Anemia - Pathophysiology I - Lecture 1 (1)

Hemoglobin hgb hematocrit hct mean corpuscular volume

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Hemoglobin (Hgb) Hematocrit (Hct) Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin Concentration (MCHC) Reticulocyte Count Folate Vitamin B-12 4.0 – 5.0 x 10 6 (female) 4.6 – 6.0 x 10 6 (male) 12.1 – 15.1 (female) 13.8 – 17.2 (male) 36.1 – 44.3 (female) 40.7 – 50.3 (male) 80 – 97.6 31-37 0.5 – 2.5 (female) 0.5 – 1.5 (male) 3.6 - 30 200-800 /mm3 /mm3 g/dL g/dL % % fL g/dL % % ng/ml ng/l *Extracted from the Adult Normal Ranges for Laboratory Studies – Quick List
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SERVICE LEARNING SERVICE LEARNING IPPE - CASE SCENARIO IPPE - CASE SCENARIO QA is a 88 yo WF who presents to the Philadelphia senior center. She is complaining of progressive pale skin color and worsening headache. She turns to you and ask – Am I anemic?
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SERVICE LEARNING SERVICE LEARNING IPPE - CASE SCENARIO IPPE - CASE SCENARIO How would you assess if QA is anemic? How would you assess if the anemia is normo-, micro-, or macrocytic?
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ANEMIA ANEMIA CLASSIFICATIONS CLASSIFICATIONS Morphology Mean Corpuscular Volume (MCV) Microcytic (Smaller than normal size RBCs) Normocytic (Normal size RBCs) Macrocytic (Larger than normal size RBCs) Mean Corpuscular Hemoglobin Concentration (MCHC) Hypochromic Normochromic
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ANEMIA ETIOLOGIES
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Clinical case #1 Clinical case #1 TD is a 75 yo AAF who presents to his primary care physician (PCP) complaining of general fatigue, dyspnea, dizziness and runny nose. PMH : osteoporosis, gastritis, and seasonal allergies Current meds: Ranitidine 150mg BID, and loratadine 10mg daily, Calcium 1000mg BID and vitamin D 800IU daily Vitals : BP 100/78 mmHg, HR 92 bpm, RR 16 bpm
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Clinical case #1 Clinical case #1 ROS : Denies BRBPR and hematuria CBC : WBC - 12.3X 10 6 /mm 3 Hemoglobin (Hgb) - 9.2 g/dL Hematocrit (Hct) – 27.5% Platelets – 221,000 Laboratory blood work : RBC 4.5 X 10 6 /mm 3 Reticulocyte count 1.2% MCV 65 fL MCH 24 pg MCHC 27 g/dL
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CLINICAL SCENARIO #1 CLINICAL SCENARIO #1 Is TD anemic? Which of TD’s symptoms are consistent with anemia? What type of anemia should you suspect based on the blood work findings?
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Nutritional deficiency anemia Iron deficiency Folic acid deficiency Vitamin B 12 deficiency
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Iron Deficiency Anemia Epidemiology ~ 500 million people worldwide ~1-2% of adults in the U.S. Most common nutritional deficiency related anemia At risk populations: Children < 2 years Adolescent girls Pregnant women Elderly > 65 years
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Iron deficiency anemia ETIOLOGY – IDA Inadequate dietary intake Decreased absorption Increased demands Blood loss
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DIETARY IRON INTAKE Daily requirements RDA > infants, toddlers, and females Absorption: 0.5-1.5mg/day ~ 5-10% of elemental iron is absorbed Food sources Meat, liver, eggs, spinach, dried nuts, fortified cereals Inadequate Intake Limited in meat or fresh fruits (i.e. alcoholism)
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LABORATORY FINDINGS Peripheral Smear: RBCs are placed on a microscope slide, stained and viewed Microcytic Hypochromic Laboratory findings (blood sample): Low MCV lab value Low MCHC lab value
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IRON STUDIES Iron studies will identify the severity of IDA Serum Iron Serum iron bound to transferrin (plasma protein) Total Iron Binding Capacity
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