Anemia
Terms
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- What are the seven elements of the CBC?
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Hemoglobin (g/dl)
Hematocrit (%)
RBC
MCV
MCH
MCHC
RDW - What are the physiological responses to anemia?
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Increased cardiac output
Vasoconstriction (w/ acute blood loss)
Kidneys retain salt and water
Increased RBC 2,3 DPG
Increased epo synthesis by kidneys - What are the reticulocyte values for hypoproliferative anemias?
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Retic index <2%
Absolute retic count <75,000 - Differential Dx for Low Retic Count (Hypoproliferative Anemia)
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1. Acute blood loss
2. Nutritional anemia (iron, B12, folate)
3. Bone marrow depression
4. Defective RBC production (kidney disease, myelodysplasia)
5. Destruction of marrow erythroid precursors (aplastic anemia, parvovirus)
6. Replacement of normal marrow by tumor or other - What is the defining characteristic of megaloblastic anemias?
- A defect in DNA synthesis leading to a characteristic morphology of bone marrow cells
- What is the characteristic morphology of bone marrow cells seen in megaloblastic anemias?
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Nucleus appears immature
Cytoplasm has mature appearance
Increased cell volume - What is the most common cause of megaloblastic anemia?
- B12 and/or folate deficiency
- What is the hematoligical clinical presentation of megaloblastic anemia?
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Anemia
MCV and RDW elevated
Peripheral smear shows hypersegmented PMNs
Marrow is hypercellular, with increased nuclear size - What is the non-hematoligical clnical presentation of megaloblastic anemia?
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Beefy red tongue
Neuropsych features (B12 only) - What two things are elevated in the blood of a person with B12 deficiency?
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Homocysteine
Methylmalonic acid - What is elevated in the blood of a person with folate deficiency?
- Homocysteine
- TIBC is a measure of what?
- Transferrin
- What are the symptoms of iron dificiency?
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Anemia
Glossitis (smooth shiny tender tongue)
Angular cheilitis
Esophageal webs
Koilonychia (spooning of nails)
Pica
Thrombocytosis - What are the CBC changes seen with iron deficiency?
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Elevated RDW (seen first)
Lowered MCV (seen second)
Lowered Hgb/Hct (seen last) - What are the characteristics of an iron panel in a patient that is iron deficient?
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Lowered serum Fe
TIBC increases after storage is depleted
Transferrin sat falls
(Transferrin sat <10% and elevated TIBC = Fe deficiency)