Pales CIS Flashcards
problem with retic count labs
it takes 5 days or more for it to be elevated in many types of anemia that would cause an elevation
RBC mass depends mostly on
hematocrit
relationship between RBC, hemoglobin, and hematocrit
Hemoglobin - 3x RBC
hematocrit- 3x hemoglobin
microcytic anemia differential?
iron deficiency thalassemias chronic disease lead poisoning sideroblastic
how to differentiate between microcytic anemias?
iron studies:
- ferritin
- TIBC
- iron
- +/- transferrin
Does having normal ferritin rule out iron deficiency?
no, normal or high ferritin doesn’t rule it out BUT low ferritin can diagnose it.
ferritin can go up in infection (it is an acute phase reactant)
microcytic anemia with normal iron studies suggests what?
probably a thalassemia (will see target cells)
in chronic disease the TIBC would be low to reflect the difficulty in using the iron.
how do we confirm thalassemia?
hemoglobin electrophoresis
if it’s negative, still consider genetic studies for an alpha thalassemia.
thalassemia minor patients do not need
iron supplements
why do we need the stomach for iron absorption?
H+ ions to reduce the Fe3+
most common cause of iron deficience in the US
chronic bleeding
reticulocyte count in iron deficient anemia
low; need iron to build reticulocytes
EPO tests in anema
never necessary.
It’s only useful in distinguishing between polycythemias (primary/ secondary)
neurological condition associated with iron deficiency?
restless leg syndrome
esophageal condition associated with iron deficiency?
Vinson-Plummer
atrophic gastritis, esophageal webs, happens to women usually
gastric bypass pt gets B12 shots. Why?
loss of intrinsic factor from the stomach –> no longer can absorb B12
why do we give iron orally?
shots leave a tattoo mark
IV is complicated and related to high allergic reaction rates
oral is best
after treating iron deficiency anemia with iron the RDW goes up. WhY?
increased reticulocytes (big), some normal RBCs, and still the old small ones around.
stuff we see in alcoholics
a little macrocytosis without anemia can be present just from the alcohol.
folate/ other nutritional deficiencies can be present from not eating, but iron can also be mising from pancreatitis
normocytic (mixed anemia or acute bleed) and microcytic (chronic bleed) could also be present in alcoholics
toxic effect on bone marrow can –> pancytopenia
pancytopenia or decreased platelets in alcoholics. causes?
bone marrow suppression
splenic sequestration
microangiopathic hemolytic anemia
haptoglobin diagnoses
hemolysis when it is down.
its elevation is of no clinical significance.
does methotrexate cause folate deficiency?
no, folate is there but not able to be used.
tests that would be positive in hemolysis
elevated unconjugated bilirubin
reticulocytosis
hemosiderin
free serum hemoglobin
to diagnose autoimmune hemolytic anemia you order
coombs test
to diagnose microangiopathic anemia order
peripheral smear to look for schistocytes bleeding studies (consumption of the coagulation factors, etc.) --> elevated PT, PTT, decreased platelets and fibrinogen
what must we give with EPO?
iron
2 times to give EPO
end-stage renal disease
after chemotherapy
otherwise, too many side effects.
