Hematologic Disorders Flashcards by vanessa Prusia

When does anemia occur

when the insult is bad enough to disturb normal homeostatic mechanisms and exceed reserves

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4 things needed for RBC formation

erythropoietin
DNA synthesis
Hgb synthesis
intact marrow

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Erythropoietin comes from

renal 90%
hepatic
diminished with renal failure starting with GFR <49

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DNA synthesis can be impaired by

chronic inflammation conditions
(lupus, RA, and chronic inflammation)
can reverse with tx of inflammation

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Hgb defined

iron-containing oxygen transport protein

from iron, vit B, C and protein

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Heme =

iron

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globin =

protein

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Component of intact marrow

reticularcytes (young RBCs)
with anemia the anticipated response is for reticulocytosis to increase so there are increase in RBCs i the body “reticking”

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Causes of anemia

blood loss: acute or chronic
reduced RBC production
premature destruction

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Acute blood loss cause in anemia

need >1L of blood loss before lab shows
hemorrhage
rule out by history and physical

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Chronic blood loss cause in anemia

erosive gastritis
menorrhagia
GI malignancy
RBCs can’t be recycled with this type of blood loss

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Normal blood volume in women

4800

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Normal blood volume in men

5600

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Causes of reduced RBC production

nutrition
(vit b12, folic acid, iron deficiency)
anemia of chronic disease
bone marrow suppression

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Premature destruction of RBCs

hemolysis

can be part of anemia of chronic disease

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normal RBC life span

90-120 days

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Normal Hgb to Hct ratio

1:3
or 30%
so if Hgb 10, Hct 30

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Normal Hgb and Hct for women

12g/dl : 36%

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Normal Hgb and Hct for men

15g/dl: 45%

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MCV =

size of cell

“mean corpuscle volume”

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Different sizes of cells

Microcytic: small
Normocytic: normal
Macrocytic: large

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Normal cell size according to MCV

80-96

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Hgb content of RBC determines its

color

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Color of RBC =

chromic

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Value of what shows color/hgb content

MCH: mean cell Hgb MCHC: mean cell Hgb concentration

2 types of color or hgb content

Normochromic: normal in color MCHC 31-37 Hypochromic: pale in color MCHC < 31

RDW in anemia

a value given based on the variation in size of RBCs | >15% shows that cells are either smaller or larger than other cells

One of the earliest lab indicators of an evolving micro or macro cytic anemia

RDW

Reticulocyte percentage

normal is about 1-2 % in response to anemia it is >2% marked reticulocytosis can cause RDW increase

Types of anemia

``` Normocytic normochromic anemia Microcytic hypochromic with elevated RDW Microcytic hypochromic with normal RDW Macrocytic normochromic with elevated RDW Drug inducted macrocytosis ```

Normocytic normochromic anemia etiology

1. acute blood loss 2. anemia of chronic disease "normal size, normal color"

example of Normocytic normochromic anemia

72 year old man with acute GI bleed | 32 year old female with newly dx systemic lupus

Lab values that would be affected with normocytic normochromic anemia

``` Hgb decreased RBCs decreased MVC normal (size) MCHC normal (color) RDW or "reticking" normal because body may still be in shock and not attempting to accomodate ```

Macrocytic hypochromic with elevated RDW etiology

iron deficiency anemia | "small and pale with new cells smaller than old cells (elevated RDW)

Lab values that would be affected with macrocytic hypochromic anemia

``` Hgb decreased RBCs decreased MCV (color) decreased MCHC (size) decreased RDW elevated: body trying to compensate or "retick" ```

Examples of macrocytic hypochromic anemia

68 year old man with erosive gastritis | 48 year old woman with menorrhagia

Microcytic hypochromic anemia with normal RDW etiology

Genetic anemias alpha thalassemia minor: Asian, African beta thalassemia minor: African, Mediterranean, Middle Eastern

Microcytic hypochromic anemia with normal RDW described

This is their normal so RDW with be normal because their body does not see a need to compensate The cells are small and pale

Lab values that would be affected with microcytic hypochromic anemia with normal RDW

``` Hgb decreased RBCs normal to elevated MCV (size) decreased MCHC (color) decreased RDW normal ```

Macrocytic normochromic anemia with elevated RDW etiology

B12 def pernicious anemia folate deficient anemia

Macrocytic normochromic anemia with elevated RDW desribed

large cells with normal hgb content and new cells are larger than old cells

Lab values that would be affected with macrocytic normochromic anemia

``` Hgb decreased RBC decreased MCV (size) increased MCHC (color) normal RDW elevated and born "big" ```

Example of macrocytic normochromic anemia

72 year old with untreated pernicious anemia

Drug induced macrocytosis described

cells are just big due to medication use no anemia occurs reversible if drug d/c'd

Drugs that cause macrocytosis

``` carbamepine zidovudine (AZT) valproic acid phenytoin alcohol ```

Lab values that would be affected with macrocytosis

``` Hgb normal RBC normal MCV (size) elevated MCHC (color) normal RDW normal ```

Interventions for anemia

treat the cause replace nutrients as needed: needs increase with reticking epoetin alfa: can be given for severe anemia or with advancing renal failure

Most common type of anemia in child

iron

Most common type of anemia in pregnancy

iron

Most common type of anemia in women of reproductive years

iron

Most common type of anemia in elderly

chronic

Most important source of body's iron supply

recycled iron content from aged RBCs

A person that is vegan should supplement their diet with

vit B12

Symptoms in history and physical that could indicate anemia

fatigue | spoon shaped nails

Cause of macrocytic hypochromic anemia with elevated RDW in 78 year old c/o fatigue and spoon shaped nails

gastrointestinal blood loss

In evaluating person with microcytic anemia the next lab to order would be

ferritin b/c it tells you the iron storage in the liver

The best way to take an Fe supplement is

on an empty stomach or with light meal | no milk because Ca and Fe will fight

68 year old female presents with peripheral numbness and oral irritation. Exam shows pale conjunctiva, grade 2/6 systolic murmur and smooth red tongue. Hemagram shows Macrocytic normochromic anemia with elevated RDW. What could be her cause of anemia?

Vit B12 def

The grade 2/6 murmur in exam above could indicate

"hemic" murmur or a murmur caused by something else such as pregnancy, fever, anemia, infection or thyroid storm a systolic murmur can be pathologic or physiologic a diastolic murmur can only be pathologic

65 year old with RA with a hemogram showing normocytic normochromic anemia would have

anemia of chronic disease

Cooley anemia =

beta thal MAJOR | very serious

Primary care of person with alpha thal minor would include

genetic counseling prior to pregnancy | don't tx with Fe because they will get over loaded