Hemat. Approach to Anemic Patient Flashcards
(47 cards)
Define Anemia
- Reduction in RBC mass or blood hemoglobin concentration
- more than 2 standard deviations below the mean for age/gender/population
6 factors affecting Hg levels
- age
- race
- gender
- sexual maturity
- genetics
- altitude
How do
age, race, gender, sexual maturity, genetics, altitude
affect Hg levels?
- Babies/ kids: small bodies mean small losses are a big deal
- African, Asian, Mediterranean at higher risk for anemia.
- Normal levels are based on Caucasians (go figure)
- Women need to make more blood for menstruation, but also have lower Hg than men
- Prepubescent lower than post
- if mom or dad have anemia, kid might
- Higher elevations make people produce more Hg so they can perfuse tissue with the lower oxygen levels…adaptive.
What’s the process erythropoiesis
- renal interstitial peritubular cells detect low O2 in blood
- They secrete EPO (erythropoietin) into blood
- EPO stimulates proliferation and differentiation of RBC progenitors into Reticulocytes and prevent apoptosis
- Retics differentiate increasing in number
why does anemia develop
- RBCs not being made efficiently (Production)
- Bleeding (Loss)
- Extravascular and Intravascular Destruction
Red Flags for Anemia History/Intake
- Neonatal jaundice in the 1st 24 hrs
- Diet low in Fe, B12, Folate, Pica.
- G6PD deficiency gene expression (x-linked)= destruction of RBC
- triggered by fava beans, moth balls, aspirin, sulfadrugs, NSAIDS, severe stress, infection, nitrofurintoin,
- Gallstones at early age (Hg stones)
- splenomegaly and fam hx of splenectomy
- hepatomegaly
- pre disposition populations
- dark urine
- jaundice, fatigue… etc.
Physical Signs on Exam secondary to Anemia
Glossitis (red swollen tongue)
angular cheilitis (B12 deficiency)
Fe deficiency: spooning nails
Icterus esp in lower scerla (under lower eye lid)
frontal bossing of forehead (bone marrow expansion): Rickets, congenital syphilis, beta thalassemia,
Hyperproliferative Anemias and Hypoproliferative anemias
hyper: associated with increased destruction: dark urine, jaundice, splenomegaly, anemia when destruction overwhelms production
hypo: lower production, etiology usually localizes in marrow, typical symptoms of anemia
Hb/Hgb
the concentration of hemoglobin: oxygen carrying proteins
2 beta and 2 alpha chains. each chain has associated heme group and each heme group has a central iron which binds oxygen.
HCT (%)
Hematocrit percent (should be 3x hemoglobin)
% of blood volume occupied by RBC
what does MCV mean?
mean cell corpuscular volume:
tells us the average volume of RBCs collected.
relates to RBC size to tell if micro=<80, normo=80-100, or macrocytic >100
neonates 110 normal, 70 at 1 year old
if larger, it’s newer cells (macrocytic)
MCH
Mean cell hemoglobin: average Hb concentration of the RBCs
(when cell size change,
what is MCHC?
Mean [Hg] per ONE Red blood cell
What does a Reticulocyte Count mean?
How do you evaluate for Anemia?
a direct reflection of rate of RBC production
indirect reflection of rate of RBC destruction (elevated in disorders with more destruction)
(reported as % and an absolute number “ARC”)
Use ARC and %retic x RBC to get the whole picture
if pt has retic of 1% (normal) that’s fine unless their Hg is low, then retic should be high and compensating.
two classifications and 3 sub classifications of anemia
PATHOPHYSIOLOGIC:
- decreased production
- blood loss
- increased destruction
MORPHOLOGIC
- Macrocytic
- Normocytic
- Microcytic
What are disorders of erythrocyte production?
- Fe deficiency
- Lead poisoning
- Inflammation
- bone marrow failure syndromes
What are disorders with destruction probs
Hemoglobinopathies
RBC Membrane defects
enzyme deficiencies
What is RBC chromicity
clues on [Hg] : color or RBC
central palor: normal
MCH, MCHC can give clues, but Peripheral blood smear is more important
hyperchromic, normochromic, hypochromic, or polychromasia
What diseases are connected with these shapes, and what are these RBC shapes:
Target cells,
echinocyte
Acanthocyte
Spherocyte
Target cells: looks like a target: liver disease, HbC, HbD, HbE, Thalassemia
echinocyte: spiney like a sea urchin: Uremia, hypokalemia, artifact
Acanthocyte: irregularly shaped RBC with thorny projection: liver disease, PK deficiency
Spherocyte: sphere shaped, no central palor: HS Immune hemolytic anemia
Microcytic Anemia causes
Fe deficiency anemia
thalassemias (alpha & beta)
Chronic disease/ inflammation
Pb toxicicty
Most common anemia
Fe deficiency with 3% of young children in US
8-10% have Fe deficiency with out anemia
(pregnant women, adolescents, elderly)
(if Fe deficient and small bodied, a small blood loss could push them over the edge to become anemic)
Etiology of Fe deficiency
- Increased demand to make blood (infancy, adolescents, pregnant, making more rbcs)
- malnutrition (vegetarians, vegans, junk food diets)
- decreased absorption (gastrectomy, H. pylori, IBD, drugs)
- GI bleeds benign or malignant, GU bleeding heavy periods, blood donors
- drugs: NSAIDS, steroids
- chronic kidney disease, IBD, heart failure, obesity
Stages of Fe depletion, what labs would you order and why
1) Depleted iron stores (marrow iron/serum ferratin) 2-3+
2) Iron deficient erythropoiesis: Serum Fe <100ug/dl and %saturation is <30
3) Iron Deficient Anemia: HCT<40, RBC become microcytic and hypochromic
*don’t stop treatment too early, gotta build up stores! Serum Fe increases in one meal, Serum ferratin slower to build
What does low Fe look like with labs?
Low: Hg, MCV, MCH, MCHC, RBC count
Low uncompensated retic count
Increased TIBC/transferin (nothing to bind them)
Low ferritin (deficiency: <10-12ng/L, depletion: 12-20ng/L
normal is 20-300ng/L
Inflammation can falsely elevate Ferratin even if you don’t have iron stores
