Anemia - Laboratory work-up introduction

Diagnosing anemia doesn't have to be hard! You can do it!
This video is an introduction to the concepts that you need in order to diagnose anemia in your clinical rotations.

I hope it helps you. If you have suggestions, send me a comment. Otherwise... Good luck in school!!

After a quick intro, I'm going to talk about red blood cells, then young red blood cells, also called reticulocytes.
Then some calculations that we do to correct for the reticulocyte count, called the Reticulocyte Index, the Reticulocyte Production Index.
And then I'll jump into kind of an overview about diagnosing anemia and the two major approaches: the Kinetic Approach and the Morphologic Approach, okay? Let's do it.
All right, dudes and dudettes, anemia work up is pretty common in your clinical rotations, whether it's in the hospital or in the, like the family medicine clinic.
You're gonna need to know it.
You're gonna see it several times, and so, it's high yield.
Also, if you don't really know the CBC or the complete blood count, go check out that video first, because you need to understand the CBC in order to do an anemia work up.
What the heck is anemia? Well, strictly defined, it is a decrease in the total number of red blood cells, or a reduction in the total red blood cell mass compared to what's normal by blood volume studies.
However, a blood volume study is slow and expensive, so what you're going to see in practical use, is you're going to get a CBC and you're going to look at the hemoglobin and the hematocrit.
There's all kinds of things that cause anemia and often times, when you see a person with anemia they are sick in a lot of different ways.
And so, there's often multiple factors that contribute to their anemia, but that's not how I'm going to teach it here.
I'm just gonna teach it as if each cause is the only cause.
Okay, that's just how you have to learn it.
Commonly, blood loss and iron deficiency anemia are at the top of the list.
You're gonna see those quite a bit.
Also B12 and folate deficiencies, or nutritional deficiencies, and then anemia of chronic disease and anemia of kidney disease are also pretty common.
Next up let's talk about a few things to set the foundation or the scaffolding that you can build on to understand anemia and how we work it up.
And I'm gonna do that by covering a couple of basics.
If this is too basic for you, you can skip past it, that's no problem.
I want to kind of talk just a minute about red blood cells.
Red blood cells live about 100 to 120 days in your system, okay? That means that you need to replace about 1/100th or 1/120th of your red blood cells every single day.
The production of red blood cells is called erythropoiesis and it occurs in the bone marrow from stimulation by a hormone called erythropoietin, which is made in the kidneys.
And if you'll remember, I said one of the common causes of anemia is kidney disease and this is why.
That the hormone that stimulates the production of red blood cells is made in the kidneys.
So the kidneys aren't happy, they're not making that hormone.
Also, healthy bone, with all of the required substrates that it needs to make red blood cells, can make up to five times more red blood cells than you need or that you lose from daily losses, okay? That's quite a bit more.
You have the ability to produce 500% more than you lose daily, but what would that look like? Well, I guess you would see a lot of immature blood cells floating around, right? If you started making five times more red blood cells, well there'd be a lot of young juvenile or immature blood cells floating around.
That makes sense, right? Yeah it does and those are called reticulocytes, or immature red blood cells.
Under the microscope, you can tell the difference between a reticulocyte or an immature red blood cell, because they are slightly larger than their more mature elder brothers or sisters, and also they have some intracellular structures or fragments of ribosomal RNA still visible with inside them.
This is called polychromasia.
Makes sense so far? Okay, what about this? If the reticulocytes took about a day to mature and we know that we lose about 1% of our red blood cells per day, what do you think the normal percentage of reticulocytes in your blood would be? You got it. About 1%.
We should see about 1% reticulocytes for a given number of red blood cells, okay? Following that logic, what would you think if I told you that you had a normal hemoglobin and a normal hematocrit, but you had a very high reticulocyte count? What would that suggest mathematically? Well, it would suggest that the lifespan of your red blood cells was somehow shorter than 100 days.
If you had, I don't know, 5% reticulocytes, that would suggest that you have to replace 5% of your red blood cells per day.
Meaning that you're losing 5% of your red blood cells per day to maintain your normal hemoglobin and hematocrit.

Видео Anemia - Laboratory work-up introduction канала Med Immersion