Normocytic Anemia

Question 0

What are the two classifications of peripheral rbc destruction?

Answer 0

Extra vascular and intra vascular hemolysis

Question 1

What is normocytic anemia? And how do you measure its cause?

Answer 1

MCV (80-100). Caused by increased peripheral destruction or underproduction. Can use reticulocyte count to distinguish between the two

Question 2

What causes extravascular hemolysis? What are the breakdown products of hemoglobin?

Answer 2

RBC destruction by the reticuloendothelial system (macrophages of the spleen, liver and lymph nodes.
Globin ~> amino acids
Heme ~> iron and protoporphyrin.
Iron ~> recycled
Protoporphyrin ~> un conjugated bilirubin bound to serum albumin

Question 3

What are clinical and lab findings of extravascular hemolysis?

Answer 3

Anemia with splenomegaly, jaundice, increased risk for bilirubin stones, marrow hyperplasia with corrected reticulocyte count >3%

Question 4

What are clinical and lab findings of intravascular hemolysis?

Answer 4

Hemoglobinemia, hemoglobinuria, hemosiderinuria (via shedding for tubular cells which contain hemosiderin), decreased serum haptoglobin.

Question 5

What are reticulocytes? What color are they on blood smear and why?What is the normal reticulocyte count? What happens to reticulocyte count in anemia?

Answer 5

Young RBCs released from the bone marrow appear bluish due to residual RNA. Normal RC count is 1-2% of RBCs. RC falsely elevated in anemia due to the decrease in RBCs but not in reticulocytes and has to be corrected.

Question 6

How do you correct RC and what do these values mean?

Answer 6

Corrected by multiplying RC with hematocrit/45. Corrected count >3% indicates good marrow response to anemia and suggests peripheral destruction, while Corrected count <3% indicates poor marrow response and underproduction.