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HemOnc Approach to Anemias
volume of RBC per volume of total blood
MCHC helpful in dermining
if there are a lot of spherocytes
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]
immature RBCs relseased by bone marrow. polychromatophilic (blue)
2 measures of Reticulocytes
(1) retic index (2) absolute retic count
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
low MCV (<80). refelcts hemoglobin synthesis problme.
causes of Microcytic Anemia
Thalassemia, anemia of chronic disease, iron deficiency, lead poisoning, sideroblastic anemia
high MCV (>100)
Causes of Macrocytic Anemia
megalobalsic (DNA synthesis impairment) or non-megaloblastic
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