The Approach To The Anemic Patient

Question 1

Hemoglobin

Answer 1

Directly measures the concentration of hemoglobin

Question 2

Hematocrit

Answer 2

Measurement of the volume of RBCs per total volume of blood. Given in percentage. It’s a calculated value in an automated CBC.

Hematocrit is about 3 times the hemoglobin.

Question 3

What is the formula to calculate Hematocrit?

Answer 3

Hct = RBC x MCV

Question 4

RBC count

Answer 4

Direct measurement of the number of red cells per volume of blood.

Question 5

MCV (Mean Corpuscular Volume)

Answer 5

Direct measurement of red cell volume in femtoliters.

Question 6

RDW (Red Cell Distribution Width)

Answer 6

Coefficient of variation of MCV. It measures how much spread there is in the MCVs of all of the different RBCs in the patient.

Question 7

Define Anemia

Answer 7

A decreased hemoglobin/hematocrit below the normal range.

Question 8

hypotension, orthostatic changes, syncope, shock are symptoms of Acute Hemorrhage that are related to

Answer 8

Hypovolemia (decrease in blood volume)

Question 9

fatigue, dyspnea, fast heart rate (tachycardia), angina/claudication, cognitive difficulties are symptoms related to

Answer 9

tissue hypoxia

Question 10

What are acute changes of body in response to anemia?

Answer 10

1. increased cardiac output (tachycardia)

2. hypovolemia triggers vasoconstriction

Question 11

What are chronic changes of body in response to anemia?

Answer 11

1. Increase in blood volume due to kidneys retaining salt and water to expand intravacular volume.
2. Increased 2,3-DPG
3. Increased erythropoietin synthesis (hormone produced by kidneys to increase RBC production)

Question 12

What are two ways to classify Anemia?

Answer 12

1. By the erythropoietic response (through reticulocyte count)
2. By the RBC size (through MCV) & hemoglobin concentration

Question 13

Hyperproliferative vs. Hypo-proliferative

Answer 13

Hyperproliferative: plenty of reticulocytes
Hypoproliferative: not enough reticulocytes

Question 14

Hypo-chromic vs Normochromic

Answer 14

Hypochromic means that the red blood cells have less hemoglobin than normal.

Normochromic means that the red blood cells have normal concentration of hemoglobin.

Question 15

How does reticulocytes appear to differet stains?

Answer 15

1. Wright-Giemsa Staining: Polychromatophilic (grayish blue)

2. Supravital Staining: RNA remnants (reticulated)

Question 16

Reticulocyte Index

Answer 16

retic count x (actual Hct / ideal Hct) x 0.5

Question 17

Absolute Reticulocyte Count

Answer 17

retic (%) x RBC

Question 18

The retic index < 2% or absolute retic count < 75,000 indicates

Answer 18

a problem with bone marrow response. This is known as hypo-proliferative anemia.

Question 19

The retic index > 2% or absolute retic count > 100,000 indicates

Answer 19

that the marrow response is normal but the cause of anemia is either blood loss or hemolysis. This is known as hyper-proliferative anemia.

Question 20

Microcytic vs. Macrocytic vs. Normocytic

Answer 20

Microcytic: small RBC size (low MCV <80)
- associated with hemoglobin synthesis defect

Macrocytic: big RBC size (high MCV >100)

• megaloblastic (impaired DNA synthesis)
• non-megaloblastic (many reasons)

Normocytic: normal RBC size
- either marrow isn’t working well or mixed problems

Question 21

T/F: There is NO ABSOLUTE hemoglobin value that should be a trigger in every patient

Answer 21

True

Question 22

What are some situations that call for RBC transfusion?

Answer 22

1. cardiovascular compromise (congestive heart failure, shock, angina)
2. Hypoproliferative anemia with no recovery
3. Anemic patient getting surgery with the potential for blood loss