RBC anemia Oct3 M2 Flashcards
normal WBC count
4-11x10E9 per L
normal platelet count
100-400x10E9 per L L
normal Hb value
120-160
Hb value in men and women
women menstruating age: 120-135
men: 140-155, 130 in older age bc have less testosterone
normal RBC value
3.9-6.5 x 10E12 per L
normal mean cell volume (RBC) (MCV)
80-95 fl
normal hematocrit
0.35 to 0.53% (45%)
sickle cell anemia cause
mutation in beta chain of Hb
thalassemia cause
defect in prod of alpha or beta chain
reticulocyte def
immature RBC still containing rRNA
name for abnormal MCV values (2)
microcytosis or macrocytosis (less than 80 fl or more than 95 fl)
erythropoeisis phases in the blood
reticulocyte and RBC phase
reticulocytes in anemia
elevated in blood
what controls level of erythropoeisis and how
EPO secretion by kidneys, kidneys sense O2 level. EPO acts on erythroid precursors
6 causes of anemia (think about birth to death of RBC)
- deficiency in nutrients
- abnormal RBC content (Hb)
- abnormal erythropoesis site
- chronic illness suppressed erythropoeisis
- loss of RBC
- decreased RBC lifespan
how can one be deficient in nutrients of RBCs
Iron (heme group) (menstruating women), B12 and folate (vitamins essential to DNA synthesis)
how can one have deficient Hb (2 ex) and why causes anemia
thalassemia
sickle cell anemia
increases hemolysis
sickle cell anemia: cause of the shape problems
Hb precipitates.
Cell can’t move in capillaries (stroke, pulm hypertension, occlusive pain crises)
fragile RBC, broken down in spleen. 10-20 days survival
how can one have abnormal erythropoeisis site (give 2)
1-aplastic anemia (empty bone marrow)
2-bone marrow space filled with something else (leukemia, lymphoma, cancer)
how can one have anemia bc of a chronic illness (or rather why)
chronic inflamm state, interleukin prod (cytokines). IL suppresses bone marrow erythropoeisis.
renal disease (EPO prod affected), lupus, heart disease, rhumatoid arthrisis
how can one have loss of RBC
bleeding (menses, nose bleeds. called epistaxis)
how can one have a decreased RBC lifespan
increased hemolysis
3 steps to anemia investigation
history, physical exam, lab investigations
5 things to cover in history for anemia
- diet
- ethnic origin
- fatigue, weight loss, bruising, feeling unwell (showing bone marrow failure)
- chronic illness
- loss of blood
5 things to cover in physical exam for anemia
- signs of anemia
- bone marrow failure
- chronic disease
- hemolysis
- bleeding
signs of anemia on physical exam (relating to diet or general) (4)
- pallor (hands’ creases, lower eye lid)
- koilonichia (nail spooning) shows iron def
- enlarged smooth tongue shows b12 def
- tachycardia
anemia on physical exam: bone marrow failure signs
infection, bruising, petechiae (tiny red dots in legs)
anemia on physical exam: chronic illness signs
look for evidence of chronic illness (sepsis, lupus, dialysis showing renal failure, rheumatoid arthrisis)
anemia on physical exam: signs of hemolysis (2)
- jaundice. heme converted to bilirubin
- splenomegaly
anemia: signs of bleeding on physical exam
- nose bleed
- GI bleeding
4 things to cover in lab investigations for anemia (includes 3 most important)
- reticulocyte count
- MCV
- CBC
- other lab values
reticulocyte count shows what (if increased and if decreased). comes back to 6 causes
increased: blood loss, hemolysis, diet deficiency supplemented
decreased: abnormal bone marrow, chronic illness, diet deficiency unsupplemented
CBC: what to look for and what it can tell us
WBCs
RBCs and Hb
platelets
if 2+ deficient, BM or diet problem
MCV: what microcyticanemias show
-microcytotic show Hb synthesis deficiency
4 causes of microcytic anemia
iron deficiency
thalassemia
sideroblastic anemia
chronic illness
2 types of macrocytic anemias, what they show, how to distinguish them
megaloblastic (more than 108 fl): abnormal DNA synthesis
non-megaloblastic (95-108 fl): RBCs large for other reason
MCV: causes of megaloblastic anemia (4)
- B12 deficiency
- Folate deficiency
- Drugs (chemo)
- myelodysplastic syndrome
MCV: causes of non-megaloblastic anemia (3)
- reticulocytosis
- liver disease
- thyroid disease
normocytic anemia: what we usually see and causes
low retic count: shows cause is aplastic anemia, leukemia (primary bone failure) or renal failure, chronic illness (BM suppression)
other lab investigations: what peripheral blood smear helps see
RBC shape (sickle cell, fragments show hemolysis, ancanthocyte shows liver prob, elliptocyte shows membrane prob)
other lab tests used in anemia
ferritin, serum iron, b12 and folate, liver renal thryoid function, BM aspirate, % sat, Hb electrophoresis for Hb problem
main sign of hemolysis
elevated reticulocyte count
4 causes of hemolysis
Hb problem, enzyme problem, membrane problem, external problem
ex of extra corpuscular problems giving hemolysis (2)
- autoimmune hemolytic anemia
- heart valves violent flow
ex of cell membrane problem giving hemolysis (2)
- elliptocytosis
- spherocytosis
ex of Hb problem giving hemolysis (2)
- sickle cell
- thalassemia
ex of enzyme problem giving hemolysis (2)
G6PD deficiency, pyruvate kinase deficiency
what lab investigations can show hemolysis (think of 4 causes of hemolysis + consequence)
-retic count (main)
- anti-globulin (Coomb’s) test
- blood smear
- Hb electrophoresis
- enzyme levels
- haptoglobin
- bilirubin
- LDH (lactate dehydrogenase)
haptoglobin job and value in hemolysis
free in blood and binds Hb. we measure free haptoglobin so drops in hemolysis
