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66 Cards in this Set
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pseudo anemia maybe from
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over hydration rehydration of a dehydrated pt.
IV fluid in specimen, pregnancy, hypoalbuminemia, laboratory error |
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factor deficiency anemia, caused by?
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low: iron, B12, folic acid, or a combo of all three
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production defect anemia
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failure of blood forming organs to produce or or deliver mature RBC's
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causes of production defect anemias
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marrow fibrosis, neoplasm, chem toxins, severe infection, chronic renal disease, widespread malignancy, rheumatoid collagen diseases, hypothyroidism.
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depletion anemia can be from;
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peripheral blood loss. hemorrhage(acute or chronic).
hemolytic anemia/ hypersplenism |
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classification of anemia by RBC morphlogy
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Microcytic, normocytic, macrocytic
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%iron in hemoglobin?
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70%
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amt. inron consumed/absorbed
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10mg/day consumed. 10% absorbed(1mg/day)
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absorption of Iron is increased by?
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absorption is inthe duodenun/jejunum. ingestin of Vit C. taking iron supplements 45-60minutes before eating.
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Fe+ absorption is decreased by?
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coffee, tea, dairy, and high fiber foods
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states of iron
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ingested as ferric, converted to ferrous. (fick/ferrus)
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daily loss of Iron
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men 1 mg/day
women 1mg/day menstruating 2mg/day |
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Iron storage (by %)
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70% in hemoglobin, 30% in bone marrow, liver, spleen, reticulum cells(60% as ferritin, 40% as hemosiderin)
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M/CC bleeding in men:
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GI bleeding. -40peptic ulcer. +40 carcinoma.
hemorrhoids |
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tests for GI bleeding
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endoscopy, stool guaiac test, barium enema, sigmoidoscopy, colonoscopy
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M/CC bleeding in women;
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GI or vag. 20-50% menstruating women are Fe defficient.
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factor deficiency Anemia blood smear;
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may appear normal in early phase.
will be microcytic/hypochromic in later stages. |
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factor deficiency A. RBC indices
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-MCV. +RDW. MCH and MCHC may or may not change.
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Factor Deficiency A. Reticulocytes
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normal in uncomplicated chronic iron def. reticulocytsis is possible w/ acute blood loss.
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Serum Iron
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sensitive indicator of possible iron defiiency. test is for iron bound to serum(transferrin) so levels depend on iron AND transferrin. levels vary w/ time of day a.d vary day to day.
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Decreased serum Iron=
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*Iron Deficiency
*Anemia of severe Chronic dz.( rheumaoid-collagen diseases, extensive malig, uremia, cirrhosis, severe chronic infection.) *3rd tri *severe stress |
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Serum Iron w/ Pregnancy
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*-during 3rd trimester.
*+1st trimester.(transferrin is elevated by estrogen) |
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Increased Serum Iron=
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*hemolytic anemia
*Fe overload *estrogen Therapy(+transferrin) *acute hepatitis *parenteral Fe therapy *thalassemia minor *IM Fe-dextran infusion. |
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Megaloblastic A. and Fe deficiency
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-Fe maybe unmasked by folate or B12 therapy
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Total Iron Binding Capacity (TIBC)
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*estimates Serum Transferrin
*+in uncomplicated chronic -Fe. *+ w/ + transferrin *- w/ - transferrin |
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Transferrin Saturation (TS)
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- %TS is MORE SENSITIVE for IDA than Serum Iron or TIBC...bu it is LESS Specific.
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Chronic Iron def. A. (IDA) test results
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*- Serum Iron
*+ TIBC * increases the unsaturated binding capacity or transferrin and lowers the % iron bound transferrin |
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Serum Ferritin
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*major Fe storage compound
*MOST SENSITIVE test for for -Fe |
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Interpretation of Serum Ferritin
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+10ng/ml is diagnostic for -Fe.
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factors elevating Serum ferritin
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*acute inflammation
* infection *trauma *transfusions *megaloblastic a. *hemolytic a. *Fe Overload *chronic viral Hep. |
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Free Erythrocyte Proporphyrin aka Zinc Protoporphyrin(ZPP)
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*involved in last step of heme synthesis.
* if no Fe available, Zinc bids with protoporphyrin. *+ w/ -Fe, Pb poison, infections, inflammation, malignancies, chron Liver dz., hemolytic anemia. |
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Bone Marrow Iron Stain
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THE GOLD STANDARD for -Fe.
* most sensitive/specific/reliable |
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Dx. of Chronic Fe def.
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* anemia w/ -MCV and +RDW
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Interpretation of Chronic Iron Def.
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*-SI & -TIBC= chronic Dz.
*- SI & + TIBC= low Fe *- DI & -%T= thalassema minor |
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B12 deficiency causes
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*lask of Intrinsic factor
*low gastric acid *malabsorption syndrome *bacterial overgrowth(dysbiosis) *fish tapeworm *pacreatic disease *drug interference *vegan diet |
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factors that can make b12 appear low
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*++Vit C dose
*prgnancy *folic Acid deficiency *chronic -Fe |
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False elevation of B12
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*Liver dz
*Myeloproliferative disorder w/ inc. WBCs |
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Megaloblastic Anemia causes
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caused by *-b12 or -folic acid
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Megaloblastic changes;
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*enlargement of RBC precursors
*+ RBC destruction in marrow *leukopenia *anemia *thrombocytopenia *bandeutrophils *....see pg 58 |
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B12 deficiency causes
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*lask of Intrinsic factor
*low gastric acid *malabsorption syndrome *bacterial overgrowth(dysbiosis) *fish tapeworm *pacreatic disease *drug interference *vegan diet |
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factors that can make b12 appear low
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*++Vit C dose
*prgnancy *folic Acid deficiency *chronic -Fe |
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False elevation of B12
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*Liver dz
*Myeloproliferative disorder w/ inc. WBCs |
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Megaloblastic Anemia causes
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caused by *-b12 or -folic acid
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Megaloblastic changes;
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*enlargement of RBC precursors
*+ RBC destruction in marrow *leukopenia *anemia *thrombocytopenia *bandeutrophils *....see pg 58 |
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***megaloblastic anemia
Methylmalonic acid (MMA) |
functional test for -B12
*MMa needs B12 to convert to succinate +MMA=-B12 MMA is + even when serum B12 is normal(60%) |
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Megaloblastic anemia findings
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+MMA
*+MCV *+serum lactic dehydrogenase(LDH)=cell damage |
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LDH means?
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LDH=cell damage
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Pernicious Anemia is from?
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atrophis gastritis causes -HCL, and IF deficiency
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pernicious A. lab findings
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macrocytic anemia w/ oval macrocytes and megaloblastic changes in bone marrow
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patients most likely to have pernicious anema
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northern europeans ages +40
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Shilling test
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definitive for pernicious anemia
may have 29% false + |
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Shilling test
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pernicious anemia
*radioactive B12 given folowed by "flushing dose" Urine collected for 24 hours *-8% recovery of radioactive b12 suggests PA *+8% recovered with IF confirms dx. |
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***folic acid deficiency
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shilling test required to distinguish from PA
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treating PA w/ folate
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may aleviate symptoms of -folic acid but -b12 will still causeneuro damage.
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Folic Acid Deficiency causes:
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*-dietary FA
*chronic OH- *malabsorption *pregnancy *oral contreceptves *Other drug interference |
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Pyridoxine Def.
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*B6 is needed for heme synthesis
*anemia will resmble chronic -Fe |
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B6(pyridoxine) def. classification
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sideroblastic anemia
*seen in bonemarow *normoblasts w/ iron-staining cytoplasmic granules that form ring around nucleus |
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Production Defect anemia
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*failure of marow to incorporate adequate supplies of raw material
* failure of marrow to release RBCs *destruction of RBC precursors in the marrow. |
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Production Defect a.
Myelofibrosis |
replacement of marrow by fibrosis
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production defect anemia neoplasm
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replacement of marrow by cancer cells
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Production Defect A. lab signs
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*normocytic/normochromic
* |
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multiple myeloma (production defect a.)
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neoplasm of plasma cells leading to rouleaux formation, plasma cells in peripheral blood and hyerglobulinemia
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aplastic anemia (pda)
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-marrow fxn w/o cell abnormality or replacement
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aplastic anemia (pda) causes
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radiation, chemicals, cytotoxic drugs, medications, ebv, rubella, herpes zoster, hep c, thmoma, etc...
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what % of PDA is idiopathic?
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50%
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PDA findings
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serum Fe and TIBC are decreased
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