HemOnc Approach to Anemias

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Hematocrit

volume of RBC per volume of total blood

MCHC helpful in dermining

if there are a lot of spherocytes

Anemia

decreased hemoglobin/hematocrit below nl range for age and gender. disease manifestation. not final diagnosis.

Sx of acute hemorrhage anemia

hypovolemia, hypotension, orthostasis, syncope, shock

Sx of tissue hypoxia

fatigue, shortness of breath, cognitive difficulties, ischemic pain

4 Response to Anemia

(1) inc HR (2) vasoconstriction (3) salt retention (3) inc 2,3 DPG (4) inc erythoproietin synthesis

3 Mechanisms of Anemia

(1) hemorrhage (2) dec RBC survival (hemolysis) (3) dec RBC proliferation

importance of reticulocyte count

if pt is making new RBCs will see high reticulocyte account (rules out dec RBC proliferation)

2 way of Anemia classification

(1) erythropoietic response (2) RBC size (MCV) and [hemoglobin]

Reticulocytes

immature RBCs relseased by bone marrow. polychromatophilic (blue)

2 measures of Reticulocytes

(1) retic index (2) absolute retic count

Retic index

retic count x Hct/ideal Hct x 0.5

Absolute retic count

retic (%) x RBC takes into account pt anemia

retic index < 2% or absolute retic count < 75,000

suggests problem with RBC production. hypoproliferative abnormality

Retic index > 2% or absolute retic count > 100,000

shows good marrow response to anemia. suggests hemorrhage or hemolysis

3 Anemias by RBC Size

(1) Microcytic (2) Macrocytic (3) Normocytic

Microcytic Anemia

low MCV (<80). refelcts hemoglobin synthesis problme.

causes of Microcytic Anemia

Thalassemia, anemia of chronic disease, iron deficiency, lead poisoning, sideroblastic anemia

Macrocytic Anemia

high MCV (>100)

Causes of Macrocytic Anemia

megalobalsic (DNA synthesis impairment) or non-megaloblastic

Normocytic Anemia

most common. marrow isnt working well or mixed or acute problem. ex acute blood loss.

2 approaches to anemia treatment

(1) treat underlying caues (2) transfusion

3 general indications for RBC transfusion

(1) cardiovascular compromise (2) hypoproliferative anemia w/ no/long recovery (3) surgery

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