hematology - anemias

without

an-

blood

-emia

anemia

• lack of blood

• specifically low RBCs

• not a disease, but an effect of some other process in the body

• mechanism (what is the body doing?)

• morphology (what cells look like)

two ways to describe anemia:

mechanism

• what is the body doing

• is the body making RBCs? (underproduction)

• is the body making more to make up for lost RBCs?

underproduction

body is not making RBCs

• Bone marrow not making RBCs correctly (neoplasm, chronic disease, toxins)

• Bone marrow does not have supplies to make RBCs correctly (amino acids, vitamins, iron)

hyperproduction

body making more to make up for lost RBCs

• hemorrhage or hemolysis in the body

morphology

• what cells look like

mean cell volume

what lab value describes RBC size

macrocytic

elevated cell volume

microcytic

low cell volume

normocytic

cell volume within normal range

none, must look under microscope

what lab value describes RBC shape?

MCH (how much hemoglobin packed into cell)

what lab value describes amount of Hgb in RBC

normochromic

normal range MCH

hypochromic

MCH low

hyperchromic

high MCH

• low RBC

• low Hgb

Anemia will manifest with a HIGH or low CBC and a HIGH or low Hgb and HCT?

microcytic, hypochromic anemia

A patient with an anemia and Low MCV, low MCH has a

macrocytic, hyperchromic anemia

A patient with an anemia and HIGH MCV, HIGH MCH has a

Normocytic, normochromic anemia

A patient with an anemia and Normal MCV, normal MCH has a

cause

§Identifying the RBC shape helps identify the _______of the anemia!

therapy

Identifying the cause is critical for choosing the ________ for the patient!

• iron deficiency anemia

• thalassemia

• anemia of chronic disease

what can a microcytic, hypochromic anemia cause?

folic deficiency anemia

what can a macrocytic, hyperchromic anemia cause?

• iron deficiency anemia

• thalassemia

• anemia of chronic disease

examples of microcytic, hypochromic anemias

Iron deficiency anemia

• inadequate iron intake or increased loss of RBCs

• Most common anemia worldwide

Thalassemia

• Hereditary disorder of hemoglobin synthesis

• Damage to alpha or beta chains of hemoglobin

Anemia of chronic disease

Continued destruction of RBCs due to inflammation

Iron is absorbed through the diet and transported via ______ and either __________

transferrin, used in RBC formation or stored as Ferrtitin

transferrin

iron transporter

• used in RBC formation

• stored as FERRITIN

• not eating enough red meat

• not absorbing their diet (medications, stomach acid)

• vegan

§What would cause someone to not ingest adequate iron?

• thrombocytopenia

• colon cancer

• bone marrow issues

• jehovah’s witness

What would cause someone to lose more blood than they replace?

• fatigued

• tachycardia/ palpatations (sped up heart rate)

• dyspnea on exertion (shortness of breath)

• cold intolerance

• pica (craving non-food substances like dirt)

symptoms of iron deficiency anemia

smooth toungue (atrophic glossitis)

right condition

Iron Deficiency Anemia Signs

• Smooth tongue (atrophic glossitis)

• Cheilosis

• Brittle nails

• Spoon shaped nails (koilonychia)

• Pale conjunctiva

• Skin pallor

pale conjunctiva (sign of iron deficiency anemia)

RBC will be: low

Hgb/Hct will be: low

MCV will be: low (microcytic)

For iron deficiency anemia:

• RBC will be:

• Hgb/Hct will be:

• MCV will be:

treat the cause

Iron deficiency Anemia Treatment

bleeding

Adult iron deficiency anemia is _____ until proven otherwise

• colon cancer

• menstrual cycle

what is adult bleeding likely in most cases?

Ferrous sulfate 325 mg TID for 3-6 mo

supplement for iron deficiency anemia (KNOW)

• take on empty stomach

• vitamin c helps with absorption (orange juice)

instructions for ferrous sulfate

thalassemia