Crisis 2- Exam 4
interpreting a CBC...
look at...
-WBC
-RBC
-Hgb
-Hct
interpreting a CBC with differential...
shows...
-neutrophils
-lymphocytes
-monocytes
-eosinophils
-basophils
-platelet count(s)
if H&H is low, the patient is _________________
anemic
analysis of anemia labs: step 1
determining the RBC size measured by the Mean Corpuscular Volume (MCV)
RBC size (MCV): low (<80)
patient has a small cell or microcytic anemia
RBC size (MCV): normal (80-100)
patient has a normal size cell or normocytic anemia
RBC size (MCV): high (>100)
patient has a very large cell or macrocytic anemia
analysis of anemia labs: step 2
look at how much hemoglobin is inside the cell
-this gives the cell its color (chromic) and is measured by the MCH and MCHC
amount of hemoglobin: normochromic
normal color & a normal MCHC (31-37 g/dl)
amount of hemoglobin: hypochromic
pale color and a low MCHC (below 31 g/dl)
analysis of anemia labs: step 3
look at the size of the cells in circulation
-size of cells in circulation is measured by the RDW (normal is 11.5-15%)
-small cells and pale cells go together!
analysis of anemia labs: step 4
look at the reticulocyte count
-normally we have 2% retics in the blood
-reticulocytosis is a normal response to anemia as the bone marrow will pump out
lots of young red blood cells (retics)
causes of microcytic/ hypochromic anemia:
-iron deficiency
,-thalassemia (genetic)
-plumbism (lead poison)
-sideroblastic (leads to leukemia)
-aluminum toxicity (unusual)
-G6PD (hemolytic anemia)
causes if normocytic/ normochromic anemia:
-anemia of chronic disease
-acute blood loss
-early iron deficiency
causes of macrocytic/ normocytic anemia:
-vitamin B12 deficiency
-folate deficiency
-pernicious anemia
type of anemia: iron deficiency anemia
poor absorption or excessive loss of iron
type of anemia: pernicious anemia
poor absorption of B12 due to absence of intrinsic factor
--> leads to low H&H, GI problems (gas), neuro symptoms
-must administer cobalamin (IM or intranasal)
type of anemia: aplastic anemia
bone marrow without erythroid, myeloid, megakaryocytic (platelet) cell lines
-xrays, some antibiotics, chemo (isolation pxns)
--> requires transfusions until bone marrow again produces cells
type of anemia: hemolytic anemia
as RBCs are destroyed, kidneys are taxed to get rid of cell byproducts and often
renal failure ensues
-bone marrow can't keep up with RBC loss
type of anemia: thalassemia
genetic disorder leading to inadequate hemoglobin production
type of anemia: sickle cell disease
chronic anemia characterized by "c" shaped cells causing painful joints --> receive
lots of pain meds!
-crisis is induced by: stress, cold temps, infection, hypoxic episodes
anemia: associated S/S
-hypotension
-tachycardia
-change of stool color
-splenomegaly
-skin paleness, yellowing eyes
-shortness of breath
-severe: may cause heart attack
, polycythemia vera:
over production of erythrocytes, leukocytes, platelets due to stem cell stimulation
-Hct > 55 (normal is 37-50)
-thick blood + large blood volume = organ congestion
polycythemia vera: S/S
-red complexion
-dizziness
-headache
-visual disturbances
-painful joints
polycythemia vera: treatment
-phlebotomy
-myelosuppressive drugs
-radiation therapy
polycythemia vera: primary
uncommon disorder of increased RBC production
polycythemia vera: secondary
response to elevated erythropoietin levels...
-living in high altitude
-smoking
-COPD
aplastic anemia:
reduced bone marrow function (all three cell lines), caused by...
-genetic failure
-trauma to stem cells (radiation, chemo, antimicrobial, anticonvulsant,
antiinflammatory drugs)
bone marrow biopsy:
for blood dycrasias
-number, size, shape of RBC, WBC and platelet precursors
-site is posterior iliac crest or sternum
-no pre-procedure prep needed, area numbed with local anesthetic
-requires consent!
sickle cell trait and disease:
interpreting a CBC...
look at...
-WBC
-RBC
-Hgb
-Hct
interpreting a CBC with differential...
shows...
-neutrophils
-lymphocytes
-monocytes
-eosinophils
-basophils
-platelet count(s)
if H&H is low, the patient is _________________
anemic
analysis of anemia labs: step 1
determining the RBC size measured by the Mean Corpuscular Volume (MCV)
RBC size (MCV): low (<80)
patient has a small cell or microcytic anemia
RBC size (MCV): normal (80-100)
patient has a normal size cell or normocytic anemia
RBC size (MCV): high (>100)
patient has a very large cell or macrocytic anemia
analysis of anemia labs: step 2
look at how much hemoglobin is inside the cell
-this gives the cell its color (chromic) and is measured by the MCH and MCHC
amount of hemoglobin: normochromic
normal color & a normal MCHC (31-37 g/dl)
amount of hemoglobin: hypochromic
pale color and a low MCHC (below 31 g/dl)
analysis of anemia labs: step 3
look at the size of the cells in circulation
-size of cells in circulation is measured by the RDW (normal is 11.5-15%)
-small cells and pale cells go together!
analysis of anemia labs: step 4
look at the reticulocyte count
-normally we have 2% retics in the blood
-reticulocytosis is a normal response to anemia as the bone marrow will pump out
lots of young red blood cells (retics)
causes of microcytic/ hypochromic anemia:
-iron deficiency
,-thalassemia (genetic)
-plumbism (lead poison)
-sideroblastic (leads to leukemia)
-aluminum toxicity (unusual)
-G6PD (hemolytic anemia)
causes if normocytic/ normochromic anemia:
-anemia of chronic disease
-acute blood loss
-early iron deficiency
causes of macrocytic/ normocytic anemia:
-vitamin B12 deficiency
-folate deficiency
-pernicious anemia
type of anemia: iron deficiency anemia
poor absorption or excessive loss of iron
type of anemia: pernicious anemia
poor absorption of B12 due to absence of intrinsic factor
--> leads to low H&H, GI problems (gas), neuro symptoms
-must administer cobalamin (IM or intranasal)
type of anemia: aplastic anemia
bone marrow without erythroid, myeloid, megakaryocytic (platelet) cell lines
-xrays, some antibiotics, chemo (isolation pxns)
--> requires transfusions until bone marrow again produces cells
type of anemia: hemolytic anemia
as RBCs are destroyed, kidneys are taxed to get rid of cell byproducts and often
renal failure ensues
-bone marrow can't keep up with RBC loss
type of anemia: thalassemia
genetic disorder leading to inadequate hemoglobin production
type of anemia: sickle cell disease
chronic anemia characterized by "c" shaped cells causing painful joints --> receive
lots of pain meds!
-crisis is induced by: stress, cold temps, infection, hypoxic episodes
anemia: associated S/S
-hypotension
-tachycardia
-change of stool color
-splenomegaly
-skin paleness, yellowing eyes
-shortness of breath
-severe: may cause heart attack
, polycythemia vera:
over production of erythrocytes, leukocytes, platelets due to stem cell stimulation
-Hct > 55 (normal is 37-50)
-thick blood + large blood volume = organ congestion
polycythemia vera: S/S
-red complexion
-dizziness
-headache
-visual disturbances
-painful joints
polycythemia vera: treatment
-phlebotomy
-myelosuppressive drugs
-radiation therapy
polycythemia vera: primary
uncommon disorder of increased RBC production
polycythemia vera: secondary
response to elevated erythropoietin levels...
-living in high altitude
-smoking
-COPD
aplastic anemia:
reduced bone marrow function (all three cell lines), caused by...
-genetic failure
-trauma to stem cells (radiation, chemo, antimicrobial, anticonvulsant,
antiinflammatory drugs)
bone marrow biopsy:
for blood dycrasias
-number, size, shape of RBC, WBC and platelet precursors
-site is posterior iliac crest or sternum
-no pre-procedure prep needed, area numbed with local anesthetic
-requires consent!
sickle cell trait and disease:
