ICL 4.1: Anemia Workup & Classification Flashcards
(52 cards)
what is anemia?
decreased ability to carry oxygen due to low RBC count or low Hb concentration
what are the signs of anemia?
- pallor
- hemolytic: jaundice, brown urine, gallstones, ecchymosis
- iron deficiency: koilonychias, angular cheilitis
- B12 deficiency: gait disturbance
- lead poisoning: lead line
what are symptoms of anemia?
- dyspnea
- fatigue
- dizziness
- tachycardia
- leg cramps
- restless legs
- dementia
- paresthesia
symptoms depend on how quickly the anemia develops and the cardiac reserve of the patient
how do you classify anemia?
- by etiology
- loss of blood
- increased destruction
- decreased production - by morphology
- microcytic
- normocytic
- macrocytic
what is considered low Hb for men and women?
<13.5 g/dL for men
<12 g/dL for women
what is MCH?
mean corpuscle hemoglobin
Hb content in an RBC
low in IDA and thalassemia
what is MCHC?
mean corpuscular hemoglobin concentration
Hb concentration per RBC
low in IDA
high in spherocytosis
what is RDW?
variance in RBC size
high in IDA, MDS, hemoglobinopathies
what’s the bone marrow response to anemia?
increased reticulocytes in peripheral blood
what is reticulocyte index? what’s the formula?
correct for early bone marrow release
tells you if the bone marrow is responding properly to anemia
RI = corrected reticulocyte count/fudge factor
> 3-8: good response
< 3: poor response
ex. 7 g/dL Hb, 21 Hct with reticulocyte count 10%
corrected reticulocyte 10 x (21/45) = 4.6
reticulocyte index = 4.6/2.1 = 2.19
what is the corrected reticulocyte count?
% reticulocytes x (pt. Hct/normal Hct (45))
what does a reticulocyte look like on a blood smear?
special stain will show you the RNA that’s still in the reticulocyte
looks like a bunch of purple dots in the cell
this RNA wouldn’t be present in a mature RBC
what are Howell-Jolly bodies?
DNA
looks like one purple dot on an RBC
spleen
when do you see Howell-Jolly bodies?
when a person has had a splenectomy because the spleen is no longer clearing them out
can also see them in hemolytic anemias and megaloblastic anemias
when are Papenhelmer bodies seen?
iron deficiencies
hemolytic anemia
thalassemia
splenectomy
what do Pappenheimer bodies look like on a blood smear?
they look like just a couple little dots clumped together on the side of the RBC
what is basophilic stippling? when do you see it?
it’s RNA; pathological precipitation of ribosomes!
seen in thalassemia and lead poisoning
what does basophilic stippling look like on a blood smear?
like an RBC heavily covered in blue polka dots
what are Heinz bodies?
denatured hemoglobin
you need a special stain to see them!
when do you get Heinz bodies?
unstable hemoglobin
thalassemia
enzyme deficiencies like G6PD deficiency**
what do Heinz bodies look like on a blood smear?
just a few randomly scattered bigger polka dots in the RBC
what does Hemoglobin H look like on a blood smear and what is it?
denatured hemoglobin
looks like a uniformly covered RBC covered in polka dots but not super heavily covered
when are target cells present?
if macrocytic = liver disease
if normocytic = HbC disease
if microcytic = thalassemia
what are schistocytes? when do you get them?
RBC fragments, randomly shaped
seen in hemolytic anemias or mechanical destruction like with a heart valve
