Anemias

red cells made in marrow along with platelets and granulocytes

whenever marrow is diseased, it has pathology
treat patient with chronic renal failure treated with erythropoietin
as red count goes down
what if decreased O2 in blood like cyanotic heart disease or chronic lung disease
hematocrit would be very high
opposite of anemia
typically see in COPD is polycythemia
this is opposite in anemia
with decreased oxygenation due to COPD
expect polycythemia
high red counts
high hematocrits
in chronic renal failure it would be the opposite
u classify anemia based on color and size
if normocytic and normochromic
some of these cells are pretty small
hypochromic, microcytic on the right
iron deficiency
Macrocytic
there is no hyperchromic
if cell is solid and loses thin zone
then its a spherocyte
whenever u order a CBC
hemoglobin
hematocrit
white count
platelet count
differential
MCV: produced by taking the hematocrit over the red count
MCHC
MCH
if kid is on motorcycle
hits a bridge and tears the femoral artery
bleeding everywhere
ambulance tried to compress bleeding

takes him to hospital half mile away

at ER, he's cold and clammy
in shock
hypotensive due to losing blood volume
get me 8 units
CBC, protime, and PTT
hematocrit ends up being the same
los red blood cells and plasma volume
lets imagine that instead of femoral artery, tore tibial artery
and didn't discover him for four hrs
what would he look like then?
he would have switched extravascular fluid to the intravascular space
but he was anemic even if coming in with normal hematocrit
if pregnant lady
not anemic
red cell mass is normal but diluted down
definition of anemia is decline in red cell mass
not decline in red cell numbers
90 is ideal for MCV
color is Hb over red count
15 grams over 5 million times 10
so should be 30 for MCH
thus classify anemias based on color and size
definition of polycythemic is greater than normal red cell mass
theres another number given to u on the printout
if all same size, there would be tall spike
if greater distribution, RDW would be wide
theres only setting where this is helpful
patients who are hypochromic, microcytic
diff btw thalassemia and iron deficiency
iron deficiency would be the one with the great variation
one other number that we need
reticulocyte is a red cell that is slightly immature
thus these do not have a nucleus
in newborn baby, is referred to as erythroblastosis
if slightly immature cell, is just slightly bigger cell
still kinda grey

referred toas reticulocyte

this tells u that the marrow is responding to the anemia
if reticulocyte is low, its marrow failure
if reticulocyte is high, its actively bleeding
Differential diagnosis of anemia
I: marrow failure
marrow has stopped working
marrow failure anemia is replacement of marrow
or aplasia
aplasia could result from a toxin
aplasia could result from chemotherapy
any cancer treatment drugs knock out the rapidly growing cells
II: nothing wrong with marrow
Hb has 4 pyyrole ring with iron in center and 2 alpha and 2 beta
chains
impaired hb synthesis
cells here would be small and lacking color
III: MCV of 110 or 120
there are big cells
u see big cells in two conditions
deficiency of folic acid
or deficiency in B12
group III anemias are macrocytic
IV: congenital spherocytic anemia
high retic count
I:marrow failure anemia
normocytic-normochromic
red cells aren't being made
low retic count
with replacement an aplasia
can only make diagnosis by doing a bone marrow biopsy
Aplastic Anemia
most often is dose related
due to various cancer chemotherapy
less common but sig is idiosyncratic
will vary depending on the patient
ex: dilantin(antiseizure)

butazolidin
insecticides
chloramphenicol
can be due to radiation
viral infections can also cause this: parvovirus B
64 yr M w/ weakness & lumbar back pain
rbi is normal
hb is low
hematocrit is low
MCH is normal
MCV is normal
is normocytic, normochromic anemia
sed rate is very high
elevated total protein is usually hypergammaglobulinemia
multiple myeloma
malignant tumor plasma cell invading the bone marrow
35 yr M with chronic renal failure. Perinuclear ANCA positive
rbi is low
Hb is low
hematocrit is low
MCH is normal
MCV is normal
retic number is normal
KNOW THE ANCA DISEASES