Anaemia Additional tests
Irons tests which include serum iron, iron transferrin, iron ferritin and total iron binding capacity, this is because iron deficiency is a leading cause of microcytic hypochromic anemia because the body needs iron to form normal red blood cell. A peripheral blood film is also ordered to determine the size, shape and color of the red blood cells and this helps in the classification of anemia in either microcytic, macrocytic or normocytic (“Iron Tests | Lab Tests Online”, 2020). A reticulocyte count can also be ordered to determine the number of new immature red blood cells produced by the bone marrow with the aim of investigating if the bone marrow is the area of the body affected bringing about the anemia (“How Is Anemia Diagnosed?”, 2020). Hemoglobin electrophoresis is done to analyses the type of hemoglobin the patient has and in turn help determine the type of anemia for instance a patient with Hb S can be classified as a sickle cell patient (“Anemia – Diagnosis and treatment – Mayo Clinic”, 2020). vitamin B9 and B12 levels are also analyzed since a deficiency in either or both causes megaloblastic anemia. The doctor may also order a stool test to check for occult or overt blood which indicate intestinal bleeding due to peptic ulcers or celiac disease.
Microcytic, normocytic and macrocytic anemia
Microcytic anemia is defined as red blood cells that are of a smaller size than the normal red blood cell. On a full blood count, it is suspected when the mean corpuscular volume (MCV) falls below 80fl (“Everything You Need to Know About Microcytic Anemia”, 2020). Macrocytic anemia is defined as red blood cells that are of a larger size than a normal red blood cell and they measure above 100fl MCV value on full blood count. Normocytic anemia is defined as red blood cells that are of similar size to a normal red blood cell that is their MCV value falls within the normal range (80-100fl) but it has both low hematocrit and low hemoglobin level on a full blood count chart (Brill & Baumgardner, 2020). The client is most likely suffering from a microcytic anemia due to the low value of MCV (76FL), high RDW (20.5%) plus a low hemoglobin and hematocrit levels.
Physiology
An anemic patient has either red blood cells levels that are lower than normal which means that his hemoglobin levels are also low or defective hemoglobin , in such a condition the oxygen supply throughout the body is greatly impaired since it completely depends on the binding ability of the hemoglobin (Pittman, 2020). The body adjusts in various ways to this anemic condition, there will be an increased perfusion by the capillaries with the aim of maintaining perfusion to the tissues, there will be a vasoconstriction of the arteries plus a fall in their viscosity in response to a decrease in hematocrit the net effect is an increase in blood flow and with it oxygen supply, this changes will cause a fall on venous oxygen but since oxygen in the arteries is still normal this change will not be picked up by respiratory chemoreceptors hence a respiratory response won’t solve the problem.
The extraction of oxygen by tissue will increase significantly especially is tissue such as the kidney and the skin. In patients with chronic anemia there will be a shift in the oxygen dissociation curve which will shift to the right which implies that hemoglobin affinity for oxygen is decreased (Keywords et al., 2020).The patients cardiac output will also be redistributed in that it will target areas of the body where there is high oxygen extraction ratio.
References
How Is Anemia Diagnosed?. HOA – Hematology-Oncology Associates of CNY. (2020). Retrieved 2 June 2020, from https://www.hoacny.com/patient-resources/blood-disorders/anemia/how-anemia-diagnosed#:~:text=Often%2C%20the%20first%20test%20used,carries%20oxygen%20to%20the%20body.
Iron Tests | Lab Tests Online. Labtestsonline.org. (2020). Retrieved 2 June 2020, from https://labtestsonline.org/tests/iron-tests.
Anemia – Diagnosis and treatment – Mayo Clinic. Mayoclinic.org. (2020). Retrieved 2 June 2020, from https://www.mayoclinic.org/diseases-conditions/anemia/diagnosis-treatment/drc-20351366.
Everything You Need to Know About Microcytic Anemia. Healthline. (2020). Retrieved 2 June 2020, from https://www.healthline.com/health/microcytic-anemia.
Maner, B., & Moosavi, L. (2020). Mean Corpuscular Volume (MCV). Ncbi.nlm.nih.gov. Retrieved 2 June 2020, from https://www.ncbi.nlm.nih.gov/books/NBK545275/.
Brill, J., & Baumgardner, D. (2020). Normocytic Anemia. Aafp.org. Retrieved 2 June 2020, from https://www.aafp.org/afp/2000/1115/p2255.html.
Pittman, R. (2020). Oxygen Transport in Normal and Pathological Situations: Defects and Compensations. Ncbi.nlm.nih.gov. Retrieved 2 June 2020, from https://www.ncbi.nlm.nih.gov/books/NBK54113/.
Keywords, A., Keywords, I., Keywords, M., Voices, E., Month, A., & Expert, A. et al. (2020). Anemia compensation. Openanesthesia.org. Retrieved 2 June 2020, from https://www.openanesthesia.org/anemia_compensation/.