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Flashcards in Anemia Deck (63):
1

blood smear

placing a drop of blood on a slide and using another slide to spread it into a thin, even layer that can be stained

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centrifuged peripheral blood

RBCs on bottom, plasma up top

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what area of the blood smear do you focus on?

the feathered edge

4

what is the color of a blood smear indicative of?

hematocrit

5

ideal characteristics of a blood smear

RBCs not touching, central pallor present in most RBCs, not too widely spread apart or distorted

6

hematocrit

ratio of the volume of RBCs to that of whole blood. typically around 3x [Hb]

7

MCV (mean red cel volume)

the average volume of a red cell in your specimen

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(RDW) red cell distribution width

measure of the variation of the RBC volume in you specimen. standard deviation of the volume over the mean

9

what do we use as a visual reference range for MCV

the size of a lymphocyte nucleus

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microcytosis definition

low MCV <80.

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hypochromasia

increased central pallor >1/3 diameter of RBC. usually associated with a low hemoglobin and microcytosis.

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macrocytosis definition

high MCV >100.

13

what does an increased reticulocyte (purplish blue) indicate?

bone marrow is responding to a stimulus to create more red blood cells. measure of marrow's ability to respond to anemia/hypoxia

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anemia definition

a decrease in the number of red blood cells or less than the normal quantity of hemoglobin in the blood. insufficient RBC mass to deliver adequate O2 to tissues

15

two causes of anemia

decreased erythropoesis, or increased bleeding/RBC destruction

16

after seeing reduced hematocrit levels, what do you look for?

MCV to determine (micro/normo/macrocytic anemia)

17

how can you distinguish between destructive/productive problem of anemia?

reticulocyte count: high (destructive/blood loss issue), low (production issue)

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MCV count for microcytic anemia

<80

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MCV count for normocytic anemia

80-99

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MCV count for macrocytic anemia

>100

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4 causes of microcytic anemia

iron deficiency anemia, anemia of chronic inflammation/chronic disease, thalssemia, sideroblastic anemia

22

iron deficiency anemia

form of microcytic, hypochromic anemia. most common nutritional deficiency in the world, toddler, adolescent women, older adults at risk

23

patient presentation with iron deficiency anemia

low hemoglobin, low MCV, high RDW. Elliptocytes also present.

24

thalassemia

problem with hemoglobin synthesis due to abnormalities in synthesis of globin chains (alpha, beta). causes microcytic hypo chromic anemia.

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patient presentation with thalassemia

VERY low MCV. presence of target cells

26

hemolytic anemia

one of the classes of normocytic anemia

27

hereditary spherocytosis

defect in RBC cytoskeleton. normochromic, normocytic hemolytic anemia. high reticulocyte count (polychromasia). undergo increased hemolysis in spleen, shorter lifespan

28

spherocyte

RBCs that have lost membrane and take on a spherical shape. lack central pallor.

29

common causes of macrocytic anemia

megaloblastic anemia, liver disease, alcohol

30

megaloblastic anemia

vitamin B12 or folate deficiency that leads to ineffective erthryopoesis due to defects in DNA synthesis.

31

patient presentation with megaloblastic anemia

large RBCs and hyper segmented neutrophils

32

life span of RBCs

120 days

33

role of G6PD in RBC

protection from oxidative damage (maintains NADPH for glutathione)

34

where are senescent RBCs destroyed?

spleen

35

advantage of sigmoid O2-Hb dissociation curve?

releases O2 at low partial pressure (deoxygenated tissues) and binds O2 at high partial pressure (lungs)

36

what right shifts O2-Hb curve?

decreased pH, increased CO2, increased temperature, increased 2,3-DPG (all leading to reduced oxygen affinity/increased oxygen unloading)

37

what left shifts O2-Hb curve?

increased pH, decreased CO2, decreased temperature, decreased 2,3-DPG, CO poisoning (all leading to increased affinity/decreased unloading)

38

cytokine most important for erythroblast formation from stem cell?

EPO

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where is EPO made?

kidney

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what induces kidney to secrete EPO?

hypoxia, anemia (reduced levels of oxygen in tissues)

via HIF-1

41

how does EPO induce erythroblast formation?

stimulates erythroid cells in bone marrow to proliferate

42

what CBC values are low in anemia?

RBC count, Hemoglobin levels, Hematocrit

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5 possible causes of anemia

kidney disease (decreased EPO), EPO unable to stimulate marrow, bone marrow disorder, blood loss, decreased red cell survival

44

how to mechanistically classify of anemia

reticulocyte levels

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how to morphologically classify of anemia

MCV

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low reticulocyte count

marrow isn't active or marrow disorder or decreased EPO (<1ish%)

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high reticulocyte count

marrow is healthy and compensating as in hemolysis or bleeding (>1ish%)

48

corrected reticulate count

takes into account actual number being made rather than percentage. corrects for anemia

49

formula for corrected reticulocyte count

%reticulocytes* (actual hematocrit/45)

50

causes of decreased RBC production

iron/B12/folate deficiencies (no building blocks), anemia from chronic disease (can't use iron), renal disease (EPO deficiency), aplastic anemia/toxins/immune mediated (lack of RBC precursors)

51

causes of intracorpuscular RBC destruction

abnormal membrane, enzyme deficiency, abnormal Hb, thalassemia

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causes of extra corpuscular RBC destruction

immune hemolytic anemia, RBC fragmentation, infection (malaria)

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reticulocyte count after acute bleeding

will take 2-7 days to increase

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reticulocyte count after occult bleeding

initially elevated but over time, with loss of iron, levels decrease from normal

55

mild anemia Hb levels

10-12

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moderate anemia Hb levels

8-10

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severe anemia Hb levels

<8

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signs and symptoms of anemia related to low oxygen delivery

fatigue, decreased exercise tolerance, light headedness, skin/conjunctiva/nail bed pallor

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signs and symptoms of anemia related to cardiovascular response

rapid, bounding pulse >100. dyspnea, heart failure

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signs and symptoms of anemia due to iron deficiency

spoon like nail changes, pica

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symptom of anemia due to hemolysis

jaundice

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hypovolemia

low blood volume, usually due to trauma and rapid loss of blood --> acute anemia

63

signs and symptoms of hypovolemia

SHOCK: pale/damp skin, low blood pressure on standing, weak pulse, confusion/coma, decreased urine output