mlab 1415- hematology keri brophy-martinez anemia part one
TRANSCRIPT
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MLAB 1415- Hematology
Keri Brophy-Martinez
Anemia
Part One
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Anemia
Anemia is the inability of the blood to supply the tissue with adequate oxygen for proper metabolic function.
Clinically, anemia is defined as a decrease in the normal concentration of hemoglobin or erythrocytes.
Anemia is not a disease, but an expression of an underlying disorder or disease.
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Development of Anemia
Anemia occurs if: Erythrocyte loss or destruction exceeds the
maximum capacity of bone marrow erythrocyte production OR
Bone marrow erythrocyte production is impaired or abnormal
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Causes of anemia
Acute blood loss (hemorrhage) Accelerated destruction of RBC’s (immune or
non-immune) Nutritional deficiency (iron, folate or B12) Bone marrow replacement (e.g. cancer) Infection Toxicity Hematopoietic stem cell arrest or damage Hereditary or acquired defect
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Anemia Classifications Functional
Uses absolute and corrected retic count, RPI, and serum iron for classification Types
Survival Defects(Increased Destruction) Proliferation Defects(Decreased production) Maturation Defects
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Anemia Classifications Morphologic
Uses erythrocyte indices (MCV) for classification Types
Macrocytic, Normochromic Causes: Folate or B12 deficiency, liver disease, alcoholism
Normocytic, Normochromic Causes: bone marrow failure, hemolytic anemia, chronic renal failure,
leukemia, metastatic malignancy Microcytic,Hypochromic
Most common anemia Causes: iron deficiency, sideroblastic anemia, thalassemia, chronic
diseases
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Diagnosis of anemia
Clinical history Physical signs such as pallor, fatigue, weakness and
shortness of breath Laboratory tests
CBC Examination of the blood smear Reticulocyte - measures effective erythropoiesis Bone marrow examination Iron studies - iron, total iron-binding capacity (TIBC), ferritin Vitamin B12 and folate Erythropoietin level
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Laboratory Tests for Measurement of Anemia
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Lab Tests Hemoglobin Reference values
Male: 14-17.4 g/dl Female: 12-16 g/dl
Moderate anemia: 7-10 g/dl
Severe anemia: <7 g/dl
Hematocrit Reference values
Male: 42-52% Female: 36-46%
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Parameters of the CBC (complete blood count)
Red Blood Count or RBC Hemoglobin Hematocrit
Note: the approximate relationship of the hemoglobin to the hematocrit is 1:3. This may vary with the cause of the anemia and the effect on the RBC indices, especially the MCV.
RBC indices MCV - mean cell volume
Normal:80-100 fL (femtoliters) Measured directly on automated cell counters Used to classify RBCs as normocytic, microcytic or macrocytic Indicates the average volume of the red cells
Calculation: Hct x 10
RBC
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RBC Indices con’t
MCH - mean cell hemoglobin weight Normal: 28-34 pg A measurement of the hemoglobin content in RBC’s
Calculation: Hgb x 10
RBC
MCHC - mean cell hemoglobin concentration Normal: 32-36 % Used to classify RBCs as normochromic, or hypochromic A measure of the concentration of hemoglobin in the average RBC
Calculation: Hgb x 100
Hct
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Parameters of the CBC(complete blood count)
RDW -Red Cell Distribution Width Calculated index used to identify anisocytosis Normal: 11.5-14.5%
Calculation: Standard deviation of MCV x100
Mean MCV
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Reticulocyte
Adult reference range: 0.5 - 2.5% Useful in determining the response to the anemia and the
potential of the bone marrow to manufacture RBC’s. Expressed as a percentage of the RBC’s.
When anemia is present, it is helpful to correct the retic using the patient’s hematocrit in order to assess appropriate bone marrow response
A supravital stain called New Methylene Blue is used to stain reticulocytes. On a Wright’s stained smear, reticulocytes appear as bluish red cells. The term used for retics on Wright’s stain is polychromasia.
Corrected retic% = retic % X Patient hct Normal hct* based on age and sex
[*Normal female hct = 42%][*Normal male hct = 45%]
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Reticulocyte
Prematurely released retics remain in the blood and take from ½ to 1 ½ days longer to mature. This will cause even the “corrected” retic to be elevated, so a calculation must be performed to correct for this situation to obtain the reticulocyte production index (RPI). A maturation time table is used for this calculation.
Indicator of the adequacy of the bone marrow response in anemia RPI>2: good bone marrow response RPI<2: inadequate response
RPI = corrected retic
maturation time in days
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Adult Reference Ranges
Red Blood Cells Male: 4.5-5.5 x 106 /µlFemale: 4.0-5.0 x 106 /µl
Hemoglobin Male: 14-17.4 g/dlFemale: 12-16 g/dl
Hematocrit Male: 42-52%Female: 36-46%
MCV 80-100 fL
MCH 28-34 pg
MCHC 32-36 %
Reticulocyte 0.5-2.5%
RDW 11.5-14.5%
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References
Harmening, D. M. (2009). Clinical Hematology and Fundamentals of Hemostasis. Philadelphia: F.A Davis.
McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc.