Anemia Review PDF

L25 Review of non-infectious vasculitis Granulomatosis With Polyangiitis (GPA) Anemia Previously called Wegener granulomatosis, GPA is a necrotizing vasculitis characterized by a triad of: PASG 61310 Pathophysiology I L26 April 2nd Spring 2024 Ithaca College, Physician Assistant Program Dr. Elena Mu...

L25 Review of non-infectious vasculitis Granulomatosis With Polyangiitis (GPA) Anemia Previously called Wegener granulomatosis, GPA is a necrotizing vasculitis characterized by a triad of: PASG 61310 Pathophysiology I L26 April 2nd Spring 2024 Ithaca College, Physician Assistant Program Dr. Elena Mueller, PhD Acute necrotizing granulomas of the upper respiratory tract (ear, nose, sinuses, throat) or the lower respiratory tract (lung) or both Necrotizing granulomas and pauci-immune vasculitis affecting small- to medium-sized vessels (e.g., capillaries, venules, arterioles, and arteries), most prominent in the lungs and upper airways but affecting other sites as well Focal necrotizing, often crescentic, glomerulonephritis CSS=now called eosinophilic granulomatosis with polyangiitis (EGPA) GPA/WG Previously called Wegener granulomatosis CSS PAN L25 Review of non-infectious vasculitis Hematopoiesis o development of the formed elements of blood from bone marrow stem cells. o Cells below the horizontal line are found in normal peripheral blood. o The principal cytokines that stimulate each cell lineage to differentiate are shown. CSF: colony-stimulating factor GM-CSF: Granulocyte-macrophage colonystimulating factor EPO: erythropoietin G: granulocyte IL: interleukin M: macrophage SCF: stem cell factor TPO: thrombopoietin NK cells? Hematology Reticulocytosis An increase in circulating RETICULOCYTES, a signs of accelerated ERYTHROCYTE production Hematology Normal cells in peripheral blood. A, Erythrocyte (red blood cell); B, neutrophil (segmented); C, neutrophil (banded); D, eosinophil; E, basophil; F, lymphocyte; G, monocyte; H, platelet. The physiologic regulation of red cell production by tissue oxygen tension Anemia ´Anemia is defined as a reduction of the total circulating red cell mass below normal limits. ´Anemia reduces the oxygen-carrying capacity of the blood, leading to tissue hypoxia. ´In practice, the measurement of red cell mass is not easy, and anemia is usually diagnosed based on o a reduction in the hematocrit (the ratio of packed red cells to total blood volume) and o the hemoglobin concentration of the blood to levels that are below the normal range. ´These values correlate with the red cell mass except when there are changes in plasma volume caused by fluid retention or dehydration. Ø The etiology of anemia depends on whether the anemia is o hypoproliferative (corrected reticulocyte count 2%) Ø The most useful of these indices are as follows: Ø Anemias are further divided by red cell size (assessed through visual inspection of peripheral smears) ´Mean cell volume, MCV: the average volume of a red cell expressed in femtoliters (fL) o normocytic (MCV 80-100 fl) o microcytic (MCV100 fl) Ø degree of hemoglobinization, reflected in the color of red cells o normochromic ´Mean cell hemoglobin concentration: the average concentration of hemoglobin in a given volume of packed red cells, expressed in grams per deciliter (g/dL) o hypochromic Ø shape o Poikilocytosis (variation in shape) o Anisocytosis (variation in size) ´Red cell distribution width: the coefficient of variation of red cell volume Other red cell indices are determined in clinical laboratories with special instrumentation. Some Laboratory Terms Ø Ø Red blood cell count (RBC) o Number of red blood cells per microliter of blood o Expressed as # X 106 cells/µL Hemoglobin (Hgb) o Amount of hemoglobin in 100 ml of blood o Expressed in grams/dL Ø Hematocrit (Hct) o measures the volume of packed red blood cells (RBC) relative to whole blood o % (Packed cell volume/total volume of blood) Ø Mean Corpuscular Volume (MCV) o Measure of the average volume of a red blood cell o Expressed as femtoliters (fL) Ø Red Blood Cell Distribution Width (RDW) o Reflects the variation in size of the red blood cells o (RDW-SD)/(MCV)×100; expressed as % o Normal range 12–15% Ø Total Iron Binding Capacity (TIBC) o Amount of iron that can be bound by transferrin o Expressed in µg/dL Ø Reticulocyte Count o Number of young red blood cell precursors o Expressed as % Some Laboratory Terms Ø Mean corpuscular hemoglobin (MCH) o The average hemoglobin content (weight) in a red blood cell o Expressed as picograms/cell (pg/cell) Ø Mean corpuscular hemoglobin concentration (MCHC) o The average hemoglobin concentration per red blood cell o Expressed in g/dL poikilocytosis = variation in shape anisocytosis = variation in size Normal blood smear (Wright stain). High-power field showing normal red cells, a neutrophil, and a few platelets Definition of Anemia o The reduction of circulating erythrocyte and/or serum hemoglobin concentration Sex Hemoglobin Hematocrit Male