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4043687
Hematology Overview/Anemia
Description
Hematology/Anemia
No tags specified
hematology
anemia
anemic
0
Mind Map by
Devin Welke
, updated more than 1 year ago
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Created by
Devin Welke
almost 9 years ago
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Resource summary
Hematology Overview/Anemia
Blood cells
White Blood Cells
Neutrophils
Demargination
Infection, exercise, epinephrine, corticosteroids, sickle cell anemia
Margination
Malaria, viral infections, hemodialysis
Localize and kill microorganisms (primarily bacterial and fungal infections)
Neutropenia
Mild=ANC < 1500 Severe=ANC <500
Causes: medications (chemo, NSAIDs, anti-seizure, etc.), post-infection, autoimmune (lupus)
Tx: G-CSF (filgrastim-Neupogen, pegfilgrastim-Neulasta), GM-CSF (sargramostim-Leukine)
Leukocytosis
WBC > 11,000
Causes: physical/emotional (exercise, seizures, labor, pain, MI), infections, inflammation, tissue necrosis, drugs/toxins (CSF, epinephrine, corticosteroids, lithium, vaccines), chronic causes (persistent inflammation, infections, malignancies, smoking, etc.)
Monocytes/Macrophage
No monocyte reserve in marrow; slow turnover in blood
Functions: initiate immune response, phagocytosis, secrete monokines
Monocytosis > 800
Causes: infection (TB, histoplasmosis, toxoplasmosis, endocarditis), collagen vascular disease (RA, SLE), GI disorders (ulcerative colitis, alcohol liver disease), leukemia
Basophils
Basophilia
Causes: CML, viral infections, anemia
Lymphocytes
Lymphocytosis
> 4000
Causes: mono, pertussis, measles, chickenpox, CLL
Lymphopenia
< 1000
Causes: inflammatory disorders, uremia, lupus, TB, HIV
B lymphocytes
Memory cells-IgM
T lymphocytes
Natural Killer Cells
Destroy tumor cells without prior sensitization
Helper T Cells
CD4 cells stimulate B cell maturation and antibody production
Cytotoxic T Cells
CD8 cells attack intracellular pathogens and regulate size and duration of immune response
Eosinophil
IgE-allergy-Eosinophils
Parasites and worms
Eosinophilia
> 700
Causes: allergic reaction, parasite/fungal infections, neoplasms, GI disorders, granulomatous disorders
Red Blood Cells
Men = 5.2 Women = 4.6
Erythrocytosis=Polycythemia
Causes: increased epoetin (malignancies), hypoxia
Anemia
Men < 13 Women < 12
Causes: renal dysfunction (decreased epoetin), bone marrow replacement (fibrosis, tumors, etc.), hemesynthesis issues (decreased B12, folate, iron)
Causes
Decreased production
Destroyed RBC's are not replaced
Lack of nutrients (iron, B12, folate), bone marrow unable to produce (aplastic anemia, myelodysplasia, RBC aplasia), suppression of marrow do to drug, chemo, or radiation, reduction of hormones stimulating production (EPO, thyroid, androgens)
Increased destruction
Hemolytic anemia, drugs (phenobarbital, phenytoin, probenecid, methyldopa)
RBC loss
Trauma, menstrual flow, hematemesis, occult bleeding, iatrogenic bleeding (hemodialysis or blood donations)
Platelets
Thrombocytopenia
<150,000 <100,000 is a problem
Decreased production
Causes: idiopathic immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura
Increased destruction
Causes: chemical, radiation, chemotherapy, drugs (heparin/LMWH, valproic acid, SMZ-TMP, etc.), cancer, B12 or folate deficiency, splenomegaly
Thrombocytosis
> 450,000
Causes: myeloproliferative disease, inflammation/infection, reaction to increased destruction, hyposplenism, anemia
Laboratory Evaluation
Hemoglobin
Men 13.5-17.5 Women 12.0-16.0
Hematocrit
Men 41-53% Women 36-46%
Usually 3x Hgn
Mean Cell Volume (MCV)
Macrocytic
B12 and folate deficiency
Microcytic
Iron deficiency, thallassemia
Mean Cell Hgb Concentration (MCHC)
Hgb/Hct
Low = hypochromia
Iron
Ferric state (Fe3+)
non-absorbed form
Ferrous state (Fe2+)
absorbed form
Total Iron Binding Capacity (TIBC)
Indirect measure of iron binding capacity of transferrin
Low iron=high TIBC
% Transferrin Saturation (TSAT)
Iron/TIBC
Amount of iron readily available
Ferritin
Storage (liver, spleen, marrow)
Best indicator of iron deficiency or overload
Iron Deficiency Anemia
Causes: blood loss, decreased absorption
Low serum iron; Low ferritin; High TIBC; Low MCV; Low TSAT
Microcytic and hypochromic
150-200 mg elemental iron /day
Normocytic Anemia
Anemia of Chronic Disease (ACD)/ Anemia of Inflammation (AI)
Causes: underlying disease. Contributing factors: frequent blood sampling, surgical blood loss, decreased EPO production, reduced RBC life span without compensatory erythropoietic response, active bleeding, nutritional deficiencies
Treat underlying disease
Iron only effective if iron deficiency is present
Erythrocyte Stimulating Agent (ESA)
Macrocytic Anemia (Megaloblastic Anemia)
B12 or folate deficiency
B12 Deficiency
Need intrinsic factor to be absorbed
Pernicious anemia is the lack of intrinsic factor
Causes: acid suppressing agents (inhibit release from food), inadequate intake (strict vegans, chronic alcoholics), malabsorption syndromes (pernicious anemia, atrophic gastritis, stomach surgery), inadequate utilization (H. pylori, inflammatory bowel disease)
Increased MCV; hypersegmented neutrophil; decreased reticulocyte count; low Hct; low cobalamin levels; increased methylmalonic acid
Need high oral doses = 1000-2000 mcg/day
Folic Acid Deficiency
Causes: inadequate dietary intake, alcoholism, pregnancy (increased requirement), azathioprine, 6MP, 5FU, methotrexate, trimethoprim, triamterene, phenytoin, phenobarbital
Increased MCV; decreased folate; decreased RBC folate level
1 mg/day
Other causes: hydroxyurea, zidovudine, methotrexate, azathioprine, 6MP, reticulocytosis, aplastic anemia, red cell aplasia, bone marrow disorder, liver disease, hyperlipidemia, alcohol abuse
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