Internal Medicine Hematology/Oncology

Physiologic anemia? - In pregnant women, RBC mass increases, but plasma volume increases to a greater extent This is physiologic dilutional anemia Reticulocyte count? - Reticulocytes are immature RBCs. Reticulocyte indicates whether effective erythropoiesis is occurring 2% (100,000 absolute) reticylocyte count implies RBC desctruction or blood loss. The bone marrow is responding appropriately. Lower than expected reticulocyte count implies erythrocyte underproduction due to: 1. deficient EPO (kidney disease) 2. Nutritional deficincies (iron, folate, B12) 3. primary RBC disorder (RBC aplasia) Appearance of reticulocytes on Wright Giemsa stain? - Larger than peripheral RBCs. Polychomasia (purple) due to increase ribonucleoproteina and RNA not present in mature RBCs. Corrected reticulocyte count? - Reticulocyte count * (pt. HCT/45) Corrected reticulocyte count 3% indicates good marrow response and suggests peripheral destruction Corrected reticulocyte count 3% indicates poor marrow response and indicates underproduction Anisocytosis, poikilocytosis? - Anisocytosis - heterogenous RBC size Poikilocytosis - heterogenous RBC shape Pica? - Craving for ice or other unusual substances Indicative of iron deficiency anemia Causes of iron deficiency anemia? - Pre menopausal women - menstruation, pregnancy! pregnancy increases iron demand Men - GI loss (peptic ulcer disease) other causes: Breast feeding (no iron in human breast milk) Celiac disease - malabsorption of iron in duodenum Lack of dietary iron (meat derived foods) Gastrectomy / PPI/ H2 blockers (HCl acid aids in iron absorption by maintaining Fe2+ state, which is more readily absorbed then Fe3+). Most useful test in evaluating iron deficiency? - Serum ferritin Treatment for iron deficiency anemia? - oral Ferrous sulfate 325 mg 3x/day Treatment of anemia of chronic disease? - Treatment of underlying disease