RBC Disorder PART 1

Question 0

in normal conditions, constant red cell replacement = red cell

Answer 0

LOSS. this is around 1%. Anemia results when the rate of RBC production does not keep up with red cell loss.

Question 1

What does EPO require?

Answer 1

1. intact marrow function and sufficient erythropoietin

2. nutrients for hgb synthesis and cell division

Question 2

What blood tests indicates the bone marrow’s response to anemia?

Answer 2

the retic count.

Question 3

for the cause of anemia listed, what is the expected retic response by the bone marrow?
cause= lack of a component essential to produce hemoglobin

Answer 3

normal/low absolute reticulocyte count (reticulocytopenia)

Question 4

For the cause of anemia listed, what is the expected retic response by the bone marrorw?
cause: reduced RBC lifespan due to destruction

Answer 4

high absolute reticulocyte count

Question 5

For the cause of anemia listed, what is the expected retic response by the bone marrow?
cause= marrow injury or replacement by malignant cells

Answer 5

normal/low absolute reticulocyte count (reticulocytopenia)

Question 6

What is anemia?

Answer 6

decreases in RBC count, hgb, and or HCT values as compared to normal for age and sex.

Question 7

What is true anemia?

Answer 7

decreased RBC mass and normal plasma volume.

Question 8

What is psuedo or dilution anemia?

Answer 8

NORMAL RBC mass and increased plasma volume: pregnacy, volume overload, CHF

Question 9

how is anemia functionally defined?

Answer 9

as tissue hypoxia

Question 10

What is the hematologic response to anemia?

Answer 10

tissue hypoxia causes increased renal release of EPO to accelerate bone marrow erythorpoiesis. The normal bone marrow can increase its activity to 7-8x normal. The bone marrow may fail to increase its acitvity due to lack of supplies.

Question 11

What may be released along with reticulocytes in the hemotologic response to anemia?

Answer 11

nucleated red cells.

Question 12

what does the ability to adapt to anemia depend on?

Answer 12

age and underlying disease. cardiopulmonary function. rate of anemia development.

Question 13

what are the symptoms of hypoxia?

Answer 13

fatigue, dizziness, headaches, dyspnea, poor exercise tolerance, cardiac stress, pallor, rapid pulse.

Question 14

What are some common physical signs of anemia?

Answer 14

leg uclers, hand foot syndrome, spooned nails, glossitis, spleen enlargement, liver enlargement, lymph node enlargement, jaundice, superficial bleeding, prominent forehead, bone tenderness, lead line (teeth), bruising.

Question 15

What are the methods of anemia classification?

Answer 15

1. morphologic

2. pathophys

Question 16

Describe the morphologic classification of anemia

Answer 16

anemia is divided into three groups on hte basis of MCV (micro, normo, and macrocytic)

Question 17

Describe the pathophysiologic classification of anemia.

Answer 17

anemia is divided into two main causes :

1. decreased delivery of red cells to the blood…retic count is low.
2. increased loss of red cells from the blood…retic count is high but red cell loss usually exceeds the bone marrow’s capacity to increase its acitivity.

Question 18

classification of anemia

Answer 18

look at chart, then fill me out

Question 19

What do you need to consider when making the diagnosis of anemia

Answer 19

patient history, physical signs and clinical symptoms when ordering tests, and or interp results.

Question 20

What does your lab investigation of anemia begin with?

Answer 20

CBC with diff:

• detects mild to severe anemia
• MCV to classify
• RBC morph abnormalities
• WBC and PLT counts are normal or increased in most anemia but low in aplastic anemia

Question 21

What will ordering a retic count tell you?

Answer 21

measures the rate of RBC production by bone marrow. Helps differentiaate normocytic anemias, usually high in hemolytic anemia.

Question 22

What is Hgb electrophoresis?

Answer 22

it quantitates normal and abnormal Hgb types. useful in thalassemias and hgb S disorders.

Question 23

What is the screen for Hgb S?

Answer 23

sickle cell anemia. Hgb S is insoluble in reagent.
lines not visible = positive for Hgb S
lines visible = - for Hgb S

Question 24

What are Iron tests used for?

Answer 24

used to differentiate microcytic anemias or detect iron overload. Iron circulates bound to the transport protein transferrin.
Tests include: serum iron and TIBC, serum ferritin.

Question 25

what does serum iron, TIBC, and serum ferritin measure?

Answer 25

serum iron= amount of iron bound to transferiin
TIBC= indirect measure of the amount of transferin protein in the serum
serum ferritin= indirectly reflects storage iron in tissues without doing a biopsy.

Question 26

What are transferrin levels regulated by?

Answer 26

iron availability

Question 27

What will you see in an Iron deficient state?

Answer 27

Increased transferrin synthesis

1. high TIBC
2. low serum iron
3. low ferritin

Question 28

What will you see in Iron overload?

Answer 28

Decreased transferrin synthesis

1. low TIBC
2. high serum iron
3. high ferritin

Question 29

What will you see in an inflammation or malignant process?

Answer 29

Low Transferrin synthesis

1. Low TIBC
2. Low Iron
3. High/Normal Ferritin

Question 30

Vit b12/folate levels tell you what?

Answer 30

ID macrocytic anemias

Question 31

Bone marrow exam:

Answer 31

evals # and type of precursor cells. Restricted to anemias due to production defects.

Question 32

DAT:

Answer 32

detects antibody and/or complement coated red cells. Useful for immune hemolytic anemias.

Question 33

Tests to detect increased RBC destruction are useful for what type of anemia?

Answer 33

hemolytic. Both normal and increased red cell removal occurs mainly in the tissues…extravascular RBC destruction.
Intravascular RBC destruction occurs in the blood with release of Hgb…haptoglobin binds free plasma Hgb.

Question 34

Presence of RBC destruction:

Answer 34

1. increased serum bilirubin, plasma hgb, LD, urine urobilinogen,
2. decreased haptoglobin