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Lab Interpretation: CBC, RBCs, LFTs, TSH > RBC > Flashcards

RBC Flashcards

1
Q

Where are RBC formed?

A

Bone Marrow, they mature in the bone marrow.

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2
Q

What is the term for the process of formation of RBC?

A

Erythropoesis

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3
Q

What is the lifespan of a mature RBC

A

120 days

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4
Q

What is the most common factor that triggers increased production of RBC?

A

Decrease in O2
Low tissue O2 levels trigger endothelial cells in the kidneys to secrete erythropoietin, with stimulates bone marrow and red cell production.

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5
Q

What is Anemia?

A

Decrease in number of RBC, Hgb, or Hct OR a decrease in the oxygen carrying capacity of the blood.

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6
Q

What is a normal RBC level?

A

4.1-5.1 m/mm3

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7
Q

What is a normal Hgb level?

A

12-16 g/dl

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8
Q

What is a normal Hct Level?

A

36-46%

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9
Q

What does MCV stand for?

A

Mean Corpuscular Volume- this allows us to further classify the type of anemia to further determine the eitology.

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10
Q

When discussing Mean Corpuscular Value MCV what are the Normocytic normal ranges?

A

80-100

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11
Q

When discussing Mean Corpuscular Value MCV what is the microcytic range?

A

<80 (defect in hgb synthesis)

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12
Q

When discussing Mean Corpuscular Value MCV what is the macrocytic range?

A

> 100

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13
Q

What are immature RBC called?

A

Reticulocytes

Mature RBC are smaller in size than immature RBC

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14
Q

What is the ratio of hgb to hct?

A

1:3, for every one hgb, three % of hct

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15
Q

What does the MCV tell us about?

A

It is telling us about the size of the RBC in circulation so we can narrow our differential diagnosis

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16
Q

What does MCHC stand for?

A

Mean Corpuscular Hemoglobin Concentration

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17
Q

What is MCHC?

A

Average concentration of hemoglobin in RBC. (Much more helpful than MCV) Provides us with information of color of the cell.

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18
Q

With MCHC what is Normochromic ranges?

A

32-37

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19
Q

With MCHC what is Hypochromic range?

A

<32

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20
Q

True/False Microcytic is always hypochromic?

A

True, MCV low- MCHC is always going to be low.

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21
Q

True/False Macrocytic is always normochromic?

A

True

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22
Q

What are the types of Macrocytic/Normochromic Anemias? Two main types

A

Increased MCV/Normal MCHC

  • Vit B12 deficiency
  • Folate deficiency
  • Hypothyroidism
  • Myelodysplastic process
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23
Q

What is another name for Vit B12 deficiency?

A

Pernicious Anemia- autoimmune destruction that allow for the production of B12, more common in women over the age of 50-60.

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24
Q

What are some causes of Normocytic/Normochromic anemias?

A

Normal MCV, Normal MCHC
Anemia of Chronic Disease (liver disease, kidney disease, lupus, RA, AK, inflmmatory autoimmune conditions, cancer, HIV
Acute Blood Loss
Early iron deficiency

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25
Q

What are some causes of Microcytic, Hypochromic Anemias?

A 
Decreased MCV and decreased MCHC
- Iron deficiency anemia 
- thalassemia
-Lead poisoning 
- Sideroblastic anemia 
- Aluminum toxicity 
- G6PH
Occasionally: Anemia of chronic disease
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26
Q

What does RDW stand for?

A

Red Cell Distribution Width

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27
Q

What is RDW?

A

Normally all red cells are equal in size, RDW is the degree of anisocytosis or the variability of the red cell size.

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28
Q

What does RDW help differentitate?

A

RDW helps to differentiate between various causes of MICROCYTIC, HYPOCHROMIC anemias
- IDA, Thalassemia, and AOCD

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29
Q

With Iron Deficient Anemia what is the RDW usually?

A

Increased

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30
Q

With Anemia of Chronic Disease, what is the RDW usually?

A

Normal

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31
Q

With Thalassemia what is the RDW?

A

Normal or slightly increased

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32
Q

What is the reticylocyte count?

A

The number of new, young, red blood cells found in 100 RBCs in circulation.
- It is an index of the bone marrows health and response to the anemia

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33
Q

What is a normal Retic count?

A

1-2%

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34
Q

What does an elevated Retic Count indicate?

A

Bone marrow is healthy and/or your treatment is working, BUT blood loss or destruction is likely occurring.

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35
Q

Anemia is not a diagnosis…..it is a….

A

Sign of an underlying health condition

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36
Q

What is the number 1 reason for IDA in indivdiuals >4?

A

Blood Loss

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37
Q

What is the most prevalent anemia worldwide?

A

IDA

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38
Q

What causes IDA?

A

Increased iron loss
Dietary inadequacy
Malabsorption
Increased iron needs

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39
Q

What are signs and symptoms of iron deficiency anemia determined by?

A

Degree of anemia
Acuteness of anemia
Presence of underlying disease

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40
Q

What labs are drawn to diagnose IDA?

A

Ferritin, Iron, TIBC, Peripheral Blood Smear

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41
Q

What does Ferritin measure?

A

Measurement of IRON STORES

42
Q

What level of Ferritin is diagnostic of IDA?

A

<16

43
Q

What is the normal reference range for Ferritin?

A

10-210

44
Q

Can Ferritin be falsely elevated?

A

Yes, in febrile illness, malignancy, liver disease, inflammatory disease

45
Q

What is the normal range for iron?

A

50-160

46
Q

What does an iron level measure?

A

The amount of circulating iron

47
Q

What is a low iron level with elevated TIBC suggestive of?

A

IDA

48
Q

What is TIBC (Total Iron Binding Capacity)?

A

Number of cells NOT bound with iron

49
Q

What is a normal TIBC?

A

250-350

50
Q

Higher the Iron……_____ the TIBC

A

lower

51
Q

Lower the iron…_____the TIBC

A

higher

52
Q

Where is ferritin stored?

A

RBC’s, if we are losing RBC we are losing Ferritin

53
Q

What does a pheripheral blood smear tell us?

A

pathologist report of what the cells look like

54
Q

What is Poikoilocytosis?

A

abnormal pigmentation of blood cells

55
Q

Waht is anisocytosis?

A

variation of size of cells in circulation

56
Q

When do we see spherocytes?

A

hereditary condition, hemolytic anemia, cells are shaped like spheres, no bi concave discs

57
Q

When do we see schistocyte?

A

prosthetic heart valve, mechanical heart valve alters the shape of the cell

58
Q

When do we see elliptocyte or ovalcyte

A

IDA

59
Q

When do we see tear drop cells?

A

IDA

60
Q

When do we see target cells?

A

Thalassemia

61
Q

When do we see basphilic stipping?

A

thalassemia, lead toxicity

62
Q

When do we see bite cells?

A

G6PD deficiency

63
Q

What are some treatments for IDA?

A
  • Iron rich food increase (liver, beef, lamb, pork, veal, chicken, eggs, fish, beans, prunes, green leafy vegetables,
  • Iron supplements Ferrous sulfate 325mg 1 PO TID, Ferrous Sequel 1 PO TID, Chromagen Forte capsules (1 cap daily, iron, plus folic acid)
64
Q

If the bone marrow is healthy in IDA in 5 days we will see what?

A

Reticulocyte count increase

With adequate treatment the Hct should rise 1 point each week

65
Q

Once Hct has normalized, how long does it take for iron stores to be replenished?

A

3-6 weeks
As long as dietary and bleeding issues have been corrected.
Need to continue to treat with Iron, dont stop too soon.

66
Q

What type of treatment is necessary if an individual is unable to absorb the iron or when the rate of blood loss exceeds absorption?

A

IV Iron Dextran

67
Q

What are the types of Macrocytic Normochromic anemias?

A 
Vit B12 deficiency 
Folate deficiency 
Acute bleeding, hemolysis 
Hypothyroidism 
Myelonodysplastic syndrome
68
Q

Vitamin B12 (cobalamin) is essential for he production of what?

A

DNA

69
Q

What does deficiency of B12 result in?

A

Alteration in the production of DNA, decreased rate of production, enlarged red cell

70
Q

What are the general causes of Vitamin B12 deficiency?

A
  • Inadequate intake
  • Decreased absorption
  • Inadequate utilization
  • Most common cause- inadequate absorption
71
Q

What are some medical causes of inadequate absorption or utilization of B12?

A
  • Crohn’s
  • Celiac Disease
  • S/p gastrectomy or bariatric sugery

Also medications: methotrexate, fluorouracil
Altered gastric acid production- PPI’s

72
Q

What is the most common cause of Vit B12 deficiency?

A

Pernicious Anemia

73
Q

What is a autoimmune disease characterized by presence of autoantibodies to teh parietal cells in the stomach and their secretory product called intrinsic factor?

A

Pernicious Anemia

74
Q

What is intrinsic factor essential for?

A

absorption of Vit B12 in the terminal ileum of the bowel

75
Q

Pernicious anemia is commonly seen in the setting of other autoimmune conditions such as:

A

Hashimotos thyroiditis and Vitiligo

76
Q

When do we often see Pernicious Anemia begin?

A

Onset is insidious
5-6th decade of life
Women > men

77
Q

What are important history questions to ask when discussing pernicious anemia?

A
  • Dietary intake
  • ETOH consumption
  • Medication hx: chemo, PPI
  • PMH- surgeries and conditions affecting the ileum/stomach
78
Q

In pernicious anemia we see the inability of the body to maintain what?

A

myelin integrity

Therefore we have neurologic manifestations

79
Q

What are Neurologic Manifestations of pernicious anemia?

A

-Parasthesias- pins and needles “stocking glove distribution”
- Weakness in extremities
- Delirium/psychosis
Decreased position and vibratory sense
Incoordination
Depression

80
Q

Words of Warning: Patients with severe Vit B12 deficiency can develop what?

A

Severe hypokalemia

- Monitor K levels as B12 is administered

81
Q

What is the standard med treatment for B12 deficiency?

A

Cyanocobalamin 1000 iu/day x 5 days, then…
weekly until hgb normal
1000 ug/month for life
Reticulocytosis within 1 week
Should see increase in Hgb and Hct with 1 week
Normalization of h/h within 2 months
Rapid improvement in symptoms, however may take 12-18 months for all neurlogic symptoms to improve.

82
Q

Nascobal (cyanocobalamin) what is the treatment/dosage?

A

500mcg/0.1ml nasal gel
Used for maintenance of Vit B12 deficiency, after IM B12 has resolved anemia
I spray into each nostril each week

83
Q

What are some causes of Folate Deficiency?

A
  • most often inadequate intake of folic acid
  • poor dietary intake, in elderly, chronically ill, ETOH users, and fad diets
  • Occastionally increased need, impaired absorption, and inadequate utlization
84
Q

What may a beefy red tongue, angular kelitis, diarrhea, anorexia, and fatigue possible symptoms of?

A

Vit B12 deficiency

85
Q

How do we make a diagnosis of B12 deficiency?

A
  • CBC- macrocytic
  • Peripheral smear
    Vit B12 level 200-800, like to have around 500 mark, around 200 they become symptomatic
  • Schilling Test
86
Q

True/False B12 and Folate deficiencies are usually found together?

A

True

87
Q

True/False? The body has very little folate in storage compared to B12?

A

True, very little folate stored, B12 3-5 years is held

88
Q

What would cause impaired absorption of Folate?

A
  • Celiac Disease
  • Giardia Infection
  • Phenytoin
89
Q

What would cause increased need of Folate?

A
  • Pregnancy
  • Hyperthyroidism
  • Malignancy
  • Chronic Inflammatory DIseases- chrohns
90
Q

What would cause impaired utilization of Folate?

A
  • Methotrexate
  • Metformin
  • Trimethoprim
91
Q

How do we diagnose Folate Deficiency?

A

Serum Folate level
Additional tests:
- MMA (methylmalonic acid)
- Homocysteine (Hcy)
- Both of these will be elevated in B12 deficiency
Only homocysteine will be elevated with Folate deficiency

92
Q

What is the first line treatment for Folate Deficiency?

A

Folic Acid 1mg PO QD, may increase to 5mg/day

  • Review cause with patient, dietary sources
  • Reticulocytosis within 1 week
  • Hct and Hgb should improve within 1 week
  • Hct should normalize within 2 months
93
Q

Chronic disorders are frequency accompanied by:

A 
Normocytic Anemia 
- Acute and chronic infections
- Malignancy
- Inflammatory disorders 
- HIV disease 
Commonly confused with iron deficiency
94
Q

What is it called when we see trapping or iron by macrophages?

A

Normocytic anemia

95
Q

With Normocytic anemia we see:

A
  • Iron unavailable for erythropoesis

- inflammatory processes also suppress erythropoesis leading to diminished production of RBC.

96
Q

With what type of anemia will we see Normal MCV, normal MCHC, rarely a hct below 25%, low serum iron, TIBC low, normal or increased ferritin?

A

Anemia of Chronic Disease

  • Low TIBC and also normal or increased Ferritin help differentiate from ACD from IDA.
97
Q

Treatment of normocytic anemia in renal disease includes what?

A

Erythropoietin (Epoetin Alfa), Procrit, Aransep

98
Q

Treatment of normocytic anemia with malignancies?

A

Chemotherapy

99
Q

Treatment of normocytic anemai with hypothyroidism? Goal: TSH:

A

1.5

100
Q

Hgb goal for individuals with normocytic anemia (ACD)?

A

10-12, increaseing hgb >12 could cause increased risk of MI

101
Q

If anemia fails to resolve, remember ______ coexisits in 1/3 of all patients with these type of anemias.

A

IDA

Lab Interpretation: CBC, RBCs, LFTs, TSH (2 decks)

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