RBCs And Iron Panel Flashcards
What do the suffixes poesis, penia and osis mean?
Poesis: “making” “formation of”
Penia: “lack of” “deficiency”
Osis: “increase” “disease condition”
What are RBC under the stimulation/influence of/
Erythropoietin (EPO)
*comes from the kidney
*bone marrow will produce more RBC
Can patients with renal disease produce erythropoietin (EPO) effectively?
No
*they will have low RBC
How long do RBC stay in the peripheral blood for?
120 days
What is primary polycythemia Vera?
- Neoplastic condition causing overproduction of RBC at the bone marrow
*issue with the bone marrow
*myeloproliferative disorder
*absence of hypoxia
What is secondary polycythemia
- 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
What are the characteristics of primary erthrocytosis (polycythemia Vera)
Expanded blood volume
1. Too many RBC
2. Elevated Hgb and Hct
3. Increased red cell mass
Is polycythemia an acquired condition (primary)
Yes
What will be the patient presentation of polycythemia Vera
- Associated with hyperviscosity
- Dizziness, tinnitus, epistaxis
- Pruritis
*due to increased histamine levels released from increased basophils and mast cells
What is erythromelalgia (polycythemia Vera)
- Episodic burning/throbbing of hands and feet with edema
*splenomegaly 75% of patients
What is facial plethora? (Polycythemia Vera)
- Ruddy complexion from marked increase in total red blood cells and capillaries
*flushed face, palms, nail beds, mucosa and conjunctiva
What will secondary polycythemia trigger?
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
What is the presentation of secondary polycythemia
- Obese
- Cigarette smoking
- Clubbing
- HTN
- Heart murmur
What is the role of erythropoietin (EPO) in primary polycythemia
- RBC is high so it causes a - feedback on EPO to shut off
- EPO is low
*body has enough RBC doesn’t need anymore from bone marrow
What is the role of erythropoietin (EPO) in secondary polycythemia
- Body needs more oxygen due to hypoxemia
- Will trigger EPO to stimulate bone more for the production
*EPO level is high or normal
What are the lab findings of primary polycythemia
- All blood lines are effected
*moreeeee RBC, Hct, WBC, platelets
*low EPO levels
*o2 levels are normal
What are the lab findings of secondary polycythemia
- Elevated RBCs
*normal WBCs and platelets - High or normal EPO levels
- O2 levels decreased
What is the management of polycythemia
- Treat the underlying cause
*stop smoking
*correct sleep apnea
*surgery for heart condition - Phlebotomy until Hct<45
- Myelosuppression using Hydroxurea
- ASA
What is the reticulocyte count
- The % of total number of circulating RBC that are immature (reticulocytes)
What is the normal value of retic count
0.5-2.0%
What does the retic count tell us
Tells us the ability of the bone marrow to respond to anemia and make RBC
*determine bone marrow function
What is a reticulocyte
- Immature red cell precursors (large in size)
*in anemia the body tries to increase RBC production to respond to the increased demand
What does the retic count help us with
- To distinguish acute vs chronic bleed
- Helpful for IDA
If there is an acute or chronic bleed what is the retic count
Acute: high retic
Chronic: low retic
What does an increased reticulocyte count indicate?
- Bone marrow functioning and releasing immature RBC into bloodstream
*response to anemia
What does a decreased reticulocyte count mean
There is a problem in the production of RBCs
1. Either with bone marrow function or lack of resources
What comes in an iron panel?
- Iron level
- Transferrin
- TIBC (total iron binding capacity)
- Transferrin saturation
*Ferritin will be a separate test
What is the importance of iron?
- Needed for hemoglobin production and function
*lack of raw material (iron) = decrease in RBCs = anemia
*iron is supplied by the diet
What is the #1 cause of IDA
WW: malnourishment
US: GI bleed
Where is iron found?
70% found in the Hgb of RBC
30% stored in the form of ferritin and hemosiderin
Where is transferrin made
The liver
What does transferrin do
Taking iron to the bone marrow after ingestion
What does serum iron measure
- Iron bound to transferrin
*how much iron is circulating in the blood stream
*iron is the passenger transferrin is the car
What will happen to the total iron binding capacity if iron is needed/
Will increase
*the body wants more iron
*cars are empty no iron passengers
What does total iron binding capacity measure? (TIBC)
Measurement of all protein available for binding mobile iron
*TIBC indirect, yet accurate measurement of transferrin
When the iron is low what is the TIBC
Think of if there is enough capacity in the car for iron?
*seats are empty
*capacity for iron TIBC is high
If there is enough iron in the system what is the TIBC
Normal
*cars have iron and everyone has a seat
If iron is high what is the TIBC
TIBC is low
*cars are too full
*no seats, no capacity
If there is no iron or low iron what is the TIBC
TIBC is elevated
*empty cars
*lots of capacity
What are some reasons for increased TIBC or Transferrin levels
- Estrogen therapy
- Late pregnancy
- Polycythemia Vera
- IDA
What are some of the reasons for decreased TIBC or transferrin levels
- Malnutrition
- Hypoproteinemia
- Acute inflammatory diseases
- Chronic diseases
- Cirrhosis
- Hemolytic anemia
- Sickle cell anemia
What does transferrin saturation measure?
- The percentage of transferrin and other mobile iron binding protein saturated with iron
What will transferrin saturation tell us
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
What are the labs results for IDA
Serum iron: low
Transferrin: high
Total iron binding capacity: high
Transferrin saturation: low
Retic: low
RDW: increased
Ferritin:low <12
What are the stages to IDA
1: depletion of iron stores without anemia
2: anemia with normal RBC indices
3: anemia with reduced indices (low MCV)
What are the cell types of IDA
Hypochromic microcytic cells
What does severe IDA show on the blood smear
- Hypochromic cells
- Target cells
- Pencil-shaped or cigar-shaped cells
What is the most sensitive test to determine iron-deficiency anemia
Ferritin
*earliest and best indicator of Fe deficiency
*good indicator of available stores in the body
*major iron-storage protein
What is ferritin used for
- To differentiate iron deficiency from anemia of chronic disease
- To differentiate and classify anemias when combined with serum iron and TIBC
A chronic bleed will have () ferritin reflecting stores exhausted and gone
Low ferritin
An acute bleed will have () ferritin reflecting stores are still intact
High ferritin
What is hemochromatosis
Excess iron deposition in the heart, liver, pancreas and endocrine organs
*autosomal recessive disorder
What is the patho of hemochromatosis
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
What is the treatment for hemochromatosis
Chelation therapy
*weekly IV treatments of ethylenediaminetetraacetic acid (EDTA)
*each treatment lasts 30 mins
*medication seeks out and sticks to metals and minerals
