Hem- Onc
Terms
undefined, object
copy deck
- 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 (COKEïŠ)
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