RBC 1 Flashcards
What is the definition of anemia?
Decrease in the number of circulating RBC/hemoglobin..we look at hemoglobin levels
Anemia is the sign/symptom of some other problem, it is not a diagnosis in itself
What is the normal level of hemoglobin?
Males: 130 g/L
Females: 120g/L
What are the 4 main causes of anemia?
1- GI blood loss
2-Nutritional deficiency
3-Renal or hepatic disease ( cannot make erythopeoitin)
4-Malignacy
What causes symptoms to appear in people with anemia?
1- Decreased oxygen delivery to tissue
2- Low blood volume ( hypovolemia)- due to less RBC/Hemoglobin
What are two way the body might compensate with chronic anemia?
1- Compensates with dilution ( hemodilution)
2- Body tissues adjust to lower oxygen delivery
does acute anemia or chronic anemia cause more severe symptoms?
acute anemia due to blood loss or hemolysis can cause more severe symptoms
What is the clinical presentation of anemia?
Fatigue
Dyspnea- exertional and at rest
Hyperdynamic state: palpitations, bounding pulse
What 4 clinical symptoms are seen in severe anemia?
Lethargy
Confusion
Shock
MI/Congestive heart failure/death
What should you ask when taking a history?
1-Onset of symtoms- recent or chronic
2-What other medical condition do they have/might they have: blood loss, renal or liver dysfunction, alcohol use/nutritional status
3- Family history
4- Medication ( NSAIDS leads to ulcers/bleeds)
5-Ethnicity ( hemoglobinopathy)
What might be your finding on a physical exam with someone who has anemia/severe anemia?
-
What are the two approaches to diagnosing anemia?
Kinetic approach
Morphologic approach
Normally use a blend of each
What leads to microcytic anemia? ( smaller RBC)
1- Iron deficiency: less Hb in cell
2-Thalassemia: one less hemoglobin chain
3-anemia of chronic disease
4-Lead poisoning: affects building block of hemoglobin
What do you see on a blood smear for iron deficiency?
Microcytic
Hypochromic
Pencil Cells
What protein carries iron around the blood?
Plasma transferrin
What is ferritin?
Ferritin: protein shell with iron inside
reflections iron stores: if you have normal ferritin you likely have normal store
Ferritin is another acute phase reactant
When is a low ferritin count not something to rely on to diagnose iron deficiency?
In an acute phase reactant
What lab results would point to Iron Deficiency?
1- Low Ferritin
2-Increased TIBC ( transferrin binding capacity)
3- Low % transferring saturation ( inside is empty)
4-Low reticulocyte Hemoglobin Content
5-Low MCV: Mean corpuscular volume
What are the three main causes of iron deficiency?
1- Blood loss until proven otherwise
2-Nutritional deficiency: increased need ( pregnancy) and vegans
3-Decreased absorption such as seen in celiac disease ( proximal duodenum)
what is normocytic anemia?
Normocytic anemia is a blood problem. It means you have normal-sized red blood cells, but you have a low number of them
What can cause normocytic anemia?
1- Acute blood loss 2- Anemia of chronic disease 3-Bone marrow suppression 4- Renal disease 5- Early iron deficiency
How do you diagnosis normocytic anemia?
Start with morphologic approach and then move to kinetic approach
What is macrocytic anemia?
Macrocytosis is a term used to describe erythrocytes that are larger than normal, typically reported as mean cell volume (MCV) greater than 100 fL.
The amount of hemoglobin increases proportionately with the increase in cell size. Therefore, if the increase in MCV is not related to macrocytic anemia, the mean cell hemoglobin concentration (MCHC) also increases in proportion
What can cause macrocytic anemia?
1- Megaloblastic anemia: B12, folate deficiency, medications 2-Alcohol/Liver disease 3-Hypothryoidism 4-Myelodysplastic syndrome 5-Reticulocytosis
What are the most common cause of megaloblast anemia?
Vitamin B12 and folate deficiency
Leads to dysfunctional DNA synthesis and the cytoplasm increased but no cell division happens
What is the storage of vitamin B12 and folate vitamins?
B12 body storage can last 2-3 years
No folate storage: get from diet, eating greens
What is pernicious anemia?
Intrinsic factor: you need this to absorb B12
look back at slide
