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NCA 621 Hematology I

Terms in this set (25)

Whole Blood Components
Plasma - 55%
Buffy Coat - 1%
Bottom Layer - 42-47%
Plasma
55% of total whole blood volume
made up of:
water (90%)
proteins (7%)
hormones
enzymes, carbs, fats, amino acids, gases, electrolytes, excretory products
buffy coat
1% of whole blood volume
made up of:
leukocytes (WBC)
thrombocytes (platelets)
Bottom layer
42-47% of the whole blood volume
made up of:
erythrocytes (RBC)
MCV (mean corpuscular volume)
average size of the red blood cell
normal value 80-100 fL

most useful index for classifying anemia (microcytic, normocytic, macrocytic)
MCH (mean corpuscular hemoglobin)
Hemoglobin amount per RBC
normal value 26-34 pg/cell
MCHC (mean corpuscular hemoglobin concentration)
Amount of hemoglobin relative to the size of the cell per RBC
normal value 31-36 g/dL
Reticulocytes
measure of bone marrow productivity
0.5-2% of total RBCs
provides an index of the rate of RBC production
Anisocytosis
marked variation in size of RBCs
Poikilocytosis
signifiant variation in the shape of RBCs
Anemia
abnormally low number of circulating RBCs or level of hemoglobin, or both, resulting in diminished oxygen-carrying capacity

classified as macrocytic, microcytic, or normocytic
Hemoglobin
Hemoglobin (Hgb)
• Males 13.5-16.5 g/dL
• Females 12 - 15 g/dL
Hematocrit
normally 3X's the hemoglobin
• Males 40-50%
• Females 37-47%
RBC count
• Males 4.2-5.4 X10^6/uL
• Females 3.6-5.0 X10^6/uL
Categories of Anemias
Kinetic approach
Morphologic approach
Kinetic approach to anemia
addresses mechanisms involved in the anemia
• Decreased RBC production
• Increased RBC destruction
• Blood loss
Morphologic approach to anemia
categorizes anemia by alterations in the RBC size
• Macrocytic
• Microcytic
• Normocytic
populations at risk for iron deficiency anemia
• Women, childbearing age (present in 10% of women of childbearing age in the US)
• Pregnant women 25% greater chance in USA
• Low- and middle- income countries
• More prevalent in older adults
Common causes of iron deficiency anemia
decreased dietary intake, reduced absorption, and blood loss (most common USA)

• Overt bleeding: trauma, hematemesis, melena, hemoptysis, menorrhagia, pregnancy and delivery, hematuria

• Other causes: frequent blood donation, excessive diagnostic testing, underestimation of menorrhagia, lactation, occult bleeding (GI, malignancy)
symptoms associated with iron deficiency anemia
fatigue, weakness, headache, irritability, exercise intolerance, exertional dyspnea, vertigo, angina pectoris, pica, ice craving
conditions associated with iron deficiency anemia
restless leg syndrome
Celiac disease
gastritis/H.pylori
exam findings with iron deficiency anemia
pallor
dry, rough skin
blue sclera
atrophic glossitis with loss of tongue papillae
heart murmur due to changes in blood viscosity
cheilosis
koilonychia
esophageal web with dysphagia
alopecia (rare, in severe cases)
chlorisis (pale, green complexion - very rare) tachycardia or HD instability
lab findings in iron deficiency anemia
Low RBC
Low H&H
Low absolute reticulocyte count
Low MCV + Low MCH = Microcytic, hypochromic anemia
Order iron studies to assess baseline and determine severity
Serum ferritin <15 ng/mL (<30ng/mL in pregnancy)
Serum ferritin <41 ng/mL (w/ comorbidities)
Transferrin Saturation <16% - mostly used in patients
for whom the ferritin is thought to be unreliable
Treatments for Iron Deficiency Anemia
Oral replacement: effective, inexpensive, safe BUT 70% report GI side effects
150-200mg of elemental iron daily and give on an
empty stomach with vitamin C to enhance absorption
IV repletion is used if pt unable to tolerated PO or pt has absorption issues (IBD, bariatric surgery etc)
nearly full-replacement in 1-2 IV doses
Anemia of Chronic Disease
2nd most common form of anemia in world

Normocytic, normochromic, mild
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