RBC Disorders Flashcards
Erythropoiesis requirements (3):
- Intact marrow function
- Sufficient erythropoietin
- Nutrients for HgB synthesis and cell division
T/F Anemia results when red cell production does not keep up with red cell loss.
True
Retic count indicates what?
Bone marrow’s response to anemia
Retic response to:
Lack of component essential to produce hemoglobin
Normal/low absolute reticulocyte count (reticulocytopenia)
Retic response to:
Marrow injury or replacement by malignant cells
Normal/low absolute reticulocyte count (reticulocytopenia)
Retic response to:
Reduced RBC lifespan due to destruction
High absolute reticulate count (reticulocytosis)
Define Anemia
decrease in RBC count, HGB, and/or HCT values as compared to normal for age and sex
functionally defined as tissue hypoxia
True Anemia
decreased RBC mass and normal plasma volume
Pseudo or Dilutional Anemia
normal RBC mass and increased plasma volume
T/F NRBC# correlates with severity of anemia.
True
Methods of Anemia Classification
Morphologic: based on MCV - microcytic, macrocytic, normocytic
Pathophysiologic: divided using two main causes
1. decreased delivery - retic count low
2. increased loss or RBC from blood - retic count high but not high enough
Microcytic, Normal/Low Retic Anemias
Iron Dificiency
Thalassemia Syndromes
Sideroblastic Lead Poisoning
Anemia of Chronic Disease
Macrocytic, Normal/Low Retic Anemias
Vitamin B12 Deficiency
Folic Acid Deficiency
Normocytic, Normal/Low Retic Anemias
Aplastic Anemia
Renal Disease
Anemia of Chronic Disease
Normocytic, High Retic Anemias
Hereditary and acquired hemolytic anemia
T/F in aplastic anemia, WBC & PLT counts are increased.
False - WBC and PLT are low in aplastic anemia
Elevated or normal in most other anemias
Lab Investigation of Anemia
CBC, Differential, Retic Count
HgB Electrophoresis
quantitates normal and abnormal Hgb types
useful for: thalassemias and Hgb S disorders
Iron Tests help identify the cause of ____cytic anemia.
A) Macro
B) Norma
C) Micro
C) microcytic anemias
or detect iron overload
Serum iron level measures:
amount of iron bound to transferrin
Total iron binding capacity (TIBC) is a _______ measure of the amount of ________ protein in the serum.
indirect, transferrin
Serum ferritin indirectly reflects:
storage of iron in tissues
Iron Test Results:
Low Iron
High TIBC
Low Ferritin
Iron Deficient State
Iron Test Results:
High Iron
Low TIBC
High Ferritin
Iron Overload
Iron Test Results:
Low Iron
Low TIBC
High/Normal Ferritin
Inflammation
Transferrin (- ) APR, levels decreased in inflammation
Vitamin B12 and Folate help identify the cause of ___cytic anemia.
A) macro
B) normo
C) micro
A) Macro
What does a direct anti globulin test (DAT) or Coomb’s test detect? What type of anemia is it used for identifying?
Detects antibody and/or complement coated red cells
Used for: immune hemolytic anemias
You ordered are RBC destruction test. What becomes depleted in RBC destruction?
Haptoglobin
Bilirubin, plasma hemoglobin, LD level, urine urobilnogen and urine hemoglobin all increase
Anemias due to impaired Hgb synthesis are _____cytic:
A) macro
B) normo
C) micro
C) Microcytic
Anemias due to impaired Hgb synthesis: iron deficiency, anemia of chronic disease, thalassemia and sideroblastic anemia
Iron Deficiency Anemia Causes
chronic blood loss - GI bleeding or menstrual loss
increased need or decreased intake - pregnancy, kids, females, elderly
Progressive depletion of body iron stores:
Iron Deficiency Anemia
decreased serum iron, increased TIBC, decreased stores
Iron Deficiency Anemia Symptoms
brittle hair and nails
pica
glossitis - red beefy tongue
ovalocytes
Inability to use iron and decreased response to EPO:
Anemia of Chronic Disease
decreased serum iron, decreased TIBC, normal or increased serum ferritin
Anemia of Chronic Disease Causes
persistant infection
chronic inflammatory or colagen disorders (RA, SLE), malignant disease (carcinoma)
Inherited decrease in alpha or beta globin chain production needed for Hgb A
Thalassemia
Epidemiology of Thalassemia
Greek/Italian (beta)
Asian (alpha)
African (both)
Major Thalassemia
conditions are severe, Hgb A is absent
requires lifelong transfusions or results in death
Minor Thalassemia
conditions are mild, common
target cells, increased Hgb A2 level (beta)
differs from iron deficiency - normal iron test
Protoporphyrin block leads to iron overload (increased serum iron, decreased TIBC, increased serum ferritin)
Sideroblastic Anemia
Primary Sideroblastic Anemia
cause unknown, irreversible
ex: myelodysplastic syndrome (order bone marrow exam)
Secondary Sideroblastic Anemia
lead poisoning, alcohol, anti-TB drugs
results in neurological dysfunction
tests show basophilic stippling
Anemias due to impaired DNA synthesis are _____cytic:
A) macro
B) normo
C) micro
A) Macrocytic
Megaloblastic - Pernicious Anemia; Malnutrition
Non-Megaloblastic - Liver
Vitamin B12 Deficiency Causes
Malabsorption Pernicious Anemia (antibodies to IF/parietal cells)
Folate Deficiency Causes
Dietary Deficiency
Increased Need - pregnancy, hemolytic anemias
Drug Induces - anti-folate chemo drugs
Anemia due to decreased production
Aplastic Anemia - decreased production of ALL cell lines by the bone marrow (low retic count); caused by injury to bone marrow stem cells/environment
Aplastic Anemia Signs and Symptoms
Pancytopenia - low WBC w/ neutropenia, low RBC/HGB, low PLT
symptoms of bleeding or infection
Anemia due to increased destruction
Hemolytic anemia
severity depends on rate of hemolysis AND
degree of bone marrow compensatory response
destruction > production (retics cannot keep up)
Schistocytes, spherocytes and target cells can be found in:
Hemolytic Anemia
Inherited production of a structurally abnormal Hgb type, amino acid substitution in beta glob in chain -> variant HgbA
Hemoglobin S disorders
Sickle Cell Trait - heterozygote, asymptomatic, no anemia, no sickle cells, problems with hypoxia
Sickle Cell Disease - homozygote, symptomatic, sickle cell anemia when oxygen removed, avoid infection, hypoxia, dehydration
Hereditary spherocytosis
inherited RBC membrane defect
tx: splenectomy to increase RBC survival
G-6-PD deficiency
inherited lack of G-6-PD enzyme needed to protect red cells from oxidative injury
problems when exposed to oxidative agents (primaquine, sulfa drugs, infection) -> schistocytes, spherocytes
common in African, Mediterranean, Asian Ancestries
Describe immune hemolytic anemias and how they are detected.
RBC directed antibody binds to red cell = lysis
Anemia w/ spherocytes, schistocytes
detected: positive direct anti globulin test (DAT)
What are examples of organisms that can cause hemolytic anemias?
Malarial parasites
Clostridial toxins
Disseminated Intravascular Coagulation (DIC)
widespread clotting triggered by sepsis, OB complications
clotting factors and platelets consumed in formation of fibrin in micro-vessels . . . bleeding
Hemolytic Uremic Syndrome
E. coli toxins cause fibrin clots, damage kidney . . . failure
Examples of conditions that can cause fragmentation anemias:
Disseminated intravascular coagulation (DIC)
Hemolytic Uremic Syndrome (HUS)
Artificial Heart Valve
Extensive Thermal Burns
define Polycythemia
increase in RBC count, HGB and/or HCT values
Primary versus Secondary Polycythemia
Primary: malignant, low EPO level
Secondary: secondary to hypoxia, increased EPO to stimulate RBC to compensate for heart or lung disease or high altitudes
Pseudo Polycythemia
normal RBC mass and decreased plasma volume
plasma loss caused by severe dehydration . . . prolonged diarrhea or vomiting, thermal burns
What type of iron state are you in? ↑ Fe, ↓ TIBC, ↑ ferritin, ↑ % saturation
Iron overload state
What would these results mean? ↓ Fe, ↓ TIBC, ↑ ferritin
Chronic inflammation
What iron state are you in: ↓ Fe, ↑ TIBC, ↓ferritin, ↓ % saturation
Iron deficient state
An accelerated retic response by the bone marrow (i.e., reticulocytosis) would be expected in
which of the following conditions?
a. Severe renal disease requiring dialysis – Low EPO
b. Hereditary and acquired hemolytic anemias
c. Following corrective therapy for a deficiency
d. a and b
e. b and c
e
You are evaluating a patient with a microcytic anemia. The HGB is 9.0 g/dl, MCV 65.2 fl, with
a low retic count and microcytic red cells reported. Which of the following tests would provide
valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination
a
You are evaluating a patient with a macrocytic anemia. The HGB is 9.0 g/dl, MCV 115.5 fl,
with a low retic count and macrocytic red cells reported. Which of the following tests would
provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination
b
You are evaluating a patient with a normocytic anemia. The HGB is 7.0 g/dl, MCV 90.2 fl,
with normal WBC and PLT counts, a high retic count, and many damaged red cells called
schistocytes reported. Which of the following tests would provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination
c
You are evaluating a patient with a normocytic anemia. The HGB is 7.0 g/dl, MCV 89.0 fl, with
very low WBC and PLT counts, a low retic count, but no damaged red cells reported. Which of
the following tests would provide valuable information?
a. Iron studies (iron, TIBC, ferritin)
b. Vitamin B12 and folate levels
c. RBC destruction tests (bilirubin, LD, plasma hgb, UA, haptoglobin)
d. Bone marrow examination
d
Pallor and symptoms of hypoxia would explain/correlate with which of the following CBC
results?
a. WBC count of 25,000/ul
b. Hemoglobin value of 6.0 g/dl
c. Platelet count of 25,000/cmm
Marked decreased platelet counts are associated with bleeding symptoms
b
Which of the following test results suggest that a normocytic anemia is the result of a
hemolytic process rather than bone marrow failure?
a. High retic count, high haptoglobin level, high LD level, and high bilirubin level
b. High retic count, low haptoglobin level, high LD level, and high bilirubin level
c. Low retic count, low haptoglobin level, high LD level, and high bilirubin level
d. Low retic count, high haptoglobin level, high LD level, and high bilirubin level
b
A recent post-surgical patient has an MCV of 105.0 fl and a Retic count of 8.0%. The most
likely explanation for the patient’s elevated MCV result is that:
a. A folic acid deficiency has developed
b. A marked reticulocyte response occurred following acute blood loss
c. Chronic loss of blood occurred during the month before surgery
b
Which of the following are considered typical findings for a normal newborn?
a. Macrocytic red cells and MCV of 110.1 fl
b. 8 nucleated red cells per differential
c. High RBC count and HGB value of 19.0 g/dl
d. All of the findings are usual for newborns
d
A 60 year old female with a 6 month history of Lupus has complaints of increasing fatigue and
shortness of breath. You suspect anemia of chronic disease has developed. Which of the
following sets of lab data support your suspicion?
a. Hgb 9.5 g/dl, ESR 90 mm/hr, low serum iron, low TIBC, and high serum ferritin
b. Hgb 7.0 g/dl, ESR 15 mm/hr, low serum iron, high TIBC, and low serum ferritin
c. Hgb 9.0 g/dl, ESR 60 mm/hr, low serum iron, high TIBC, and high serum ferritin
a
You are evaluating a 40 year old woman who has been vomiting for the past 3 days. Her
hemoglobin is 17.9 g/dl and hematocrit is 54.0%. These findings suggest:
a. Dilutional/pseudo anemia due to increased plasma volume
b. Pseudo polycythemia due to severe dehydration with plasma loss
c. True polycythemia secondary to pulmonary disease
b
