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35 Cards in this Set

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What are some areas that are more pale in anemic patients?
skin, conjunctiva, creases of hands, mucous membranes
What are some signs of anemia?
CNS, Immune System, Cardiorespiratory, Genital tract, vascular and renal systems, gastrointestinal
What are the PCV and Hb for men and women for anemia
Men: less than 13 Hb, and 39%
Women: less than 12 Hb, and 37%
What are the kinetics that cause anemia?
-decreased production (hypoproliferative)
-increased destruction (hemolysis)
-ineffective production
-acute blood loss
-redistribution (i.e. enlarged spleen)
What are the factors used to determine RBC production?
reticulocyte production and reticulocyte index
What is the reticulocyte index?
= the corrected retic count divided by two (to take into account the presence of shift cells)
What are the factors for RBC destruction?
indirect bilirubin level and LDH elevation.
What does a low retic count mean?
means there is a production problem. hypoproliferative or ineffective erythropoiesis.
What shows up in a reticulocyte stain?
Both reticulocytes and marrow reticulocytes (shift cells). Shift cells look a little bigger, but can differentiate them by use of wright smear.
What should the retic index be greater than to suggest increased production of RBC's
Retic index greater than 3
What is the difference between extravascular intravascular hemolysis?
extravascular occurs in the spleen, intravascular occurs in the blood vessels.
For extravascular hemolysis what components are recycled?
globin and iron.
What are the steps for extravascular RBC destruction?
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)
What is direct biliruben used for?
direct bili is used to help digest. it is excreted by the liver in the bile.
What takes the most time in extravascular RBC breakdown (in terms of biliruben)?
taking indirect biliruben and making it direct biliruben in the liver.
Explain Intravascular RBC breakdown.
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.
In intravascular RBC breakdown what is the level of haptoglobin and hemopexin.
both are low due to complexation with the feric and ferous dimers.
What is the Retic and Indirect Bili for decreased production anemia?
retic low, indirect low or the same
What is the Retic and Indirect Bili for increased destruction (hemolytic) anemia?
retic high, indirect high
What is the Retic and Indirect Bili for ineffective production anemia?
retic low, indirect high
What is the Retic and Indirect Bili for acute blood loss anemia?
retic high, indirect bili is normal
What is the Retic and Indirect Bili for redistribution anemia?
retic is normal, indirect bili is normal
What is the Retic and Indirect Bili for dilution anemia? give large amounts of saline to a hypovolemic patient causing anemia
retic is normal or low, indirect bili is normal or low.
What is the normal for MCV and how is it calculated?
normal is 80-100. calculated by Hct/RBC
What is the normal for MCH and how is it calculated?
normal 28-33. calculated by Hb/RBC
What is the normal for MCHC and how is it calculated? What is the only case where there is an increase in MCHC?
normal is 31-35, MCHC equals Hb/Hct. High MCHC indicates spherocytes.
What are some causes of decreased production? (5)
Aplastic anemia, iron deficiency, anemia of chronic disease, infiltration of abnormal cells in marrow (leukemia or lymphomas), renal failure
What causes aplastic anemia?
drugs (antibiotics, immune suppressing drugs), radiation, infections (TB, hepatitis), autoimmune diseases, idiopathic
What causes iron deficiency in adults and children?
adults-chronic blood loss
children-dietary or blood loss
Why does renal failure cause decreased production?
No EPO produced.
What are two causes of ineffective production anemia?
Megaloblastic anemia caused by low B12 or Folic Acid
What does the smear and bone marrow look like for megaloblastic anemia?
smear has oval macrocytes, hypersegmented polys, poikliocytosis and anisocytosis (varies RBC size). bone marrow is hypercellular
What can be causes of B12 deficiency?
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).
For hemolytic anemias, what are the three hereditary types?
1. membrane abnormalities- hereditary spherocytosis or elliptocytosis
2. hemoglobin abnormality- sickle cell, thalassemia, unstable hemoglobins
3. enzyme abnormality- decreased G6PD or Pyruvate kinase
Name an acquired hemolytic anemia.
PNH- paroxymal nocturnal hemoglobinuria.