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25 Cards in this Set

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What an orthochromatic RBC?
Precursor RBC with nucleus
How do reticulocytes differ from mature RBCs?
Appear bluer (ribosomes) and are larger

But like mature RBCS, they LACK NUCLEI
EPO is made in _____.

Which cells are affected by EPO?
The kidney

EPO increases RBC production/maturation by acting in BFU-E, CFU-E, and Normoblast (erythroblast)
Normal Hgb levels.
Men: 15 +/-1.7
Women: 13 +/-1.5
Normal RBC counts.
~5
Normal hematocrit.
Men: 45
Women: 38
EFfect of hydration status on Hgb levels.
All measures of anemia measured per plasma volume

Thus, dehydrated pt will have falsely elevated Hgb
Effect of pregnancy on Hgb levels.
In pregnancy, plasma volume rises disproportionate to RBC volume; so will get falsely low Hgb
Effect of altitude on Hgb levels.
High altitude-->inc'd EPO (lower PAO2)
Effect of gender on Hgb levels.
Women have lower Hgb than males; likely androgen related
What physical exam findings are general to anemic patients?

What physical exam potential clues may lead to diagnosis?
Conjunctival pallor
Tachycardia
Hypotn

Potential clues (less specific):
Jaundice (hemolysis)
Heart murmur (rbc destruction on damaged valve)
Splenomegaly
Neurologic (B12 deficiency)
Mean Corpuscular Volume:
What is it?
Normal value.
Abnormal values (categories).
Avg size of a blood cell
NL: 80-100

If under 80-->microcytic anemia
Over 100-->macrocytic anemia
Causes of low MCV.
Reduced iron availability
Reduced heme synthesis (lead poisoning)
Reduced globin synthesis: thalassemia
What is thalassemia?
Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia.
Causes of elevated MCV.
-B12 and folate deficiency
-Inc'd number reticulocytes (they're bigger than mature RBCs)
-Inc'd number target cells (sign of liver dz)
-Myelodysplasia
Mean Corpuscular Hemoglobin:
What is it?
Avg amount of Hgb per RBC; tends to parallel MCV
RBC Distribution Width:
What is it?
Measures variability in size of RBC (anisocytosis) but is NEVER a substitute for examining peripheral smear
What is the normal reticulocyte count?
RBCs live 100 days, retics seen only 1 day, thus normal retic count is 1%
These cells exhibit polychromasia.
Reticulocytes (blue hue = ribosome)
This test unequivocally identifies reticulocytes.
Supravital stain
What is the reticulocyte index and how is it calculated?
Retic index adjusts retic count for degree of anemia:

Retic index = retic count x pt hgb/normal hgb
What does an elevated reticulocyte index imply?
Causes?
Implies BM capable of appropriately responding to anemia (BM is healthy)

Causes: acute bleeding, hemolytic anemia
What does a normal or low reticulocyte count--in face of anemia--imply?
Causes?
Implies impaired BM unable to inc RBC production in setting of anemia

Causes: nutritional deficiency (Fe, B12, folate)
Marrow replaced by tumor (lymphoma, leukemia)
Dec'd stem cells (aplastic anemia)
When are BM exams performed?

Site of exam?
Low retic count, cause of anemia not clear from prelim tests

Site: posterior iliac crest
Physiologic responses to anemia.
Volume retention (immediate)
Inc'd cardiac output (immediate)
Right shift to O2 dissocn curve (rapid)
Erythropoiesis