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33 Cards in this Set
- Front
- Back
what is the hemoglobin/hematocrit definition of anemia?
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- hemoglobin >2 SD below normal (male 13-16, female 12-15)
- hematocrit % decrease (male 39-48% female 36-45%) |
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what is MCV? MCH? MCHC?
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- MCV = mean cell volume = Hct/RBC
- MCH = mean cell hemoglobin = Hb/RBC - MCHC = Mean cell hemoglobin concentration = Hb/hct |
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without the supravital stain what do reticulocytes look like in a peripheral blood smear?
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- polychromasia = solid purple on blood smear
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what are two ways to measure the reticulocytes?
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- absolute reticulocyte count: retic percentage x total RBC
- reticulocyte index: retic count x Pts Hct/40 |
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what should the reticulocyte index be in pt with anemia w/ adequate BM response?
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- reticulocyte index: retic count x Pts Hct/40
- should be >2 in anemia w/ adequate BM response |
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what is the reticulocyte index or absolute retic count in pt with hypo-proliferative anemia? hyper-proliferative?
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- RI <2 with hypo, absolute retic count < normal
- RI >2 with hyper, absolute retic count increased |
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what are some examples of macrocytic anemia?
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- folate def, B12 def, alcoholism, myelodysplastic syndrome
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what are some examples of microcytic anemia?
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- iron def, toxins (lead), anemia of chronic disease
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what are some examples of normocytic anemia?
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- anemia of chronic disease, hypothyroidism, kidney disease
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what is the most common form of anemia? what is the most common cause of this? what are other causes?
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- 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) |
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what are some symptoms of iron deficiency anemia?
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- hair loss
- PICA = craving strange things - koilonychia (spoon shaped nails) - angular stomatitis |
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where is iron stored in the body? how can you test this to see if pt is anemic?
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- ferritin, however not huge amount of storage
- if serum ferritin is low then it has been mobilized to the BM - aka iron deficiency |
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what carries iron around in the body?
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- transferrin
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once iron is taken up into the cell who does it interact with?
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- hephaestin: basolateralferrioxidase facilitates release of enterocyte iron
- ferroportin: protein that exchanges Fe from intestinal cell to transferrin |
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where does Fe go once it has been absorbed?
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- 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 |
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how is Fe stored?
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- ferritin: soluble, reflects iron stores
- hemosiderin: insoluble, in macrophages w/ special stain |
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what is the best serum reflection of Fe stores?
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- ferritin
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why does iron usually always have to be protein bound?
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- it is toxic in free form
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what do the cells look like in iron deficiency anemia?
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- central pallor >1/3 cell diameter
- hypochromia = low Hb in cell |
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what do the labs look like in iron deficiency anemia?
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- low MCV, low MCH, decreased RBC, low reticulocyte count
- serum Fe = low, TIBC = high, ferritin = low, transferrin sat = low |
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how do you have to take oral Fe? when do you give iron transfusion?
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- have to take it with OJ or with acidic stomach (aka empty)
- give transfusion for severe symptoms, infections, allergic rxn, etc |
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what is the pathophys of anemia of chronic disease?
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- 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 |
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what do the labs look like for anemia of chronic disease?
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- low serum Fe
- decreased TIBC - increased or normal ferritin - normocytic or microcytic anemia |
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what happens in Tb toxicity anemia?
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- Pb leads to inhibition of heme & globin chain synthesis --> inhibits breakdown of RNA
- rRNA aggregates in rbc = basophilic stippling - anemia w/ low MCV |
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what are the tests for Pb toxicity?
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- diagnostic test = serum Pb levels
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what kinds of drugs can cause folate deficiency?
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- anti-folate drugs = trimethoprim sulfamethoxazole, methotrexate
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what is pernicious anemia? what does it cause? what do you see on peripheral blood smear?
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- 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 |
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what does the bone marrow look like with B12 deficiency?
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- sever dysynchrony in cell cytoplasm maturation
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how do the labs differ between B12 & folate deficiency?
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- B12 has low serum B12, RBC folate normal, serum folate normal
- Folate def has normal serum B12, low RBC folate & low serum folate |
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how do RBC & serum folate differ?
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- serum folate changes quickly after eating --> real folate deficiency can be seen in RBC - always look at RBC folate deficiency labs
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what are the levels of homocysteine & methymalonic acid like in B12 vs folic acid deficiency?
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- homocytsteine + methymalonic acid elevated both in B12
- only homocysteine elevated in folate deficiency |
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how do you treat B12 or folate deficiency?
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- 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 |
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what is hereditary hemochromatosis?
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- increased Fe absorption, mutation in HFE gene chromosome 6
- increased ferritin & transferritin - iron deposits in body, usually present with heart failure - treatment = phlebotomy |