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Hematology Exam 1 > Patient with Anemia > Flashcards

Patient with Anemia Flashcards

1
Q

Retic index >2% or absolute retic count > 100,000 indicates

A
  • There is a good marrow response, so there must be an issue of hemorrhage or hemolysis
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2
Q

CBC provides information about which type of cells?

A
  • Red cells
  • White cells
  • Platelets
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3
Q

Reticulocytes

A
  • Young red cells that are immediately released from the bone marrow as the end result of erythropoeisis
  • Full of RNA
  • Appear as polychromasia in blood smear
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4
Q

What do patients with chronic anemia complain that they can hear and why do they hear this?

A

Hear their heartbeat

  • The blood flow out of the heart is turbulent as the heart pumps faster to pump the fewer red cells quicker to exchange oxygen sufficiently
  • There is an increased stroke volume and heart rate
  • The blood comes out of the heart and up the ascending aorta that is pointed towards the ears and that is how they can hear theit heartbeat
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5
Q

Mean Corpuscle Hemoglobin Concentration (MCHC) may be elevated in what type of diseases?

A

Spherocytic diseases –> hemolytic

  • 36 is normal, but if increases even a small amount, that can indicate presence of a significant number of spherocytes
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6
Q

What are the kidneys response to chronic anemia?

A
  • Kidneys retain salt and water to expand the intravascular volume and patients with compensated, chronic anemia have expanded blood volume
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7
Q

Acute hemorrhage and hypovolemia will trigger

A
  • A reflex vasoconstriction (patients will feel cold and clammy)
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8
Q

Iron deficiency produces a low/high RDW

A

High RDW because it is a progressive disease and the younger cells will become smaller and smaller

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9
Q

RDW: Normal vs. Widened

A
  • A widened distribution= anisocytosis
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10
Q

RDW

A

Red cell distribution of width

  • Coefficient of variation of the MCV
  • How much spread there is in the MCV of all of the different red cells in the patient’s body
  • Should be a normal gaussian distribution of red cells
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11
Q

What are the calculated values in a CBC?

A
  • Hematocrit (%)
  • MCH
  • MCHC
  • RDW
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12
Q

What are the 2 ways that anemias may be classified?

A
  1. Erythropoietic response (reticulocyte count)
  2. Red cell size (MCV) and the hemoglobin concentration
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13
Q

If the underlying condition such as malaria or progressive kidney failure causes the anemia, can have further complications such as

A

Marlarial anemia: Fever will cause more demand on the heart along with the already high demand due to the anemia

Progressive kidney failure: A patient who develops anemia of chronic disease may be more sensitive to the volume overload since they may not be able to excrete the extra volume

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14
Q

Low hemoglobin correlates to

A

Low O2 delivery that leads to tissue hypoxia, that decreases function in tissues such as the heart, brain, muscles, intestines, etc.

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15
Q

Anemic patients may experience symptoms of tissue hypoxia due to the lack of oxygen delivery to the tissues and these are:

A
  • Fatigue
  • Shortness of breath, especially with exertion and eventually even with rest
  • Cognitive difficulties
  • Ischemic pain (angina or claudication)
    • Angina pectoris: chest pain from a lack of oxygen delivery to the myocardium
    • Claudication: pain in the leg muscles (calves or glutes) with walked (gets better with rest) –> limping; abdominal pain after eating
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16
Q

Red Cell Indices

A
  • MCV
  • MCH
  • MCHC
  • RDW
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17
Q

What happens to the RDW whenever a person with very low levels of iron starts to take iron?

A

The RDW will increase because the new cells will not be microcytic while the old ones will be

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18
Q

Why can older patients not tolerate anemia as well as younger patients?

A

Older patients hearts are not as functional, so they may have angina from the increased heart rate

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19
Q

Low MCV (<80)

A
  • Microcytic anemia
  • Problem with hemolgobin synthesis
  • Causes: iron deficiency, thalassemia, lead poisoning, anemia of chronic disease, sideroblastic anemias
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20
Q

Which value measures how big the RBCs are?

A

MCV

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21
Q

Which cells sense low oxygen and what do they do in response?

A

Renal mesangial cells and they increase synthesis of erythropoietin (EPO) that hopefully increases bone marrow red cell production

22
Q

If blood volume changes abruptly, the heart rate will increase/decrease

A

Increase in order to maintain the proper caridac output (Q)

23
Q

Most symptoms of acute blood loss are related to ________

A
  • Hypovolemia
24
Q

Symptoms of volume overload in anemic patients:

A
  • Swollen ankles and feet
    • This is called “high output heart failure” and is seen in patients with chronic heart failure
25
Q

Reticulocyte Index

A
  • retic count x (Hct/ideal Hct) x 0.5
  • If the bone marrow is working then the retic index should increase as anemia gets worse
26
Q

Anemia

A

Decreased hemolgobin/hematocrit below the normal range for gender and age

** Manifestation of a disease and not a final diagnosis

27
Q

Symptoms of acute hemorrhage are related to hypovolemia and are:

A
  • Hypotension- low BP
  • Orthostasis- BP falls and HR rises when the patient stands up and the paint can feel faint when standing
  • Syncope- fainting
  • Shock- lack of perfusion (oxygen) to vital organs
28
Q

Patients with chronic anemia have higher/lower levels of 2,3-DPG

A
  • Higher levels that causes rightward shift on the O2 disassociation curve that favors delivery of O2 to tissues
29
Q

If a person with very small red cells receives a red cell transfusion, what will happen to the RDW value?

A

It will increase drastically because there are 2 distinct populations of RBCs

30
Q

The smaller the RDW means

A

The red cells are more uniform in size

31
Q

Chronic anemia may lead to

A

Fluid retention that leads to increased blood volume

32
Q

Retic index < 2% or absolute retic count < 75,000 suggests

A
  • Problem with red cell production
  • Hypoproliferative abnormality
33
Q

What lab value is the most accurate and reproducible way to describe and monitor anemia?

A
  • Hemoglobin (Hgb or Hb)
34
Q

What are the directly measured values in a CBC?

A
  • Hemoglobin (Hgb)
  • RBC (number of RBCs)
  • MCV (measurement of red cell volume in femtoliters)
35
Q

Why must someone with chronic anemia be monitored when receiving a red cell transfusion?

A
  • To see if they develop CHF and if they do, they need to be put on a diuretic
36
Q

Absolute reticulocyte count

A
  • retic (%) x RBC
37
Q

Low blood pressure may be a sign of what in relation to blood volume?

A

Low blood volume

38
Q

How does the rate of change of hemoglobin levels affect a person symptomatically?

A

If someone with a hemoglobin drops from 16 to 13 in a period of 4 hours, then they will have more symptoms than someone who has a steady decrease to a hemoglobin of 4 over the course of years regardless of the hemoglobin being close to normal

It all depends on the rate of change

39
Q

Hematocrit

A
  • Volume of red cells/ total volume of blood
  • Hct= RBC x MCV
  • Hct is about 3x the amount of hemoglobin
40
Q

Which hemoglobin value will make a patient more symptomatic, 4g/dL or 10g/dl?

A

4 because there is a reduction in the oxygen carrying-capacity

41
Q

Elevated heart rate may be a manifestation of

A

Anemia

42
Q

Hypovolemia

A
  • Decrease in blood volume
43
Q

In patients with mild thalassemia is the RBC increased/decreased and the MCV small/large?

A

Increased RBC

Small MCV

44
Q

What will the RDW be for a person with thalassemia?

A

Normal because it is not progressive and the cells are uniformly microcytic

45
Q

High MCV (>100)

A
  • Macrocytic anemia
    • Megaloblastic- impairment of DNA synthesis
    • Non-megaloblastic- variety of other causes
46
Q

Macrocytic anemias can be divided into:

A
  • Megaloblastic
    • Problem with DNA synthesis
    • B12 and folate deficiency are the hallmark causes
    • AZT and hydroxyurea can cause this
  • Non-megaloblastic
    • Elevated reticulocyte counts can increase the MCV since they are larger than mature RBCs
    • Liver disease, alcohol, hypothyroidism, myelodisplasia, aplastic anemia
47
Q

What are the 2 approaches to treating anemia?

A
  1. Treat the underlying cause
    • Let the patient’s marrow replace the red cells
    • Leads to a complete correction of the anemia although it is slower
  2. Transfusion
48
Q

How would you treat anemia of someone with leukemia or bone marrow failure?

A
  • Transfusion
49
Q

How would you treat a vegetarian woman who has been iron deficient for years?

A
  • Give iron supplements
50
Q

What are the general indications for transfusion?

A
  • Cardiovascular compromise
    • CHF
      • Fluid backs up into the lungs and hear crackles and sometimes an S3 gallop
      • Must give diuretics when transfuse these patients
    • Shock
      • Patient is cold and clammy as the blood is shunted to the vital organs
      • BP is low
      • Body quits perfusing the kidneys
    • Angina
  • Hypoproliferative anemia with prolonged recovery period
    • If patient has acute leukemia or aplastic anemia, their bone marrow does not work properly
    • Given to oncology patients to make them feel better
  • Need for surgery to correct source of bleeding
    • If someone has iron deficiency from uterine fibroids or colon cancer then need to give iron and transfuse on the way to surgery
  • Need for emergent surgery
    • Give blood immediately
51
Q
A

Hematology Exam 1 (16 decks)

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