TEST 2- Anemia Flashcards
Anemia definition
Anemia is defined as a reduction in the number of red blood cells (RBCs), hemoglobin concentration, or hematocrit. In general, a hemoglobin concentration in adults below 13.6 g/dL for men or below 12 g/dL for women suggests anemia.
Symptoms of anemia
Asymptomatic generally until hgb <7.5= Fatigue, malaise, headache, dyspnea, irritability, and mild decrease in exercise tolerance
Normal RBC
male: 4.7-6.1
Female: 4.2-5.4
Normal hemoglobin
- 8-17.2
female: 12.1-15.1
Hematocrit
male: 41-50%
Female: 36-44%
rule of thumb: 1 hgb for every 3 hct
MCV
normal: 80-100
volume of RBC: tells you how big the RBC is. allows for classification of anemia:
MCHC
normal: 32-36
concentration of hgb in RBC’s: tells you how colorful RBC’s are (Pale, dark, normal).
Reticulocyte count
normal 0.5-2%. baby RBC’s. marrow production of RBC’s differentiate if anemia is related to decreased production or increased loss.
hgb electrophoresis
shows percentage of subclass of hgb helps identify thalassemias
Rdw
12.2-16.1 in females
11.8-14.5 in males
rbc distribution. tells you variance in size of RBC (lets you know if there are a lot of reticulocytes or not)
TIBC
transferrin iron binding capacity
normal: 250-420
indirectly measures amount of transferrin
indicates the availability of binding sites on the protein for iront ransport
Serum ferritin
10-120 ng/ml in females
20-250 in males
total body iron stores
first level to become abnormal when iron stores are becoming depleted.
Serum iron
50-170 females
65-175 males
amount of iron bound to transferrin
Transferrin saturation percentage
20-50%
Types of anemia
Microcytic hypochromic- MCV <80, decreased MCHC
Macrocytic, normochromic: MCV >100 normal MCHC
Normocytic, normochromic: MCV: 80-100, normal MCHC
IDA is most common in..
Young children and pregnant women.
most common anemia in the world- usually nutrient deficiency
What diagnostic test when considering anemia..
number 1: CBC peripheral smear reticulocyte count ferritin TIBC serum iron transferrin stool for occult blood x3 electrophoresis Iron studies- to differentiate between microcytic d/t IDA versus ACD, thalassemia, etc.
What leads to mild IDA
inadequate diet, normal/heavy menses, blood donation, malabsorption, periods of rapid growth, pregnancy
what leads to moderate to severe IDA (symptomatic)
chronic blood loss, PUD, varices, malignancy, diverticulitis, severe menorrhagia, severe malabsorption.
Labs for IDA
CBC w diff, ferritin, iron, TIBC,
HGB will be low, ferritin will be low, iron can be low, tibc high, transferrin saturation low.
Management for IDA
1st line: treat underlying cause!!
If severe, or malabsorption syndrome/unable to tolerate PO- consider IV iron AND REFER to hematologist.
replace iron: oral: 150-200mg daily until anemia corrected. Continue empirically until ferritin level is over 50.
side effects: nausea, constipation, upper gi discomfort, black stools, diarrhea.
iron absorption is optimum when taken 30 minutes before meals with vit. C. No dairy or calcium 1-2 hours after taking iron.
start on a low dose and increase slowly. Once ferritin levels have increased, hgb should follow in 1-2 weeks. MCV in 1-2 months.
ferrous sulfate 325mg= 65mg of elemental iron for ida give 750-1500mg/day divided BID-QID
for kids: 1mg/kg/day
pregnancy: supplementation almost always required. best indicator is serum ferritin.
older adults: if IDA throughoughy evlauate for GI cancers.
incrase iron rich foods, screen for nsaid overuse, strict vegetarians need supplementation.
symptoms specific to IDA
if severe: paresthesia, sore tongue, brittle nails, spoon shaped nails, pica
(other symptoms if severe (general anemia symptoms): fatigue, exercise intolerance, weak, palpitations, irritability headaches)
What is Thalassemia?
Inherited blood disorder that affects how the body makes hemoglobin. Microcytic, hypochromic (MCV<80, decreased MCHC).
Thalassemia Alpha types
Alpha: 4 genes (two from each parent)
Silent carrier: 1 gene affected, asymptomatic, normal hgb and rbc.
Alpha thalassemia minor (trait): two genes affected, carrier, mild anemia, asymptomatic
Hemoglobin H disease: three genes affected, moderately to severely anemic
Alpha thalassemia major (hydrops fetalis): four genes affected, leads to premature births that are either stillborn or die shortly after birth → incompatible with life
Beta
Autosomal recessive
Affected people: Mediterranean, Middle Eastern, African, Asian
2 genes (one from each parent) involved
Beta thalassemia minor (trait): one gene affected
Beta thalassemia intermedia: two genes affected, moderate anemia
Beta thalassemia major (Cooley’s anemia): two genes affected, severe anemia
CM of Beta Thalassemia intermedia/major
Short stature Abnormal facies Cranial marrow expansion - trying to make more RBCs Pallor, jaundice, enlarged spleen, liver, or heart Beta thalassemia intermedia Moderate microcytic, hypochromic anemia Not transfusion dependent Beta thalassemia major Severe anemia Transfusion dependent
Thalassemia Alpha Major
Alpha → incompatible with life
Labs for Thalassemia
Anemia
⬇ MCV
✔ iron studies
Hemoglobin electrophoresis (⬆ levels of hemoglobin A2) >3.5%- p.751 (primary diagnostic)
Alpha globin DNA mutation (REFER for this if thalassemia is suspected, test not readily available)
Mentzer index <13
