Lab value interpretation Flashcards
Iron deficiency stages:
- depletion of storage iron - labs may not show anything yet
- drop in [Hb] in blood -> RBCs become smaller (microcytic) and paler (hemochromic), with abnormal size variation
- fully developed anemia, RBC changes as per above, mean corpurcular volume (MCV) down
mean corpuscular Hb (MCH) down
mean corpuscular Hb concentration (MCHC) down
What is serum iron and TIBC?
Serum iron - amount of iron bound to transferrin (iron transport protein in the blood)
TIBC - total iron binding capacity - maximum amount of iron that could be bound to transferrin
transferrin saturation (%) = serum iron /TIBC = amount currently bound to transferrin / total amount that could be bound = % currently bound to transferrin
What is serum ferritin?
serum ferritin - storage form of iron (up to 4500 molecules covered by proteins)
females naturally have lower ferritin stres
low ferritin is diagnostic of iron deficiency = iron stores depletion
anemias of chronic disease - inflammation, malignancy, and infection prevents release of Fe from macrophages (RE) that “digest” RBCs - ferritin stores go up, but Fe+ within blood cells may be low
Lab findings in iron deficiency?
serum iron : down!
TIBC: up! (iron wants to bind and get transported)
% saturation of transferrin: down
ferritin: down (storage down)
free erythrocyte protorphyrin: up (protorphyrin ring that misses Fe2+ on the inside)
hemoglobin: down
MCV: down
MCH: down
abnormal peripheral blood smear: image shows hypochromia (central pallor) and size variation)
platelet count: up
Lab findings in hemochromatosis?
serum iron: up
serum transferrin (TIBC): down
% saturation of transferrin: up
ferritin: up
! opposite to iron deficiency !
test genetics, liver biopsy - measure iron content (less used now b/c DNA testing available)
What is free erythrocyte protoporphyrin?
Small number of protoporphyrin molecules bind Zn2+ instead of Fe2+ to produce zinc protoporphyrin, which then circulates in RBCs. A decrease in iron available to RBCs increases formation of Zn protoporphyrin. Usually measured as free erythrocyte protoporphyrin (FEP) = Zn -> assessment of iron available for Hb production
Both iron deficiency (absolute lack of iron) and chronic disease (impaired utilization of iron stores) will increase FEP.
Outline general lab results for a variety of anemias?
iron deficiency vs chronic disease vs hemochromatosis
More detailed results for anemias?
Outline blood groups, Rh and their associated antibodies and antigens?
Blood group A: A antigen on RBC surface and anti-B antibody in plasma
Blood group B: B antigen on RBC surface and anti-A antibody in plasma
Blood group AB: A and B antigens on RBC surface, no antibodies in plasma - universal donor of plasma, universal recipient of RBCs (remember that plasma and RBCs separated in blood transfusion)
Blood group O: no antigens on RBC surface, anti-A and anti-B antibodies in plasma - universal recipient of plasma, universal donor or RBCs (remember that plasma and RBCs separated in blood transfusion)
Rh - Rh antigen on RBC surface. Rh - mothers exposed to Rh+ blood (ex. delivery) may make anti-Rh IgG (can cross placenta and cause hemolytic disease of the newborn in the next pregnancy that is Rh+
Anti-A antibodies and Anti-B antibodies are IgM and cannot cross placenta; anti-Rh antibody is IgG and CAN cross placenta - give RhoD immune globulin to mom to prevent sensitization = RhoGam - solution of IgG anti-D (anti-RhD) antibodies that take out any fetal RhD-positive erythrocytes which have entered the maternal blood stream from fetal circulation, before maternal immune system can react to them, thus preventing maternal sensitization
What is available for blood transfusions?
Why do we only give to symptomatic/high risk patients?
- Red blood cells (RBCs) - contains A/B surface antigens, Rh surface antigens
- platelet pool
- plasma: frozen plasma (thawed) - contains anti-A/B,.. antibodies, coagulation factors, etc = FP (for frozen plasma - frozen w/i 24 hrs of collection)
- plasma: cryoprecipitate - FP that is thawed at low temperatures
- In Canada, blood products are leukodepleted via filtration immediately after donation (no lymphocytes, monocytes or granulocytes)
- think of blood being separated into Plasma, Platelets and RBCs
ex. plasma for S**YMPTOMATIC **anemia - *platelets** - coagulopathy patient who is BLEEDING or at **HIGH RISK of BLEEDING **
- *don’t just give for numbers, must have clinical indication - transfusion has risks**
- transfusion is always a temporary solution - underlying cause must be adressed
What is a good transfusion rate for RBCs?
2-4 hrs , 3 hrs is ideal
transfuse w/i 42 days of collection - RBCs from donors lyse faster, if transfuse late, risk of hyperkalemia (since RBCs lyse, K+ released - terrible for heart)
Indications for RBC transfusions (lecture)?
Lecture notes:
- Improved oxygen carrying capacity
- supression of abnormal hematopoiesis
transfuse if:
- symptoms of anemia (SOB, fatigue, angina, confusion)
- acute blood loss
- current Hb low and chronic anemia
- patient history/special situation (volume loss, fever/chills, CAD, etc)
if Hb 100+ almost always inappropriate to transfuse
<80 Hb - transfuse for symptoms of anemia or consider post-surg
<70 Hb - if in ICU (adult or peds) and stable
Indications for RBC transfusions - Toronto Notes?
Hb < 70 g/L -> goal to maintain Hb between 70-100 during active bleed
consider higher Hb in:
CAD/unstable coronary syndromes
uncontrolled bleed
impaired pulmonary function
increased O2 consumption - high with fever/chills, anesthesia
What tests should be ordered before transfusion?
1. Group and screen
Group: determines ABO GROUP = ABO antigens and D (Rh) = RBC surface => worry about acute hemolytic transfusion reaction
Think group anything on RBC surface
screen: for minor blood antigens (Duffy, Kidd, etc), allo-antibodies in patients serum=> worry about delayed hemolytic transfusion reactions (delayed because antibodies to these are made first, 10-14 days)
allo-antibodies = antibodies against something foreign (ex. in transfusion or pregnancy)
2. Crossmatch - donor and recipient blood together to see if they agglutinate - if Y = baaad idea
3. DON”T FORGET INFORMED CONSENT
What are allo-antibodies ?
allo-antibodies = a**ntibodies against something foreign RBC antigens **(ex. via blood transfusion or pregnancy), they are non-ABO red cell antigens, IgG (cross placenta)
ex. Rh, Kell, Kidd, Duffy, etc