Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
|
what is the hemoglobin/hematocrit definition of anemia?
|
- hemoglobin >2 SD below normal (male 13-16, female 12-15)
- hematocrit % decrease (male 39-48% female 36-45%) |
|
|
what is MCV? MCH? MCHC?
|
- MCV = mean cell volume = Hct/RBC
- MCH = mean cell hemoglobin = Hb/RBC - MCHC = Mean cell hemoglobin concentration = Hb/hct |
|
|
without the supravital stain what do reticulocytes look like in a peripheral blood smear?
|
- polychromasia = solid purple on blood smear
|
|
|
what are two ways to measure the reticulocytes?
|
- absolute reticulocyte count: retic percentage x total RBC
- reticulocyte index: retic count x Pts Hct/40 |
|
|
what should the reticulocyte index be in pt with anemia w/ adequate BM response?
|
- reticulocyte index: retic count x Pts Hct/40
- should be >2 in anemia w/ adequate BM response |
|
|
what is the reticulocyte index or absolute retic count in pt with hypo-proliferative anemia? hyper-proliferative?
|
- RI <2 with hypo, absolute retic count < normal
- RI >2 with hyper, absolute retic count increased |
|
|
what are some examples of macrocytic anemia?
|
- folate def, B12 def, alcoholism, myelodysplastic syndrome
|
|
|
what are some examples of microcytic anemia?
|
- iron def, toxins (lead), anemia of chronic disease
|
|
|
what are some examples of normocytic anemia?
|
- anemia of chronic disease, hypothyroidism, kidney disease
|
|
|
what is the most common form of anemia? what is the most common cause of this? what are other causes?
|
- iron deficiency (microcytic) anemia
- blood loss is the most common cause of this in adults - other causes include malabsorption syndromes (celiacs, gastric bypass, inflammatory diseases) |
|
|
what are some symptoms of iron deficiency anemia?
|
- hair loss
- PICA = craving strange things - koilonychia (spoon shaped nails) - angular stomatitis |
|
|
where is iron stored in the body? how can you test this to see if pt is anemic?
|
- ferritin, however not huge amount of storage
- if serum ferritin is low then it has been mobilized to the BM - aka iron deficiency |
|
|
what carries iron around in the body?
|
- transferrin
|
|
|
once iron is taken up into the cell who does it interact with?
|
- hephaestin: basolateralferrioxidase facilitates release of enterocyte iron
- ferroportin: protein that exchanges Fe from intestinal cell to transferrin |
|
|
where does Fe go once it has been absorbed?
|
- Fe either free Fe or transferrin-bound Fe goes to hepatocyte
- transferrin receptors 1 & 2 - transferrin receptor 2: influences expression of hepcidin which is primary regulator --> influences Fe uptake in intestine |
|
|
how is Fe stored?
|
- ferritin: soluble, reflects iron stores
- hemosiderin: insoluble, in macrophages w/ special stain |
|
|
what is the best serum reflection of Fe stores?
|
- ferritin
|
|
|
why does iron usually always have to be protein bound?
|
- it is toxic in free form
|
|
|
what do the cells look like in iron deficiency anemia?
|
- central pallor >1/3 cell diameter
- hypochromia = low Hb in cell |
|
|
what do the labs look like in iron deficiency anemia?
|
- low MCV, low MCH, decreased RBC, low reticulocyte count
- serum Fe = low, TIBC = high, ferritin = low, transferrin sat = low |
|
|
how do you have to take oral Fe? when do you give iron transfusion?
|
- have to take it with OJ or with acidic stomach (aka empty)
- give transfusion for severe symptoms, infections, allergic rxn, etc |
|
|
what is the pathophys of anemia of chronic disease?
|
- dysregulation of iron transport & inflammatory cells upregulate hepcidin --> less intestinal iron uptake
- Fe release from macrophages inhibited - decreased plasma Fe but normal bone marrow stores |
|
|
what do the labs look like for anemia of chronic disease?
|
- low serum Fe
- decreased TIBC - increased or normal ferritin - normocytic or microcytic anemia |
|
|
what happens in Tb toxicity anemia?
|
- Pb leads to inhibition of heme & globin chain synthesis --> inhibits breakdown of RNA
- rRNA aggregates in rbc = basophilic stippling - anemia w/ low MCV |
|
|
what are the tests for Pb toxicity?
|
- diagnostic test = serum Pb levels
|
|
|
what kinds of drugs can cause folate deficiency?
|
- anti-folate drugs = trimethoprim sulfamethoxazole, methotrexate
|
|
|
what is pernicious anemia? what does it cause? what do you see on peripheral blood smear?
|
- pernicious anemia = autoimmune condition, blocks absorption & incorporation of B12
- anti-parietal antibodies - macrocytic anemia - see tear drop cells & hypersegmentation of neutrophils, fat cells = high MCV |
|
|
what does the bone marrow look like with B12 deficiency?
|
- sever dysynchrony in cell cytoplasm maturation
|
|
|
how do the labs differ between B12 & folate deficiency?
|
- B12 has low serum B12, RBC folate normal, serum folate normal
- Folate def has normal serum B12, low RBC folate & low serum folate |
|
|
how do RBC & serum folate differ?
|
- serum folate changes quickly after eating --> real folate deficiency can be seen in RBC - always look at RBC folate deficiency labs
|
|
|
what are the levels of homocysteine & methymalonic acid like in B12 vs folic acid deficiency?
|
- homocytsteine + methymalonic acid elevated both in B12
- only homocysteine elevated in folate deficiency |
|
|
how do you treat B12 or folate deficiency?
|
- administer both folated & B12 because if only folate given for B12 def might make peripheral neuropathy worse
- treating will increase Hb, but spinal cord damage is irreversible, peripheral neuropathy may improve |
|
|
what is hereditary hemochromatosis?
|
- increased Fe absorption, mutation in HFE gene chromosome 6
- increased ferritin & transferritin - iron deposits in body, usually present with heart failure - treatment = phlebotomy |
