Question

1. Explain why a 30-year-old female who smokes a pack of cigarettes a day and lives in the Rocky Mountains can be diagnosed with anemia when her hemoglobin is 12 g/dL (reference range for Hgb: 12-16 g/dL).

2. What laboratory test is the least invasive and most cost effective to evaluate erythrocyte production in the presence of anemia?

3. Explain why classification of anemia is important, and give the categories of the morphologic and functional classifications.

4. A patient's iron studies revealed serum iron 100 mcg/dL and TIBC 360 mcg/DL. Calculate the percent saturation and UIBC. Are these values normal or abnormal?

5. How does the peripheral blood picture in anemia of chronic disease (ACD) differ from that seen in iron deficiency anemia (IDA)?

Answer 1

1. There are two factors that cause increased oxygen carrying capacity, they are smoking and living in a high altitude. The normal hemoglobin count for a female is 12 - 16 g/dL. Smoking causes upward shift of hemoglobin distribution curve, these causes reduction in chances of detecting anemia. Increae in hemoglobin in smokers mediated by exposures to carbon monoxide. Smoking deprives the bone marrow of oxygen. In high altitudes also the amount of hemoglobin increases, to substitute the decresed oxygen supply, so the people who live in high altitudes and who smokes generally shows high hemoglobin levels. In these patient it is showing as border line even though shez living in high altitude and a smoker, so she would be anemic.
2. Erythropoietin (EPO) test.it is a hormone, place a key role in production of RBC's. It helps to diagnose anemia , decrease or abnormal production of RBC. To test a blood sample is drawn from the vein.
3. Classification of anemia is very important because there is a variety of causes for anemia or reduced RBC levels in blood. The treatment according to the cause only will cure the anemia, thrre will be more serious diseases behind the anemia.

Morphologic classification:

• Microcytic anemia : MCV < 80fL example:iron deficiency anemia, anemia of chronic disease, globin deficiency thalassemia, sideroblastic anemia
• Macrocytic anemia : MCV > 100fL example:megaloblastic anemia, non megaloblastic anemia.
• Normocytic anemia : MCV 80- 100fL example:hemolytic anemia, bone marrow suppression

Fuctional classification

• Hypoproliferative : erythropoietin, iron lack ,marrow damage
• Infective : macrocytic , normocytic, microcytic
• Hemolytic : rephagocytosis, pigmentation, intravascular hemolysis

4. Percentage saturation PS = (serum iron ÷ TIBC )× 100

• Serum iron = 100 mcg d/L
• TIBC = 360 mcg d/L

PS = (100÷360) ×100 = 27.7 %

Normal level of transferrin satiration

UIBC = TIBC - serum iron

TIBC = 360 mcg d/L

serum iron = 100 mcg d/L

UIBC = 360 - 100 = 260 mcg d/L

260 mcg d/L = 46.57 micromol/L

So it is in normal range

5. Peripheral blood picture in Anemia of Chronic Disease (ACD) is norma , because it has normal neutrophils and lymphocytes . This is normochromic normocytic anemia

Peripheral blood picture of iron deficiency anemia (IDA) shows microcytic , hypochromic RBC's