Hematology-1/09/08 Introduction : Approach To Anemia

Front 1

What are some areas that are more pale in anemic patients?

Back 1

skin, conjunctiva, creases of hands, mucous membranes

Front 2

What are some signs of anemia?

Back 2

CNS, Immune System, Cardiorespiratory, Genital tract, vascular and renal systems, gastrointestinal

Front 3

What are the PCV and Hb for men and women for anemia

Back 3

Men: less than 13 Hb, and 39%
Women: less than 12 Hb, and 37%

Front 4

What are the kinetics that cause anemia?

Back 4

-decreased production (hypoproliferative)
-increased destruction (hemolysis)
-ineffective production
-acute blood loss
-redistribution (i.e. enlarged spleen)

Front 5

What are the factors used to determine RBC production?

Back 5

reticulocyte production and reticulocyte index

Front 6

What is the reticulocyte index?

Back 6

= the corrected retic count divided by two (to take into account the presence of shift cells)

Front 7

What are the factors for RBC destruction?

Back 7

indirect bilirubin level and LDH elevation.

Front 8

What does a low retic count mean?

Back 8

means there is a production problem. hypoproliferative or ineffective erythropoiesis.

Front 9

What shows up in a reticulocyte stain?

Back 9

Both reticulocytes and marrow reticulocytes (shift cells). Shift cells look a little bigger, but can differentiate them by use of wright smear.

Front 10

What should the retic index be greater than to suggest increased production of RBC's

Back 10

Retic index greater than 3

Front 11

What is the difference between extravascular intravascular hemolysis?

Back 11

extravascular occurs in the spleen, intravascular occurs in the blood vessels.

Front 12

For extravascular hemolysis what components are recycled?

Back 12

globin and iron.

Front 13

What are the steps for extravascular RBC destruction?

Back 13

Heme is broken down into biliverdin in the splenic macrophages. this is broken down into bilirubin and excreted and conjugated to albumin (indirect bili). this goes to the liver where it becomes direct bili. excreted in the bile and goes ther urobilinogen (yellow- also in urine) and then stercobilinogen (brown- in stool)

Front 14

What is direct biliruben used for?

Back 14

direct bili is used to help digest. it is excreted by the liver in the bile.

Front 15

What takes the most time in extravascular RBC breakdown (in terms of biliruben)?

Back 15

taking indirect biliruben and making it direct biliruben in the liver.

Front 16

Explain Intravascular RBC breakdown.

Back 16

RBC lysis in the blood and there is free alpha and beta dimers. ferous dimers are excreted in the urine (urine pink). can cause kidney damage and loss iron. dimer can also be mopped up by haptoglobin. over time the ferous dimers become feric metheme dimers. this can be excreted in the urine (brown) feric metheme dimers can be bound to albumin or hemopexin. methemalbuin, hemopexin complex and haptoglobin complex are all taken up by the liver and resolved by excretion in the bile/urine.

Front 17

In intravascular RBC breakdown what is the level of haptoglobin and hemopexin.

Back 17

both are low due to complexation with the feric and ferous dimers.

Front 18

What is the Retic and Indirect Bili for decreased production anemia?

Back 18

retic low, indirect low or the same

Front 19

What is the Retic and Indirect Bili for increased destruction (hemolytic) anemia?

Back 19

retic high, indirect high

Front 20

What is the Retic and Indirect Bili for ineffective production anemia?

Back 20

retic low, indirect high

Front 21

What is the Retic and Indirect Bili for acute blood loss anemia?

Back 21

retic high, indirect bili is normal

Front 22

What is the Retic and Indirect Bili for redistribution anemia?

Back 22

retic is normal, indirect bili is normal

Front 23

What is the Retic and Indirect Bili for dilution anemia? give large amounts of saline to a hypovolemic patient causing anemia

Back 23

retic is normal or low, indirect bili is normal or low.

Front 24

What is the normal for MCV and how is it calculated?

Back 24

normal is 80-100. calculated by Hct/RBC

Front 25

What is the normal for MCH and how is it calculated?

Back 25

normal 28-33. calculated by Hb/RBC

Front 26

What is the normal for MCHC and how is it calculated? What is the only case where there is an increase in MCHC?

Back 26

normal is 31-35, MCHC equals Hb/Hct. High MCHC indicates spherocytes.

Front 27

What are some causes of decreased production? (5)

Back 27

Aplastic anemia, iron deficiency, anemia of chronic disease, infiltration of abnormal cells in marrow (leukemia or lymphomas), renal failure

Front 28

What causes aplastic anemia?

Back 28

drugs (antibiotics, immune suppressing drugs), radiation, infections (TB, hepatitis), autoimmune diseases, idiopathic

Front 29

What causes iron deficiency in adults and children?

Back 29

adults-chronic blood loss
children-dietary or blood loss

Front 30

Why does renal failure cause decreased production?

Back 30

No EPO produced.

Front 31

What are two causes of ineffective production anemia?

Back 31

Megaloblastic anemia caused by low B12 or Folic Acid

Front 32

What does the smear and bone marrow look like for megaloblastic anemia?

Back 32

smear has oval macrocytes, hypersegmented polys, poikliocytosis and anisocytosis (varies RBC size). bone marrow is hypercellular

Front 33

What can be causes of B12 deficiency?

Back 33

food is deficient in B12, no stomach (so no R0binders, pernicious anemia (autoimmune), pancreatic insufficiency, disease of ileum (e.g. Crohn's), competition for B12 (e.g. tapeworm).

Front 34

For hemolytic anemias, what are the three hereditary types?

Back 34

1. membrane abnormalities- hereditary spherocytosis or elliptocytosis
2. hemoglobin abnormality- sickle cell, thalassemia, unstable hemoglobins
3. enzyme abnormality- decreased G6PD or Pyruvate kinase

Front 35

Name an acquired hemolytic anemia.

Back 35

PNH- paroxymal nocturnal hemoglobinuria.