Anemia is defined as reduction in one or more RBC measurements:
RBC count
Hgb
Hct
Lab value to look at size of RBC
MCV
Lab value to look
... [Show More] at color of RBC
MCH
Lab value to look at degree of variation of RBC size (<15% is normal)
RDW
Why would the bone marrow make small RBC?
Not enough iron
Iron lab values
Serum iron
Serum ferritin
TIBC
Serum iron
Measure of iron in circulation
Serum ferritin
Measure of iron in storage
TIBC (total iron-binding capacity)
Reciprocal relationship to iron count
Peripheral smear
Visual description of RBC
Should always be considered when a patient presents with anemia
Reticulocytes
Immature RBC
Usually about 1%
Indicates ability of bone marrow to produce RBC
Microcytic anemia examples
Iron deficiency anemia
Thalassemia
Iron deficiency anemia: what type & clinical presentation
Microcytic hypochromic
Young-adults: fatigue, weakness, headache, exercise intolerance
Older-adults: worsening symptoms of another disease
How to tell the difference between IDA and thalasemmia?
Serum iron and ferritin will be low and TIBC will be high in IDA
How much elemental iron does a person need daily for IDA and for how long?
150-200 mg daily for 4-6 months
What is the most well-tolerated iron source?
Ferrous sulfate
What normal lab values indicates that iron supplementation may be stopped?
Serum ferritin level
What kind of anemia is anemia of chronic disease and why?
Normocytic, normochromic
RBC life is shortened
Best way to treat anemia of chronic disease?
Better control of underlying chronic disease
Macrocytic anemia examples
B12 deficiency
Folate deficiency
Symptoms and causes of B12 and folate anemias
Often asymptomatic
May present with neuro symptoms
Often older adults, malnourished, alcohol abuse, bariatric surgery patients
Multiple melanoma:
What is it?
Symptoms
Labs
Affects plasma cells
Fatigue, weakness, bone pain
Proteinuria, hypercalcemia, normocytic anemia
Hemophilia A:
What is it?
Factor VIII deficiency
aPTT prolonged
Gold standard test to diagnosis hemoglobinopathies:
Hemoglobin electropheresis
Pernicious anemia:
What is it?
Treatment
Autoimmune disorder stops intrinsic factor production (necessary for vit B 12 absorption)
Tx: B12 injection every week x 4 wks, injection once a month for life
Aplastic anemia:
What is it?
Gold standard test
Destruction of cells in bone marrow results in pancytopenia
Bone marrow biopsy
Hemochromatosis:
What is it?
Labs
Treatment
Total body iron overload
High ALT/AST, ferritin
Phlebotomy
When will Hgb/Hct return to normal after treatment?
1-2 wks will starting increasing
4-8 wks back to normal
Vit B12 vs. folate deficiences
B12 will cause nerve damage
MCV < 80
Microcytic
MCV > 80
Macrocytic [Show Less]