FHEA - Hematologic Disorders
Anemia - Answer -A complex of signs and symptoms characterized by decreases in numbers of RBCs or
Hb content caused by blood loss, deficient erythropoiesis, excessive hemolysis, or a combination of
these changes
*Anemia only occurs when insult is severe enough to disturb normal homeostatic mechanisms and
exceed reserves*
4 components necessary for RBC formation - Answer -1. Functional erythropoietin (hormone)
mechanism: source 90% renal, 10% hepatic. (erythropoietin supply is diminished in advancing renal
failure, usually beginning when GFR <49 mL/min.
2. Uncompromised DNA synthesis: impaired by chronic inflammation (ex. autoimmune disorders
including SLE, RA, and chronic infection). Reversible when inflammation tx.
3. Hemoglobin synthesis unimpaired by lack of iron, vitamin or globin production: need iron, B vitamins,
vitamin C, protein and others
4. Intact marrow microenvironment - revealed in production of reticulocytes (N 1-2% of total RBC).
Reticulocytosis = body working to correct anemia. Absence of reticulocytosis or presence of
reticulocytopenia = inadequate bone marrow response.
Causes of anemia: Blood loss
What are some primary care causes and corresponding questions you'd ask? - Answer -Clinically
significant = 1 L sudden, as little as a few mL/d for chronic
, Causes: miscarriage, erosive gastritis, menorrhagia, GI malignancy. Are you bleeding from your rectum,
vagina, are you throwing up blood?
Causes of anemia: Premature destruction of RBC
Normal lifespan of RBC? - Answer -Hemolysis - shortened RBC lifespan (<90 d)
Normal = 90-120
Part of mechanism of ACD
CBC Evaluation of Anemia: which 7 lab values to look at - Answer -Hb, Hct, and RBC count - values should
be proportionately decreased (normal H&H ratio 1:3)
Cell size: MCV (microcytic=<80 fL, normocytic 80-96 fL, macrocytic >96 fL)
Hb content: Mean cell hb (MCH), mean cell hb concentration (MCHC) - hb gives cell color (-chromic)
Hypochromic = pale = MCHC <31 g/dL
RBC distribution width (RDW): an index of variation of RBC size. >15% = new cells differ in size (larger or
smaller) when compared with older cells. One of earliest signs of evolving micro or macro anemia.
Reticulocyte percentage - 1-2% N. NL response to anemia is reticulocytosis (>2%).
What type of Anemia? Most common etiologies?
- Decreased Hg, Hct and RBC. Normocytic (MCV =80-96 fL), normochromic anemia with NL RDW
MCV=NL
MCHC=NL
Anemia - Answer -A complex of signs and symptoms characterized by decreases in numbers of RBCs or
Hb content caused by blood loss, deficient erythropoiesis, excessive hemolysis, or a combination of
these changes
*Anemia only occurs when insult is severe enough to disturb normal homeostatic mechanisms and
exceed reserves*
4 components necessary for RBC formation - Answer -1. Functional erythropoietin (hormone)
mechanism: source 90% renal, 10% hepatic. (erythropoietin supply is diminished in advancing renal
failure, usually beginning when GFR <49 mL/min.
2. Uncompromised DNA synthesis: impaired by chronic inflammation (ex. autoimmune disorders
including SLE, RA, and chronic infection). Reversible when inflammation tx.
3. Hemoglobin synthesis unimpaired by lack of iron, vitamin or globin production: need iron, B vitamins,
vitamin C, protein and others
4. Intact marrow microenvironment - revealed in production of reticulocytes (N 1-2% of total RBC).
Reticulocytosis = body working to correct anemia. Absence of reticulocytosis or presence of
reticulocytopenia = inadequate bone marrow response.
Causes of anemia: Blood loss
What are some primary care causes and corresponding questions you'd ask? - Answer -Clinically
significant = 1 L sudden, as little as a few mL/d for chronic
, Causes: miscarriage, erosive gastritis, menorrhagia, GI malignancy. Are you bleeding from your rectum,
vagina, are you throwing up blood?
Causes of anemia: Premature destruction of RBC
Normal lifespan of RBC? - Answer -Hemolysis - shortened RBC lifespan (<90 d)
Normal = 90-120
Part of mechanism of ACD
CBC Evaluation of Anemia: which 7 lab values to look at - Answer -Hb, Hct, and RBC count - values should
be proportionately decreased (normal H&H ratio 1:3)
Cell size: MCV (microcytic=<80 fL, normocytic 80-96 fL, macrocytic >96 fL)
Hb content: Mean cell hb (MCH), mean cell hb concentration (MCHC) - hb gives cell color (-chromic)
Hypochromic = pale = MCHC <31 g/dL
RBC distribution width (RDW): an index of variation of RBC size. >15% = new cells differ in size (larger or
smaller) when compared with older cells. One of earliest signs of evolving micro or macro anemia.
Reticulocyte percentage - 1-2% N. NL response to anemia is reticulocytosis (>2%).
What type of Anemia? Most common etiologies?
- Decreased Hg, Hct and RBC. Normocytic (MCV =80-96 fL), normochromic anemia with NL RDW
MCV=NL
MCHC=NL
