Lecture 10 Anemia Flashcards
(26 cards)
how can you diagnose anemia?
Hgb level = < reference range
pt RBC and/or Hct are low too
what does it mean to have an inadequate supply of O2?
not enough for proper metabolic function
T/F anemia is a disease
false, it is the demonstration, indication or manifestation of an underlying condition or deficiency
what can you examine to determine if treatment for anemia is working?
reticulocyte count
how can a delta check help us with investigating anemia?
compares current with previous, will flag if Hgb is dropping super quickly
is a delta check flag always very bad with regards to the patients Hgb?
NO! maybe the patient had surgery and they knew they were going to lose blood
what is a retic count
provides information on bone marrow’s ability to compensate for an anemia (index of bone marrow production)
a retic count is ordered to:
narrow down anemia cause
determine if treatment is working for SOME types of anemia
what are the expected retic results?
depends on anemia but:
High Retic Count –> BM is compensating
- pt has all essential components for Hgb synthesis (iron, heme, globin chain)
Low Retic Count –> BM is not compensating (cant)
- pt is missing essential components of Hgb synthesis
why would you complete a bone marrow study?
in cases of unexplained anemia, can assess maturation of all 3 cell lines
- gives BM cellularity, ME ratio, iron stores assessed, note abnormal cells
what is the expected BM cellularity? how would you calculate it?
ratio of hematopoietic cells to adipose tissue
formula: 100 - patient age (+/- 10)
if patient is 40, 100-40 = 60 so the expected ratio is 50-70%
what is M:E ratio
ratio of myeloid to erythroid cells
normal ratio: 1.5:1 - 4:1 (sliding scale)
what could a ratio of 6:1 mean?
either increased myeloid cells compared to erythroid cells
OR
decreased erythroid compared to myeloid
what could a ratio of 0.5:1 mean?
increased erythroid compared to myeloid
OR
decreased myeloid compared to erythroid
what are the references ranges for male, female, severe, moderate and mild anemia?
male: 140-180g/L
female: 120-160g/L
severe: <70g/L (critical)
moderate: 70-100g/L
mild: <RR>100g/L</RR>
how does the body compensate during anemia?
tissue hypoxia stimulates:
- increased EPO (release more mature&immature RBC into PB)
- does not help in all anemias
- increased RBC 2,3-BPG
- decreases Hgb affinity for oxygen = release more oxygen to tissue or stop pick up of O2
how does the body compensate during acute blood loss? (minutes to hours)
- body responds w/ immediate and rapid measures making & releasing blood stores
- increased blood flow and redistribution
how does the body compensate during chronic anemia?
- body does not use emergency compensations
- production, affinity, delivery adjusted
- not as extreme
what happens during ineffective erythropoiesis?
- effective RBC production rate is less than total RBC production rate & results in less normal circulating RBC = anemia
- RBCs being produced are not normal or function, OR being destroyed bfore maturation & release –> apoptosis
e.g. megaloblastic, thalassemia, hemolytic
what happens during insufficient erythropoiesis?
- less RBC precursors being produced, but the RBC being produced are normal in function, just enough to meet supply and demand
-RBC production is being decreased bc one of the essential factors is missing (iron deficiency anemia –> missing iron)
how are leukemia and anemia connected?
- bone marrow inflitrated with non-hematopoietic cells/other cells (malignant cells)
- no room in bone marrow for normal cells to be produced
- low Hgb, Hct, RBC, platelet
how could you treat anemia?
- determine cause/ origin bc that dictates treatment
- supportive or replacement therapy (replace whats missing)
- transfusion –> caution! last resource!
–> can develop Ab, suppress EPO, alter vitamin and iron levels, confuse diagnostic tests
microcytic/hypochromic
Indices:
- decreased MCV
- decreased MCH/MCHC
Micro/Hypo Anemias:
- iron deficiency anemia
- thalassemia
- sideroblastic anemia
- chronic blood loss
macrocytic/normochromic
indices:
- increased MCV and MCH
- normal MCHC
Megaloblastic Anemias:
- vitamin B12 deficiency
- folate deficiency
- pernicious anemia
Non-Megaloblastic Anemia:
- liver disease (macrocytes present and non-megaloblatic changes)
