Академический Документы
Профессиональный Документы
Культура Документы
Anemia:
Diagnosis and Clinical
Considerations
1
1. Study Questions
2. Homework
Assignment
3. Exam for Unit III
2
Anemia: Diagnosis and Clinical
Considerations
InChapter 4, you will learn how
anemia is diagnosed using different
classification systems. You will also
see how anemia affects an individual's
physiology and how the body tries to
compensate for the anemia.
Laboratory tests used to diagnose
anemia are discussed. Finally, you
will learn the normal ranges for each
parameter of a CBC and how to
calculate the red blood cell indices. 3
Definition of Anemia 1 of 2
Nutritionaldeficiencies
Hemolytic disorders
Blood loss
Bone marrow (hypoproliferative)
Infection
Toxicity
Hemopoetic stem cell damage
(maturation disorder)
Heredity or acquired defect
Unknown
8
RBC and Hemoglobin
Production 1 of 2
In healthy individuals, about 1% of RBCs lost
daily. Bone marrow continuously produces
RBCs to equal daily loss. Reticulocyte count
is a lab measurement of this loss. Normal
retic count is 0.5-2.0% of circulating RBCs.
Replacement requires functioning bone
marrow, normal RBC maturation and ability
to release mature RBCs to peripheral blood.
Proper nutrition required (B12, Folate). Also
requires normal hemoglobin synthesis.
9
RBC and Hemoglobin
Production 2 of 2
Severe anemia (<7 Hb) may see other organ
system failures: Cardiac and respiratory.
Do have compensatory mechanism: See an
increase in 2,3-DPG levels which results in
an increase in RBCs oxygen carrying
capacity.
Erythropoietin levels (Epo) useful diagnostic
tool. Anemic people usually respond by
increasing erythropoietin levels.
Erythropoietin is a hormone produced in the
kidney. Levels of erythropoietin varies with
oxygen tension in kidney tissues ( Oxygen
- Epo, and vice versa) 10
Clinical Diagnosis
13
Functional
Classification of Anemias
15
Clinical
Classification of Anemias
16
Quantitative
Classification of Anemias
Quantitatively by:
Hematocrit
Hemoglobin
Blood cell indices
Reticulocyte count
17
Hemoglobin and Hematocrit
1 of 2
20
MCV
Mean cell volume
MCV is average size of RBC
MCV = Hct x 10
RBC (millions)
If 80-100 fL, normal range, RBCs considered
normocytic
If < 80 fL are microcytic
If > 100 fL are macrocytic
Not reliable when have marked anisocytosis
21
MCH
22
MCHC
MCHC is average hemoglobin
concentration per RBC
MCHC = Hgb x 100
Hct (%)
If MCHC is normal, cell described as
normochromic
If MCHC is less than normal, cell
described as hypochromic
There are no hyperchromic RBCs
23
RDW
Advantages:
Most forms of hemoglobin are measured
Sample can be directly compared with a
standard
Solutions are stable
Method is precise
Errors in the measurement of Hgb:
Must draw and handle specimen correctly
Reagents must be properly prepared and
stored
Equipment failure 30
Hct
(In the Diagnosis of Anemia) 1 of 3
Problems
in measurement of
hematocrits include:
Incorrect centrifuge calibration
Choice of sample site
Incorrect ratio of anticoagulant to blood;
Improper amount of blood drawn
Reading errors
33
RBC Indices
(In the Diagnosis of Anemia) 1
of 2
35
Peripheral Blood Smear
(In the Diagnosis of Anemia)
Very useful in diagnosing and
classifying anemias
Look for:
Neutropenia
Thrombocytopenia
Hypochromia
Size and shape of RBCs
Unusual leukocytes (hypersegmentation)
Red cell inclusions: basophilic stippling,
Howell-Jolly bodies
36
Reticulocyte Count
(In the Diagnosis of Anemia)
38
Other Tests
(In the Diagnosis of Anemia)
Hemoglobin Electrophoresis
Antiglobulin Testing
Osmotic Fragility
Sugar Water Test
Hams Test
RBC Enzymes
B12, Fe, TIBC, Folate Levels
39