Preventing Iatrogenic Anemia-LABS Flashcards
Hemoglobin
-oxygen carrying component of a red blood cell
-Normal: 135.5-16.0 g/dl
High HGB
-Hypoxia (Smoking, OSA, Lung Dx, High Altitude, CO)
-Dehydration
-Polycythemia Vera (JAK2V617F)
-EPO producing tumors (Liver, Renal, Hemangioblastoma, Pheo, Uterine)
-PV is most common chronic myeloproliferative disorder
MCV
-way to differentiate anemia. -The higher the MCV is to be more likely it’s going to be B12 or folate.
-Normal: 85.2-95.1 fL
B12
-absorbed in the small bowel. If you have something that is rerouting past the small bowel or bacterial overgrowth, something inhibiting absorption, vegan, vegetarian’s-deficiency
-deficiency most likely Pernicious Anemia (decreased intrinsic factor).
Folate deficiency
-think about medications or alcohol. Alcoholics will have macrocytosis. People on methotrexate, chemotherapy, or on high doses of Bactrim for pcp prophylaxis or PCP pneumonia
Low HGB
-Nutritional Deficiency (Iron, B12, Folate)
-Blood Loss (Trauma, GI Tract, Hematoma)
-Hemodilution
-Hemolysis
-Renal Failure
-Chronic Disease
Macrocytosis
-B12 and Folate Deficiency (most common)
-Pernicious Anemia, Surgical Resection of ileum, sprue, fish tapeworm, bacterial overgrowth (B12)
-ETOH (folate)
-Hypothyroidism
-Drugs (AZT, MTX, Hydroxyurea, Bactrim, Valacyclovir, Triamterene, Phenytoin)
-Liver disease
-Pregnancy (Folic Acid)
-Myelodysplastic Syndromes
-Cold and Warm Agglutinins
-Hyperglycemia (>600)
-Extreme Leukocytosis (>50,000)
-Reticulocytosis
RDW
-RDW can differentiate Microcytic anemias. HIGH RDW= Iron deficiency LOW RDW= Thal
Microcytosis
-If you have ever had a normal MCV, you do not have Thalassemia
-Iron Deficiency (most common)-Ferritin
-Thalassemia (alpha or beta minor)-MCV always low
-Chronic Disease
-Lead Poisoning
-Sideroblastic Anemia
-Aluminum Toxicity
WBCs
3,500-10,000 x10^9
Leukocytosis
-High WBC count
-Infection (most common)
-Leukemia
-Steroids
-Stress
-Tumor Necrosis
-Drugs (Lithium, Digoxin)
-Platelet Clumping
-Cryoglobulins
–Large leukocytosis (pneumonococcus, staphylococcus, clostridium)
Leukopenia
-Low WBCs
-Leukopenia is low WBC and is different than neutropenia
–Medications
-Myeloproliferative Disorders
-Infections (Virus, Bacterial, Rickettsial)
-Gram Negative Sepsis
Neutrophils
3500-10000/L
-Most predominant white blood cell
Neutrophilia
-high neutrophil count
-Bacterial infection
-Smoking
-Inflammatory States
-Drugs (Lithium, Beta Agonists, Minocycline)
-Myeloproliferative Disorders
-Ethylene Glycol Intoxification
-Leukocytosis with a left shift is high neutrophil count
Neutropenia
-Low neutrophils
-Post Infectious (most common)
-Drug Induced (clozapine, sulfasalazine)
-Immune Disorders
-Hypersplenism
-Bacterial infections that cause neutropenia (salmonella, tularemia)
-Neutropenia (Influenza, measles, chickenpox, rubella, HIV, dengue fever, etc. Increased lymph)
Lymphocytosis
-High lymphocyte count
-Viral infections
-Leukemia
-Bacterial (TB, Brucella, Pertussis)
-Thymoma
Lymphopenia
-low lymphocyte count
-viral (HIV)
-Inflammatory (SLE)
Monocytes
-Bacterial (Listeria, TB, Rickettsia)
-CML
Eosinophilia
-Allergies/drug reaction
-Parasites
-Churg-Strauss
-Heme Malignancies
-Cancer patients-graft vs. host
Basophilia
-Heme malignancies
Platelets
-150,000-450,000/L
-30% of platelets found in normal size spleen. Anything that causes splenomegaly can cause decrease platelets.
-(Ferritin, CRP, Sed Rate, Ceruloplasmin, Fibrinogen, alpha 1 antitrypsin, haptoglobin)
-Acute Phase Reactants… Body mobilizes for stress situation. Iron, fibrinogen, haptoglobin to handle bleeding.
Type 2 heparin induced thrombocytopenia (HIT)
is 3-5 days drop in plts after exposure-if large drop 5-10 days after exposure is something to be concerned about
Type 1 HIT
1 day after exposure to heparin
Thrombocytosis
-High Plt
–Infection (most common)
-Post Surgical Status
-Malignancy
-Splenectomy
-Acute blood loss
-Iron deficiency
-Inflammation (Acute Phase Reactant)