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Clinical Patient Care 2023 > RBCs And Iron Panel > Flashcards

RBCs And Iron Panel Flashcards

1
Q

What do the suffixes poesis, penia and osis mean?

A

Poesis: “making” “formation of”
Penia: “lack of” “deficiency”
Osis: “increase” “disease condition”

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2
Q

What are RBC under the stimulation/influence of/

A

Erythropoietin (EPO)
*comes from the kidney
*bone marrow will produce more RBC

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3
Q

Can patients with renal disease produce erythropoietin (EPO) effectively?

A

No
*they will have low RBC

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4
Q

How long do RBC stay in the peripheral blood for?

A

120 days

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5
Q

What is primary polycythemia Vera?

A
  1. Neoplastic condition causing overproduction of RBC at the bone marrow
    *issue with the bone marrow
    *myeloproliferative disorder
    *absence of hypoxia
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6
Q

What is secondary polycythemia

A
  1. Decreased O2 carrying capacity or greater need for O2 due to underlying conditions
    *hypoxic state COPD, sleep apnea, congenital heart disease)
    *will be an increase in HCT
    *not a bone marrow problem, WBC will not increase
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7
Q

What are the characteristics of primary erthrocytosis (polycythemia Vera)

A

Expanded blood volume
1. Too many RBC
2. Elevated Hgb and Hct
3. Increased red cell mass

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8
Q

Is polycythemia an acquired condition (primary)

A

Yes

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9
Q

What will be the patient presentation of polycythemia Vera

A
  1. Associated with hyperviscosity
  2. Dizziness, tinnitus, epistaxis
  3. Pruritis
    *due to increased histamine levels released from increased basophils and mast cells
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10
Q

What is erythromelalgia (polycythemia Vera)

A
  1. Episodic burning/throbbing of hands and feet with edema
    *splenomegaly 75% of patients
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11
Q

What is facial plethora? (Polycythemia Vera)

A
  1. Ruddy complexion from marked increase in total red blood cells and capillaries
    *flushed face, palms, nail beds, mucosa and conjunctiva
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12
Q

What will secondary polycythemia trigger?

A

The body is in a state of chronic hypoxia
*so it needs more oxygen which will trigger EPO to stimulate bone marrow for more production

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13
Q

What is the presentation of secondary polycythemia

A
  1. Obese
  2. Cigarette smoking
  3. Clubbing
  4. HTN
  5. Heart murmur
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14
Q

What is the role of erythropoietin (EPO) in primary polycythemia

A
  1. RBC is high so it causes a - feedback on EPO to shut off
  2. EPO is low
    *body has enough RBC doesn’t need anymore from bone marrow
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15
Q

What is the role of erythropoietin (EPO) in secondary polycythemia

A
  1. Body needs more oxygen due to hypoxemia
  2. Will trigger EPO to stimulate bone more for the production
    *EPO level is high or normal
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16
Q

What are the lab findings of primary polycythemia

A
  1. All blood lines are effected
    *moreeeee RBC, Hct, WBC, platelets
    *low EPO levels
    *o2 levels are normal
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17
Q

What are the lab findings of secondary polycythemia

A
  1. Elevated RBCs
    *normal WBCs and platelets
  2. High or normal EPO levels
  3. O2 levels decreased
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18
Q

What is the management of polycythemia

A
  1. Treat the underlying cause
    *stop smoking
    *correct sleep apnea
    *surgery for heart condition
  2. Phlebotomy until Hct<45
  3. Myelosuppression using Hydroxurea
  4. ASA
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19
Q

What is the reticulocyte count

A
  1. The % of total number of circulating RBC that are immature (reticulocytes)
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20
Q

What is the normal value of retic count

A

0.5-2.0%

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21
Q

What does the retic count tell us

A

Tells us the ability of the bone marrow to respond to anemia and make RBC
*determine bone marrow function

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22
Q

What is a reticulocyte

A
  1. Immature red cell precursors (large in size)
    *in anemia the body tries to increase RBC production to respond to the increased demand
23
Q

What does the retic count help us with

A
  1. To distinguish acute vs chronic bleed
  2. Helpful for IDA
24
Q

If there is an acute or chronic bleed what is the retic count

A

Acute: high retic
Chronic: low retic

25
Q

What does an increased reticulocyte count indicate?

A
  1. Bone marrow functioning and releasing immature RBC into bloodstream
    *response to anemia
26
Q

What does a decreased reticulocyte count mean

A

There is a problem in the production of RBCs
1. Either with bone marrow function or lack of resources

27
Q

What comes in an iron panel?

A
  1. Iron level
  2. Transferrin
  3. TIBC (total iron binding capacity)
  4. Transferrin saturation
    *Ferritin will be a separate test
28
Q

What is the importance of iron?

A
  1. Needed for hemoglobin production and function
    *lack of raw material (iron) = decrease in RBCs = anemia
    *iron is supplied by the diet
29
Q

What is the #1 cause of IDA

A

WW: malnourishment
US: GI bleed

30
Q

Where is iron found?

A

70% found in the Hgb of RBC
30% stored in the form of ferritin and hemosiderin

31
Q

Where is transferrin made

A

The liver

32
Q

What does transferrin do

A

Taking iron to the bone marrow after ingestion

33
Q

What does serum iron measure

A
  1. Iron bound to transferrin
    *how much iron is circulating in the blood stream
    *iron is the passenger transferrin is the car
34
Q

What will happen to the total iron binding capacity if iron is needed/

A

Will increase
*the body wants more iron
*cars are empty no iron passengers

35
Q

What does total iron binding capacity measure? (TIBC)

A

Measurement of all protein available for binding mobile iron
*TIBC indirect, yet accurate measurement of transferrin

36
Q

When the iron is low what is the TIBC

A

Think of if there is enough capacity in the car for iron?
*seats are empty
*capacity for iron TIBC is high

37
Q

If there is enough iron in the system what is the TIBC

A

Normal
*cars have iron and everyone has a seat

38
Q

If iron is high what is the TIBC

A

TIBC is low
*cars are too full
*no seats, no capacity

39
Q

If there is no iron or low iron what is the TIBC

A

TIBC is elevated
*empty cars
*lots of capacity

40
Q

What are some reasons for increased TIBC or Transferrin levels

A
  1. Estrogen therapy
  2. Late pregnancy
  3. Polycythemia Vera
  4. IDA
41
Q

What are some of the reasons for decreased TIBC or transferrin levels

A
  1. Malnutrition
  2. Hypoproteinemia
  3. Acute inflammatory diseases
  4. Chronic diseases
  5. Cirrhosis
  6. Hemolytic anemia
  7. Sickle cell anemia
42
Q

What does transferrin saturation measure?

A
  1. The percentage of transferrin and other mobile iron binding protein saturated with iron
43
Q

What will transferrin saturation tell us

A

Tells us in percentage how much binding proteins that are “saturated with iron” in the system % or cars with iron passengers”
*will be low in bleed

44
Q

What are the labs results for IDA

A

Serum iron: low
Transferrin: high
Total iron binding capacity: high
Transferrin saturation: low
Retic: low
RDW: increased
Ferritin:low <12

45
Q

What are the stages to IDA

A

1: depletion of iron stores without anemia
2: anemia with normal RBC indices
3: anemia with reduced indices (low MCV)

46
Q

What are the cell types of IDA

A

Hypochromic microcytic cells

47
Q

What does severe IDA show on the blood smear

A
  1. Hypochromic cells
  2. Target cells
  3. Pencil-shaped or cigar-shaped cells
48
Q

What is the most sensitive test to determine iron-deficiency anemia

A

Ferritin
*earliest and best indicator of Fe deficiency
*good indicator of available stores in the body
*major iron-storage protein

49
Q

What is ferritin used for

A
  1. To differentiate iron deficiency from anemia of chronic disease
  2. To differentiate and classify anemias when combined with serum iron and TIBC
50
Q

A chronic bleed will have () ferritin reflecting stores exhausted and gone

A

Low ferritin

51
Q

An acute bleed will have () ferritin reflecting stores are still intact

A

High ferritin

52
Q

What is hemochromatosis

A

Excess iron deposition in the heart, liver, pancreas and endocrine organs
*autosomal recessive disorder

53
Q

What is the patho of hemochromatosis

A

There will be increased intestinal iron absorption which increases serum iron and deposition in organs
*also known as Bronze diabetes due to metallic bronzing of the skin

54
Q

What is the treatment for hemochromatosis

A

Chelation therapy
*weekly IV treatments of ethylenediaminetetraacetic acid (EDTA)
*each treatment lasts 30 mins
*medication seeks out and sticks to metals and minerals

Clinical Patient Care 2023 (33 decks)

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