Flashcards in Clinical Approach to Anemia Deck (43)
What is anemia?
It refers to a decrease in the number of red blood cells. It is actually, however, defined as a reduction in oxygen transporting capacity of the blood.
What is polycythemia?
It is also known as erythrocytosis. This condition is an increase in the total number of red blood cells.
Polycythemia Vera (Primary Polycythemia)
It is a primary abnormality of the bone marrow categorized as a myeloproliferative syndrome.
This occurs in people who smoke or live at high altitudes
What are examples of microcytic anemias?
Iron deficiency (late stages)
Anemia of chronic disease (late stages)
What are examples of macrocytic anemias?
- Folate deficiency
- B12 deficiency
- Liver disease
What are examples of normocytic anemias?
Iron deficiency (early)
Anemia of chronic disease and chronic inflammation
Chronic kidney disease
Aplastic anemia (marrow failure)
How does the nature of iron deficiency anemia change over time?
In early iron deficiency anemia, the MCV may be normal, but as the iron levels continue to decline over time, the anemia will often become microcytic.
What does a high reticulocyte count in response to anemia mean?
A high reticulocyte count reflects an adequate response of the bone marrow to the anemia.
What does a low reticulocyte count in response to anemia mean?
A low reticulocyte count indicates an underproduction or an inadequate response of the bone marrow.
Reticulocyte index (RI)
% of reticulocytes x (pt's hematocrit / 45)
40 for females
What is the normal RI?
Absolute reticulocyte count
Measured by flow cytometry
Normally, the ARC should be greater than 25,000-75,000µL
What are the 3 general causes of anemia?
Blood loss (acute or chronic)
Decreased production (ie bone marrow failure issues)
Increased destruction (ie hemolytic anemias)
What are some common symptoms of anemia?
Shortness of breath
Children - growth retardation and failure to thrive
How do prosthetic heart valves contribute to hemolysis?
They can cause physical breakage of red blood cells
MCH or mean corpuscular hemoglobin
It is the average mass of hemoglobin per red blood cell
MCH = (Hemoglobin x 10) / RBC
MCHC or mean corpuscular hemoglobin concentration
It is a measure of the concentration of hemoglobin in a given volume of red blood cells
MCHC = Hemoglobin / Hematocrit
Anemias in which the red cell looks pale due to decreased Hb. Both MHC and MCHC will be decreased.
What are the most common hypo chromic anemias?
The most common hypochromic anemias are iron deficiency and thalassemia.
Hyperchromic anemias are anemias in which the red blood cell appears darker and deeper in color on a blood smear.
MCHC is elevated in hyperchromic anemias.
What is an example of hyper chromic anemia?
What is the MCHC like in macrocytic anemia?
MCHC is normal in macrocytic anemias. Although the amount of hemoglobin is elevated (MCH is high) the cell itself is also large, so the total concentration of hemoglobin relative to cell volume remains normal.
RDW, or red cell distribution width
RDW, or red cell distribution width, is a measure of variation in red cell sizes.
When is RDW high?
RDW is high in iron deficiency anemias and macrocytic anemias.
With what types of anemia is RDW normal?
RDW is normal in thalassemias and anemias of chronic disorders.
Anisocytosis refers to a variation in red blood cell size. RDW is a quantitative measure of this.
Poikylocytosis refers to a variation in red blood cell shape.
Acanthocyte or spur cell.
Have multiple tiny projections seen all over their surface. Seen in liver disease.
Echinocyte or burr cell
These cells are often confused with spur cells. The projections on burr cells are smaller and more evenly spaced than spur cells. They also show a small area of central pallor as compared to spur cells. These cells are often present in chronic kidney disease.
Seen in a G6PD deficiency. Red blood cells typically form Heinz bodies, which are small round inclusions in the cell, made up of denatured hemoglobin. As this atypical cell passes through the spleen, it removes the Heinz body and the result is a bite cell.
Dacrocyte or teardrop cell
These cells are typically seen in myleofibrosis (bone marrow fibrosis) or infiltration of the bone marrow by a proess like metastatic cancer. These cells take on a teardrop shape because they are forced to squeeze themselves in narrow spaces in a fibrosed bone marrow or marrow crowded with cancer cells.
Codocyte or target cell
These cells are named as such because they appear with a central, darker area surrounded by a white ring, giving them the appearance of a bull's eye. These cells are typically seen in liver disease and thalassemia.
What disease has a defect related to spectrin?
What disease increases a patient's risk for infection by encapsulated bacteria?
Sickle Cell Anemia
What disease may have symptoms develop upon treatment for malaria?
When are hyperhsegmented neutrophils seen?
When are bite cells seen?
When are shistocytes seen?
Microangiopathic Hemolytic Anemia
When are teardrop cells seen?
Bone Marrow Infiltration
Autoimmune condition that results in the atrophy of the parietal cells in the stomach.
1.) Antibodies that block the cobalamin from binding to IF 2.) Antibodies that bind to the IF and do not allow attachment in the ileum and
3.) Antibodies directed against the parietal cells themselves.
In the direct test, an animal anti-IgG or anti-C3 is added to the patient's serum. If the patient's red blood cells are coated with an antibody or complement, they will agglutinate.