absoprtion
b12 binds to gastric r binder
parietal cells release intrinsic factor
b12-r binder dissociate in duodenum due to pancreatic proteases
B12 and IF bind –> absorbed in distal ileum
sickle cell anemia
abnormal Hb (glutamate instead of valine at 6th position of beta chain) HbS becomes polymerized in times of low Oxygen--> sickling--> microvascular infarcts and severe anemia
sickle cells and target cells
1- acanthocyte 2- echinocyte 3 - elliptocyte 4 - schistocyte 5 - sickle cells 6 - spherocyte 7 - stomatocyte 8 - codocyte/target cell 9 - dacrocyte
1 spines w irregular lengths and spacing 2 short rounded even spaced spines 3 oval and elongated 4 fragmented, crescent with a few spines 5 crescent, pointy ends 6 small spheres with no central pallor 7 slit like center 8 thin cell, increased diameter Hb 9 tear drop
what disease has a majority of TARGET cells
thalassemia
bite cells –>
G6PD deficiency
Hgb is measured
directly
microcytic anemias
CELTICS chronic disease eHgb lead poisoning thalassemis iron deficiency cancer sideroblastic
normocytic anemias
early renal or early chronic disease
sickle cell
hemolytic
hemorrhage
macrocytic anemias
b12/folate, alcohol, meds, thyroid, reticulocytosis, aplastic anemia,
hepcidin
iron absorption regulator
iron deficient anemia synptoms
pica
pallor
glossitis
koilonychias of nails
in IDA, TIBC is? ferritin is?
tibc high ferritin low (
when is ferritin high?
not IDA
it is in inflammatory states
in anemia of chronic disease, MCV is
initially normocytic, but become microcytic
labs of anemia of chronic disease
high esr or crp normal or high ferritin normal or low tibc normal or low iron increased IL6 increased hepcidin
in anemia due to chronic kidney disease…
underproduction of EPO (produced in the kidneys in adults)
low reticulocyte count and increased inflammation
pernicious anemia
destruction of parietal cells -> b12 cant be absorbed (no intrinsic factor)
B12 is a cofactor for two rxns
1) methylation of homocyteine to methionine by homocsteine methyltransferase
2) methylmalonyl coa –> succinyl coa by methylmalonyl coa mutase
b12 molecules has
cobalt (cobalamin) - picks up the methyl from FH4
folate vs b12 def
foalte = low folate, high homocysteine (NO NEURO symptoms) b12 = normal folate, low b12, high homocycteina and methylmalonic acid
