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22 Cards in this Set

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Spurious anemia
subnormal hematocrit produced by increased plasma volume=normal numbers of Rbc’s but they are “diluted out by expanded plasma volume. Not a true anemia. Often seen in third trimester, heart and renal failure.
SYMPTOMS of ANEMIA
-Fatigue, weakness, decreased work and exercise tolerance, light-headedness, dyspnea, palpitations.
-Differential= sore tongue, ataxia, fever, anorexia, jaundice or unusual bleeding.
-Previous anemias or blood transfusion.
-Several pregnancies in succession
-Changes in bowel habits
-Alcohol use
-Drug and medication history= aspirin or NSAIDS
-Diet deficient in protein, iron, B12 or folate
-PICA*** urge to eat things other than food
Low Hemoglobin
<14 gm/dl in males
<12 gm/dl in females
Decreased MCV <80
Could be...
-Iron Deficiency
-THalassemia
-Anemia of chronic disease
-Lead poisoning
Increased MCV >100
Could be ...
-Megaloblastic Anemia (B12 or Folate Deficiency)
-Alcoholism
-Hypothyroidism
-Chronic Liver Disease
-Hematologic Malignancy
If MVC is normal (80-100)
Order ...
Reticulocyte count
Low reticulocyte count ...
-Check WBC and Platelet Count
-If low RBC and Platelet count then…
-Leukemia
-Metastatic Malignancy
-Aplastic Anemia
High Reticulocyte
-Chronic Infection/ Inflammation
-Malignancy
-Chronic Renal Disease
-Endocrine Dysfunction
Reticulocyte is..
an immature red blood cell containing a network of filaments or granules
Microcytic Anemia
= small RBC's
- <80 fl
iron deficiency
- **Most commonly diagnosed anemia in US
- women more than men
Iron Deficiency
Causes
Usually caused by blood loss…not dietary!!!! Common sources of bleeding:
- menstruation
- uterine tumors
- GI bleeds
- angiodysplasia= development of abnormal, dialated blood vessesl within the wall of the bowel often seen in elderly
Iron Deficiency
S/S
-again, remember that iron deficiency develops slowly
-pica
-intolerance to cold
-cheilosis
-Also other common anemia signs
LAB DX:
-earliest indicator is REDUCTION OF SERUM FERRITIN <10-20 ug/L
-variation in RBC size/microsytosis
-Hypochromia
-Declining hemoglobin and hematocrit
CLASSIC PICTURE OF FULL BLOWN IRON DEFICIENCY
- microcytic hypochromic anemia with decreased serum ferritin, low serum iron, increased TIBC and reduced transferring saturation
TX of iron deficiency
-identify and correct underlying cause for iron loss
-replenish iron stores and return RBC production to normal
-Ferrous Sulfate 325 mg 3x/day
-Iron therapy can be awful
-IV injections if necessary (COKE)
oHigher risk of anaphylaxis.
-RBC transfusion usually reserved for emergency cases
Other Causes of Microcytic Anemia
Thalassemia
Anemia of chronic diseas
lead poisoning
Sderoblastic anemias
Thalassemia
inherited genetic disorders associated with defects in the synthesis of the globin subunits of hemoglobin
-Alpha and beta forms (depending on which is DECREASED)
-Severe forms harm both beta and 3 or 4 of the alpha globins (rare)
Thalassemia
TX
-Can be confused with Iron deficiency
oThal. Tend to have much lower MCV’s often <70
oRed cell width normally normal with Thal.
oSerum Ferritin and other iron studies are normal with thal.
o***confirm diagnosis= hemoglobin electrophoresis
increased levels of hemoglobin A2 and F are see
Target cells seen sometimes ONLY THal
Anemia of Chronic Disease
oMay see increased erythrocyte sedimentation rate (ESR) or decreased serum albumin
o*** TIBC is usually decreased= due to a defect in the ability of the body to transfer iron from its storage forms into circulation
oTX= directed towards the underlying disease
Lead Poisoning
-Lead interferes with the functioning of an enzyme that is necessary for incorporation of iron into the heme molecule
-RBC’s may show basophilic strippling on stained blood smear
-May also see neurologic symptoms
-*** Free Erythrocyte Protoporphyrins= easy test used to screen
Sideroblastic anemias
- Very rare heterogeneous group of disorders frequently assosicated with defects in the RBC’s ability to incorporate iron into the heme molecule