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HEM Exam 1 > Approach to the Anemic Patient > Flashcards

Approach to the Anemic Patient Flashcards

1
Q

hemoglobin is a measurement of

A
  • concentration of hemoglobin
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2
Q

hemoglobin type of measurement

A
  • direct measurement
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3
Q

hematocrit is a measurement of

A
  • volume of red cells per volume of blood

- given as a percentage

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4
Q

hematocrit type of measurement

A
  • calculated value
  • Hit = RBC x MCV

height of red cells divided by total height of the liquid in the tube

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5
Q

hematocrit compared to hemoglobin

A
  • generally Hct is 3x hemoglobin
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6
Q

RBC type of measurement

A
  • direct measurement
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7
Q

MCV is a measurement of

A
  • red cell volume

- how big the red blood cells are

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8
Q

MCV type of measurement

A
  • direct measurement
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9
Q

RDW measurement of

red cell distribution of width

A
  • how much spread there is in MCVs of different red cells in patient’s body
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10
Q

iron deficiency cells change in RDW

A
  • RDW gets wider
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11
Q

microcytic cells then transfusion - change in RDW

A
  • RDW gets wider
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12
Q

anemia definition

A
  • a decreased hemoglobin/hematocrit below the normal range for gender and age
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13
Q

anemia (manifestation of disease versus final diagnosis)

A
  • anemia is a manifestation of disease not a final diagnosis
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14
Q

anemia leads to

A
  • reduction of oxygen carrying capacity
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15
Q

acute blood loss leads to

A
  • low blood volume
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16
Q

chronic, longstanding anemia leads to

A
  • fluid retention

- increased blood volume

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17
Q

faster rate of change of hemoglobin will lead to

A
  • more dramatic symptoms
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18
Q

if an anemic person is volume overloaded, but needs a transfusion, what do you do?

A
  • give a diuretic first
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19
Q

most symptoms of acute hemorrhage in anemia related to

A
  • hypovolemia
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20
Q

symptoms of hypovolemia

A
  • hypotension
  • orthostatic changes
  • syncope
  • shock
21
Q

symptoms of tissue hypoxia

A
  • fatigue
  • shortness of breath
  • cognitive difficulties
  • ischemic pain
22
Q

cardiac response to anemia

A
  • increased heart rate

- increased cardiac output

23
Q

vascular response to anemia due to acute blood loss and hypovolemia

A
  • vasoconstriction
24
Q

kidney response to chronic anemia

A
  • retain salt and water to expand intravascular volume
25
Q

erythrocyte 2,3-DPG response to chronic anemia

A
  • increased
  • right shift in O2 curve
  • increased O2 delivery to tissues
26
Q

renal mesangial cells response to chronic anemia

A
  • sense decreased oxygen deliverty

- increase erythropoietin synthesis

27
Q

mechanisms by which anemia can occur

A
  • hemorrhage
  • decreased red cell survival
  • decreased red cell production
28
Q

ways to classify anemia

A
  • by erythropoietic response

- by red cell size and hemoglobin concentration

29
Q

erythropoietic response

A
  • hyperproliferative

- hypoproliferative

30
Q

hyperproliferative

A
  • plenty of reticulocytes

- problem due to loss or destruction of reticulocytes

31
Q

hypoproliferative

A
  • not enough reticulocytes
32
Q

red cell size and hemoglobin concentration classification

A
  • microcytic, hypochromic
  • macrocytic
  • normocytic, normochromic
33
Q

reticulocyte definition

A
  • young red cells immediately released by the bone marrow as the end result of erythropoiesis
34
Q

reticulocyte on Wright-Giemsa staining

A
  • polychromatophilic (grayish blue)
35
Q

reticulocyte composition

A
  • RNA remnants on supra vital staining

- reticulated

36
Q

absolutely reticulocyte count formula

A
  • retic (%) x RBC
37
Q

if reticulocyte index is <2%

or absolute reticulocyte count <75,000

A
  • problem with red cell production

- HYPOPROLIFERATIVE ABNORMALITY

38
Q

if reticulocyte index > 2%

or absolute reticulocyte count > 100,000

A
  • good marrow response

- anemia due to blood loss (HEMORRHAGE) or red cell destruction (HEMOLYSIS)

39
Q

microcytic anemia MCV level

A
  • MCV <80
40
Q

microcytic anemia tends to reflect a problem with

A
  • problem with hemoglobin synthesis
41
Q

macrocytic anemia MCV level

A
  • MCV > 100
42
Q

macrocytic anemia types

A
  • megaloblastic

- non-megaloblastic

43
Q

megaloblastic anemia cause

A
  • impairment of DNA synthesis
44
Q

normocytic anemia cause

A
  • marrow not working well
  • mixed problem
  • acute problem
45
Q

two approaches for treatment of anemia

A
  • treat underlying cause

- transfusion

46
Q

whether or not to transfuse

A
  • how symptomatic is the patient?
  • can we reverse the underlying cause?
  • do we have enough time to treat the underlying cause?
47
Q

hemoglobin value that should be a trigger in every patient for transfusion

A
  • NO ABSOLUTE VALUE
48
Q

general indications for transfusion

A
  • cardiovascular compromise
  • hypo proliferative anemia with no or prolonged recovery
  • anemia patient going into surgery now and may lose blood
49
Q

cardiovascular compromise conditions

A
  • CHF
  • shock
  • angina

HEM Exam 1 (22 decks)

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