Anemia 1 Flashcards by Wendy Pitts

Anemia definition?

↓ in circulating RBC mass

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Normal Anemia Values:

Women

Men

Hgb:Hct

women: Hgb < 12 - 16 g/dl, Hct < 35 - 45%
men: Hgb < 14 - 18 g/dl, Hct < 40 - 50%
1: 3

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Hct =

Hct = vol of packed RBC

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RBCs removed by what organ?

spleen

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Steps in Development of RBCs

Erythropoiesis

Pluripotent Stem Cell >
Erythroid Colony Forming Unit (CFU-E) >
Proerythroblast >
Nomoblast >
Reticulocyte >
Erythrocyte (RBC)

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What is a Retic Count?

count of reticulocytes,
indication of RBC production,
retics stain blue (lots of blue = lots of new)

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Value of normal retic count?

0.5 - 2.5%

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Retics take how long to mature into RBCs once released into blood stream?

1 - 2 days

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3 causes of anemia?

1) ↓ RBC production
(iron, B12, folic acid deficiencies, chronic dx)

2) ↑ RBC destruction (hemolysis)
3) Blood loss (bleeding)

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3 RBC sizes?

normoblast
microblast
macroblast

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Mean Cell Volume (MCV) is?

calculated value used to determine average RBC size

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MCV =

hct / red cell count

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Normal MCV values?

80 - 100 fl

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Microcytic MCV value?

< 80 fl

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Mean Cell Hemoglobin (MCH) and

Mean Cell Hgb Concentration (MCHC) test what?

amount of hgb in RBCs

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MCH =

normal value =

MCH = hgb / RBC

normal = 26 -34

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MCHC =

normal value =

MCHC = hgb / hct

normal = 32 -36

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Red Cell Distribution Width (RDW) is?

indicator of degree of variation in size of RBC

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Normal RDW =

11 - 15%

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Anisocytosis?

variation in size of RBC > 15%

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Standard lab tests for anemia eval? (4)

CBC
RBCs (MCV, MCH, MCHC, RDW)
Retic Count
Peripheral smear

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Signs/sxs of anemia U not noticeable until Hgb of what?

< 10

Anemia sxs? (6)

fatigue/weakness,
lightheaded/syncope (U) w/ orthostatic ∆s,
dyspnea OE,
palpitations,
HA,
Pica for ice, clay, starch

Anemia signs?

pallor,
↑ pulse,
↓ BP w/ ortho,
systolic murmur,
hyperdynamic impulse,
heme in stool (if blood loss)

Anemia late signs? (3)

glossitis cheilitis koilonychia

3 categories of Anemia?

1) Hypochromic/Microcytic 2) Normochromic/Normocytic 3) Macrocytic

Hypochromic/Microcytic caused by?

iron deficiency thalassemia sideroblastic lead poisoning

Normochromic/Normocytic caused by?

hypothyroidism liver dx chronic dx

Macrocytic caused by?

folate, B12 deficiencies

Fe Deficiency Anemia (IDA) caused by? (4)

(U) menstrual ↑ requirements w/ pregnancy GI blood loss ↓ absorption

IDA typical Labs Results: MCV Color/size RDW

MCV = normal in EARLY IDA Hypochromic/microcytic RDW = high (high variation of size)

IDA Special Labs Results: Serum Ferritin (Fe storage protein) Serum Fe TIBC Bone Marrow

Serum Ferritin = ↓ (first measure to fall in IDA, if low then diagnostic) Serum Fe = ↓ to < 50 µg/dl TIBC = ↑ to > 450 µg/dl **order Serum Fe and TIBC together Bone Marrow = absent Fe stores

What is diagnostic test for IDA?

Ferritin below 10 ng/dl (or 10 mg/ 100 mL) ↓ Ferritin U precedes other signs of Fe deficiency

First move in treating IDA?

Identify cause

IDA tx?

1) tx cause 2) replace Fe 3) blood transfusion if cerebrovascular or cardiopulmonary sxs

Fe replacement med?

oral ferrous sulfate 325 mg BID - TID until corrected and + 6 add'l months IV if can't absorb

Thalassemias are? Result in? (C) in what ethnicities?

inherited Hgb production disorders ↓ prodxn of α- or β- globulin chains Mediterranean, African, Mid Eastern, Indian, Asian

Normal Hgb genes?

αα/αα + β/β

α-thalassemia results in? ↓ in 1 α = ↓ in 2 α = ↓ in 3 α = ↓ in 4 α =

↓ fxn of any of the α-chain genes: ↓ α-1 = mild microcytosis ↓ α-2 = mild hypochromic/microcytic ↓ α-3 = hemolytic anemia, splenomegaly ↓ α-4 = hydrops fetalis (stillbirth)

β-thalassemia results in? dysfxn of 1 β-globulin chain = dysfxn of both β-globulin chains =

↓ or absent β-globulin chains: 1 β = Thalassemia Minor (asymp; hypo/micro) 2 β = Thalassemia Major (Cooley's) (U) death < 30 yo

Thalassemia typical Lab Results: MCV color/size RDW shape will also see

MCV = low color/size = hypo/micro RDW = normal (all RBC are small) shape = Poikilocytosis (abn shapes) Target Cells Nucleated RBCs

Thalassemia tx? (2) Goal of tx?

1) transfusion (1-2 units/month) 2) Fe chelation (for Fe overload from transfusions) Goal = Hgb > 9 g/dl (prevent skeletal issues)

2 kinds of Microcytic Anemia?

1) IDA | 2) Thalassemias

Testing Summary for Microcytic Anemia | 1st and 2nd tests

1st test: Serum Ferritin if low = IDA otherwise > 2nd tests: Serum Fe and TIBC

Anemia of Chronic Dx (ACD) common result of?

inflammatory dx, malignancy, autoimmune dx, chronic infections

ACD typical Lab Results: color/size Ferritin may also see

color/size = Normo/Normo Ferritin = normal or ↑ may also see microcytes NO diagnostic test

ACD tx?

Treat underlying dx | (P) erythropoetin

Myelodysplastic Syndrome is? Results in? May progress to?

Acquired hematopoietic stem cell disorder refractory anemia bone marrow failure or leukemia

Myelodysplastic Syndrome etiology?

idiopathic or | 2º to radiation, chemo or toxins

Sideroblastic Anemia is?

heterogeneous disorders w/ abnormal RBC Fe metabolism

Sideroblastic Anemia etiology?

hereditary or | acquired from toxins, malignancy, chronic inflamm or infections

Sideroblastic Anemia typical Lab Results: MCV Serum Fe Bone marrow may also see

MCV = ↑, ↓, or normal Serum Fe = normal or ↑ Characteristic bone marrow findings Anisocytosis Poikilocytosis Ringed sideroblasts Fe deposits

Sideroblastic Anemia tx?

tx underlying cause | supportive

DDX Process for Anemias: Fe, TIBC and Ferritin

Fe ↓ and TIBC high Ferritin ↓ (Fe/TIBC < 16%) = ID Fe, TIBC and Ferritin normal = Fe deficiency is unlikely Fe and TIBC ↓ = (P) ACD Ferritin normal or ↑ Fe ↑ and TIBC normal = (P) Thalassemia Ferritin ↑