1/4 Anemia1 - Wondisford Flashcards
interpreting CBC
RBC, WBC, platelets
what if all counts low?
- RBC ~5mil/ul
- WBC ~6k/ul
- platelets ~200k/ul
all counts low → bone marrow issue
normal range of Hb (g/dL)
birth
childhood
adolescence
adult man
adult woman (menstruation)
adult woman (postmenopausal)
during preg
WHO def: anemia
birth: 17
childhood: 12
adolescence: 13
adult man: 16 +/- 2
adult woman (menstruation): 13 +/- 2
adult woman (postmenopausal): 14 +/- 2
during preg: 12 +/- 2 (bc of incr plasma volume)
WHO def: anemia is Hb level < 13 in men, < 12 in non-preg women
hematocrit normal values
what does it look like when…
- normal
- anemia
- polycythemia
- dehydration
mean hematocrit
- adult male: 47%
- adult female: 42%
less reliable indicator of anemia than hemoglobin due to changes in plasma volume and Hb conc
reticulocytes
- what are they/how identified
- normal count vs corrected count
- how to use in anemia
immature RBCs which still have RNA in them
- identified with methylene blue stain (hits RNA)
normal count: 1-2%, reflective of daily replacement of circ RBCs
corrected count: reliable measure of effective red cell production
10 days post onset of anemia,
- IF epo/erythroid marrow responses are intact: RBC production rises to 3x normal
- IF less than 3x normal? → inadequate marow resp
reticulocyte corrections
2 types
correction #1 for anemia:
- absolute reticulocyte count = ret count (Hb/normal Hb)
- can also use hematocrit (instead of Hb)
correction #2 for longer life of rematurely released reticulocytes in blood
- reticulocyte production index = corrected ret count/2
anemia RBC sizes
- microcytic
- normocytic
- macrocytic
microcytes assoc with poor cytoplasmic maturation (no Hb)
macrocytes assoc with poor nuclear maturation (more time to synthesize more Hb)
3 classes of anemia
- RPI
- bone marrow
- RBC size
1. hypoproliferative (RPI < 2.5; bone marrow erythroid hypoplasia; normocytic)
- 75% of all anemias are due to Fe def and inflammation (ACD)
- causes
- Fe deficiency (early)
- inflammation (early)
- marrow damage
- decreased epo from kidney disease
2. ineffective erythropoeisis (RPI < 2.5, BM erythroid hyperplasia, macro/microcytic)
- nuclear maturation defect (folate/b12 def; drugs)
- cytoplasmic maturation defect (iron def - late, infl - late, thalassema, sideroblastic)
3. blood loss/hemolysis (RPI > 2.5, BM erythroid hyperplasia, normocytic)
chromasia
measure of amount of Hb
hyperchromic: more Hb than normal
hypochromic: less Hb than normal
*overlay with size (micro/normo/macrocytic)
pathologic RBC forms
diseases associated with…
- acanthocyte
- basophilic stippling
- dacrocyte (teardrop)
- bite cell
- Burr cell
- hereditary elliptocytosis
- macro-ovalocyte
pathologic RBC forms
diseases associated with…
- ringed siderblast
- schistocyte
- sickled cells
- spherocytes
- target cells
- Heinz bodies
- Howell-Jolly bodies
anemia chart
microcytic anemias
(TAILS)
- thalassemia [issue with GLOBIN SYNTH]
- anemia of chronic disease [issue with IRON]
- iron deficiency [issue with IRON]
- lead poisoning [issue with HEME SYNTH]
- sideroblastic anemia [issue with protoporphyrin/HEME SYNTH]
all issues with producing hemoglobin!
recall: three types of anemia → ineff erythropoeisis → cytoplasmic maturation defect
- Fe def - late
- infl - late
- thalassemia
- sideroblastic
microcytic hypochromic anemia
most common: Fe deficiency due to…
- chronic bleeding
- malnutrition
- gastrectomy (acid promotes Fe+2 form, more easily abs)
- incr demand (preg)
- hookworm
sx:
- decr iron and ferritin
- incr TIBC
- fatigue, conjunctival pallor, pica, spoon nails (koilonychia)
- on periph smear: central pallor > 1/3 RBC diameter
*may manifest as Plummer-Vinson syndrome
- triad of Fe def anemia, esophageal webs, atrophic glossitis
in microcytic hypochromic anemia,
why LOW FERRITIN and HIGH TIBC?
exception
when ferritin decreases in liver, transferrin (TIBC) synth increases in attempt to replenish iron stores
- i.e. vary inversely with one another: one rises, the other falls and vice versa
exceptions: OCP use, pregnancy - hepatic transferring synth is incr due to estrogen
lab values in anemia
serum iron, TIBC, ferritin, % transferring sat in…
- iron deficiency
- ACD
- hemochromatosis
- pregnancy/OCP use
iron deficiency: low Fe stores (ferritin), compensatory incr in TIBC
anemia of chronic disease: high iron stores (ferritin), low TIBC [bc issue is ACCESS to the iron stores in the cells]
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