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What are the classifications of erythrocytosis?
- Absolute increase in RBC
- Polycythemia vera
- Secondary erythrocytosis
- Relative increase in RBC
- relative erythrocytosis
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Describe the etiology of polycythemia vera
- Primary disease of the bone marrow
- Unknown origin (idiopathic)
- Abnormal proliferation of pluripotential stem cells (the cells that give rise to both lymphoid and myeloid cells)
- Considered a neoplastic myeloproliferative disease
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neoplastic, myeloproliferative disease
- neoplastic: cancerous
- myeloproliferative disease: category of disease of bone marrow which causes excessive proliferation of pluripotent stem cell
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Describe the clinical features of Polycythemia vera
- Found in 50-70 year olds (more in males)
- Splenomegaly
- Hepatomegaly
- Headaches, dizziness, breathlessness
- Night sweats, weight loss, increased BMR
- clotting and bleeding in nose, gums
- Flushed, reddened complexion
- Gout
- Kidney failt
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Describe the laboratory findings of Polycythemia vera
- Viscous peripheral blood
- Increased RBC, WBC, and platelets
- NRBC (nucleatedRBC)
- poikilocytes, tear drop cells
- hypercellular bone marrow
- decrased erythropoietin
- RBC: 6.9x106/μL
- Hgb: 18-23g/dL
- Hct: >52% in women, >58% in men
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Describe the treatment and prognosis for polycythemia vera
- Routine phlebotomy (could result in chronic iron deficiency)
- myelosuppressive drugs (could cause acute leukemia if incorrectly administered)
- Mean survival rate is 10-20 years or longer with treatment; 1.5-3 years without
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Describe the etiology of secondary erythrocytosis (appropriate vs inappropriate)
- Increased erythropoietin stimulation of RBC precursors (only)
- *an appropriate reaction in response to hypoxia (eg lung and heart disease, live in high altitude)
- *an inappropriate increase (eg kidney tumors, endocrine disorders)
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Describe the laboratory findings of secondary erythrocytosis
- RBC are increased
- WBC and platelets are normal
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What is relative erythrocytosis? Alternate names? Etiology?
- A relative increase in RBC when compared to other cells (the hematocrit)
- AKA "Pseudo-polycythemia"
- Often seen in cases of burns, dehydration, vomiting, diarrhea
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What is anemia?
- Decrease in hgb and/or RBC mass
- Decrease in hct
- Inability of blood to provide adequate O2 to tissue
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What factors affect the diagnosis of anemia?
- Gender (female vs male)
- Age (young vs old)
- Geography (low vs high altitude)
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What are the clinical features of anemia?
- Fatigue
- Shortness of breath
- Headaches
- Pale lips and nailbeds
- Increase CO with palpitations
- Tachycardia
- Varied pulse rate
- Congestive heart failure may result
- Increased 2,3-DPG
- Increased erythropoeitin
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What are the etiological classifications of anemia?
- Iron deficiency
- Blood loss (menstruation, nose bleed, etc)
- Nutritional deficiency
- Hemolysis
- Metastatic bone marrow replacement (cancer metastizes for different locations, replaces marrow)
- Infections (of marrow)
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What are the morphological classifications of anemia?
- Microcytic, hypochromic anemias (RBC too small, lack of color; iron deficiency)
- Megaloblastic (macrocytic) anemias (RBC too big; B12 and folate deficiency)
- Normocytic, normochromic anemias (lack of RBC #)
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What are the laboratory methods in the diagnosis of anemia
- RBC count
- hemoglobin
- hematocrit
- RBC indices
- Peripheral blood smear
- reticulocyte count
- bone marrow smear, biopsy, and culture
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