RBC Disorders Flashcards
What is the definition of anemia according to the WHO?
Hemoglobin less than 13 in men and 12 in women
How do we calculate mean corpusclar hemoglobin and mean corpuscular hemoglobin concentration?
Hemoglobin divided by RBC count
Hemoglobin divided by HCT
What is a reticulocyte count that indicates appropriate bone marrow response and what is an RPI value that implies inadequate bone marrow response?
Over 100k
RPI under 2
Symptoms in aplastic anemia result from what, and what are those symptoms?
They result from pancytopenia, so fatigue, dyspnea, bleeding and infection.
What will the peripheral blood and bone marrow show in aplastic anemia?
Peripheral blood will show anemia, thrombocytopenia, and leukopenia
BM will show hypocellularity and lots of fat
Two treatment options for aplastic anemia?
If under 40 and qualify for allergenic HSC transplantation, this is the go to.
If patients don’t qualify, then they will need immunosuppressive therapy with antithymocyte globulin and cyclosporine
What disease can affect the duodenum and hinder iron absorption?
Celiac disease
What is the diagnostic lab value for iron deficiency, but what is the catch?
Serum ferritin less than 10-15, but it doesn’t have diagnostic value in iron deficiency with inflammation because ferritin is an acute phase reactant out of the liver.
What is the usual treatment for iron deficiency anemia?
Oral ferrous sulfate for 6 months to a year to get hemoglobin levels and iron stores back to normal.
What is considered acquired Spherocytic hemolytic anemia?
Immune hemolytic anemia
What is a byproduct of oxidative hemolysis and what will the result be?
Methemoglobin
Patients will have arterial PO2 levels that appear higher than the expected oxygen saturation
An MCV over 115 is almost always due to what kind of cause?
Megaloblastic cause
Three lab value consequences of iron deficiency due to inflammation?
Serum iron is down, transferrin is down, and ferritin is up
What are the 5 things cytokines do in inflammation that add to the anemic state?
Reduce EPO Reduce responsiveness of precursors cells to EPO Reduce iron absorption Reduce transferrin levels Increase ferritin levels
So then, what is the value we look at to determine anemia due to inflammation?
Ferritin
What is the idea to keep in mind when treating anemia due to inflammation?
Treat the underlying inflammatory condition and if that doesn’t help give EPO
What is best for management of anemia-associated symptoms?
Supportive blood transfusions
What is the treatment of a newborn once we know they have sickle cell disease and why?
Give prophylactic penicillin or a macrolide if allergic, for 5 years which has shown to reduce mortality and co-morbidity from pneumococcal infections.
What is a big time complication to know of with sickle cell trait?
Increased risk of sudden death with intense physical activity
3 clinical symptoms these patients will have with sickle cell?
Acute pain, chronic pain and anemia
What is the hemoglobin level, reticulocyte count, and type of anemia in these patients?
7-8
High
Normocytic normochromic
What is the most common abnormality found on an echo for sickle cell patients?
Pulmonary HTN associated with older age and prior history of ACS.
What are two additional lab values he wants us to now for sickle cell disease due to the spleen not working?
High platelets and leukocytes
What is the only FDA approved for sickle cell and what are 4 major effects of it?
Hydroxyurea
Augments fetal hemoglobin, inhibits polymerization of sickle hemoglobin, reduces incidence of ACS, dropped reticulocyte and neutrophil counts with decreased adhesiveness and greater flow.
What is another treatment to consider outside of hydroxyurea for sickle cell?
Exchange transfusions.
What two things to give for patients with sickle cell and kidney problems/failure?
ACE inhibitors to lower intraglomerula pressure and reduce the progression of the kidney disease.
EPO because the kidney ain’t making enough.
What would we do for all the hemolysis and what would we do for the concern of infections because of the spleen not working?
Give folate
Pneumococcal, h influenza b and influenza vaccinations
When patients have acute pain crisis and go to the ER, what 4 meds can we give them?
Tylenol, NSAIDS, morphine and any adjuvant therapy they need.
When do we give supplemental oxygen to sick cell disease patients?
Only when hypoxia is present, so o2 sat less than 92 or arterial PO2 less than 70
What can we do for patients with severe symptoms of anemia?
Blood transfusions, just don’t get hemoglobin over 10 because the blood will be too viscous
When do we do allergenic bone marrow transplantation in patients with sickle cell disease?
In patients who are less than 16 years of age and severe symptoms.
What is unique about the result of doing bone marrow transplantation in a patient with sickle cell anemia?
It can be curative
