General Anemia

Question 1

Question 2

RBC

Lifespan
Phagocytized by

Answer 2

~120 days

Eventually phagocytized in reticuloendothelial system

• Macrophages in the liver and spleen
  Accumulated damage to the aging RBC renders it unfit to circulate, leading to destruction - Senescence
• RBC component recycling
• Red cell destruction stimulates erythropoiesis
  Mediated by EPO

Question 3

Question 4

RBC

how much HGB per RBC?

Answer 4

several thousand

Question 5

Anemia

Definition

Answer 5

Reduction in the volume (hematocrit) of or concentration (hemoglobin) of RBCs when compared to similar values from a reference population

Question 6

Anemia

Mechanisms of disease

Answer 6

RBCs destroyed ~100 days or less, RBC production can’t keep up and patient becomes anemic
Ineffective erythropoiesis
Insufficient erythropoiesis
Blood loss
Acute blood loss
Chronic blood loss
Hemolysis
Increased RBC hemolysis

Question 7

Expression of amount (units) for HgB, Hct, RBC

Answer 7

Hgb = expression of amount (g/dL)
Hct = expression of volume (% or decimal fraction)
RBC = expression of number (#/mm3)

Question 8

Question 9

Question 10

erythropoietin (EPO)

general
Where is it produced and what’s it do

Answer 10

Primarily Kidney (90%) & Liver (10%)
Stimulates RBC production when O2 is low (hypoxia)
Hypoxia + EPO = INCREASED RBCs

Question 11

HGB concentration

general

Answer 11

• In anemia, hypoxic signal in kidneys (mainly) and liver results in ↑EPO.
• As Hct falls, plasma EPO ↑↑↑
• In anemia due to impaired RBC production: erythroid progenitors are unresponsive to ↑EPO.
• In anemia is due to hemolysis or blood loss, elevated EPO levels maximize RBC production.

Question 12

5 Main Compensatory Responses to anemia

Answer 12

Question 13

Answer 13

Question 14

02- Hgb dissociation curve

Left shift

Answer 14

Question 15

O2 Hgb dissociation curve

right shift

Answer 15

Question 16

Question 17

Anemia

classifications

2

Answer 17

Decreased production of RBCs

Accelerated loss of RBCs

Question 18

decreased RBC production

examples

Answer 18

• Marrow failure
  Decreased raw materials
  RBC defects
  Myelodysplasia (Example: Leukemia)
• Renal failure
  Decreased EPO
• Lack of nutrients (iron, B12, folate).
  Due to dietary lack
  Malabsorption (pernicious anemia, celiac disease)
  Blood loss (iron deficiency)

Bone marrow disorders (aplastic anemia, myelodysplasia, tumor)
Bone marrow suppression (drugs, chemotherapy, irradiation)
Think about the patient
Have we intentionally or inadvertently given a drug that is suppressing the marrow?
Nutrients may be present, but the bone marrow is shut down

Question 19

Decreased RBC production

Low levels of hormones which stimulate RBC production

Answer 19

Chronic renal failure (low EPO)
Hypothyroidism
Hypogonadism

Think about the patient
Is the patient on dialysis
Are there signs of hypothyroidism or hypoandrogenism?

Question 20

Decreased RBC production

Anemia of chronic disease/anemia of inflammation

Answer 20

Evolutionary defense strategy of the body to limit availability of iron for invading microbes

Iron studies are normal, but the iron is unavailable to microbes…and to the patient

Question 21

Accelerated loss of RBCs

Destruction of RBCs

Answer 21

Differentials:
* Inherited hemolytic anemias
Sickle cell disease, thalassemia major
* Acquired hemolytic anemias
Autoimmune hemolytic anemia, TTP/HUS, malaria
* G6PD deficiency
RBCs are not stable during oxidative stress, so they get destroyed

Question 22

Accelerated Loss of RBCs: Destruction

Primary prevention
Screening

Answer 22

Screening
Infants at 9-12 months age
High risk infants/children any age
Pregnant women

Question 23

Anemia

Hx of a medical condition known to result in anemia

Answer 23

Tarry stools in a patient with ulcer-type pain,
Known rheumatoid arthritis or renal failure

Question 24

Anemia Hx

Is anemia recent origin or lifelong?

Answer 24

Recent anemia is almost always an acquired disorder
Lifelong anemia, particularly if positive FHx, is likely inherited

Question 25

# anemia Hx Ethnicity and country of origin may be helpful

Answer 25

Thalassemias and other hemoglobinopathies are common in patients from the Mediterranean, Middle East, sub-Saharan Africa, and Southeast Asia

Question 26

# Hx Meds, supplements, other

Answer 26

Medications and supplements Prescribed and OTC Use of: Alcohol (folate deficiency) Aspirin and NSAIDs (GI blood loss) History of blood transfusions Exposure to toxic chemicals in the workplace/environment

Question 27

# Hx Liver disease

Answer 27

Hypersplenism secondary to portal hypertension may be removing RBCs (and platelets) from circulation Deficiency of coagulation factors synthesized by liver may be causing blood loss Aplastic anemia (decreased RBC production) may follow hepatitis

Question 28

# Anemia Symptoms

Answer 28

Question 29

# Anemia Signs (8)

Answer 29

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Question 31

RBC INDICES

Question 32

# Anemia: Hbg, Hct, MCV, MCH, RDW | CBC

Answer 32

Complete blood count: * Hgb Protein in RBCs that carries oxygen to tissue * Hct Volume of RBCs: Volume of blood * MCV – indication of RBC size Macrocytic, normocytic, or microcytic * MCH – Average hgb content in RBC Hyperchromic, normochromic, or hypochromic * RDW – indication of RBC size variation Anisocytosis

Question 33

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Question 35

why is MCV important?

Answer 35

Question 36

# Morphology Classification Microcytic anemias( 5)

Answer 36

Microcytic (MCV <80 µ3): Iron deficiency Thalassemia Chronic disease/inflammation Sideroblastic anemia Lead poisoning

Question 37

# Morphology Classification Normocytic

Answer 37

Normocytic (MCV 80-100 µ3): Acute blood loss Chronic disease Hypersplenism Bone marrow failure Hemolysis

Question 38

# Morphology Classification Macrocytic

Answer 38

Macrocytic (MCV >100 µ3): **B12** or folate deficiency Hemolysis with reticulocytosis Chemotherapy Hypothyroidism MDS

Question 39

Reticulocyte Count

Answer 39

of immature RBCs released from bone marrow into peripheral circulation Normal levels 0.5%-1.5%

Question 40

Increased reticulocyte count

Answer 40

Question 41

decreased reticulocyte count

Answer 41

Question 42

additional labs for anemia work up | 10

Answer 42

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Question 44