Anemia 1 Flashcards
primary driver of red cells
erythropoietin
where is epo produced
kidneys
stimulants for epo production
decreased o2 tension
kidney, lung, heart problems
other things used in rbc production
iron, folate, b12
t/f anemia is a decrease in red cells
false, decrease in hemoglobin causing decreased oxygen carrying capacity of blood
who standard for anemia
< 13.0 g/dl in males
< 12.0 g/dl in females
first step in classification of anemia
get cbc and reticulocyte count
indexes in anemia
index < 2.5: red cell morphology, hypoproliferative
index >/= 2.5: hemolysis/hemorrhage
types of morphology pathologies
normocytic normochromic = marrow damage (aplasia, aplastic anemia), iron deficiency in early stages, decreased stimulation (kidney disease)
microcytic = cytoplasmic defects
macrocytic = nuclear defects
causes for hemolysis or hemorrhage
blood loss, intravascular hemolysis or destruction of red cells, membrane abnormality or hemoglobinopathy
causes for microcytic, hypochromic anemia (hypoproliferative anemia)
iron deficiency anemia thalassemia (not always) myelodysplastic syndromes (sideroblastic anemia)
causes for macrocytic anemia (hypoproliferative anemia)
vitamin b12, folate deficiency drug toxicity myelodysplastic syndrome (refractory anemia)
causes for normocytic, normochromic anemia
myelopthisis (marrow infiltration/fibrosis)
anemia of inflammation
anemia of chronic renal disease
aplastic anemia
causes of proliferative anemias
acute blood loss
hemolysis (toxin-induced, autoimmune, paroxysmal nocturnal hemoglobinuria)
most common form of anemia worldwide
iron deficiency anemia
who are at risk for iron deficiency anemia
pregnant women
growing children and teenage girls
normal values for checking iron deficiency
serum ferritin 60 mcg/l
transferrin saturation 35%
hemoglobin >120 g/l in females, >130 g/l in males
stage of iron depletion
- depleted iron in ferritin, hemosiderin, or reticuloendothelial cells
- decreased serum ferritin (<15 mcg/l)
- normal hemoglobin
stage of iron deficient erythropoiesis
- low serum ferritin (<15) and transferrin saturation (<15)
- normal hemoglobin (can still make rbc)
stage of iron deficiency anemia
- no more stores, and no more in transport
- hemoglobin, transferrin, and ferritin are low
best test used to detect iron deficiency
serum ferritin
t/f the daily diet has 10-20mg of iron, and we absorb only 1-2 mg of iron
true
___ mg of iron is lost in a day because of desquamation of epithelium
1-2 mg
iron is obtained from _____ to make new red cells
old senescent red cells
breakdown of iron use
75: erythropoiesis
10-20% in liver and heart via ferritin
5-15% others
t/f iron has no physiologic excretion mechanism
true
causes of iron deficiency
increased demand for iron
increased iron loss
decreased iron intake or absorption
causes of increased demand for iron
rapid growth in infancy or adolescence
pregnancy
epo therapy
causes for increased iron loss
chronic blood loss (females: gyne conditions, males: occult bleeding)
menses
acute blood loss
blood donation
phlebotomy as treatment for polycythemia vera
common cause of iron deficiency in males and post-menopausal females
gi bleed unless proven otherwise (common ulcer or bleeding mass)
needed diagnostic test for elderly patients with blood loss
gastroesophagealduodenoscopy
or colonoscopy
___ are also at risk for iron deficiency
patients who regularly donate blood
causes for decreased iron intake or absorption
inadequate diet
malabsorption from disease (sprue, crohn’s disease)
malabsorption from surgery (gastrectomy and bariatric surgery)
acute or chronic inflammation
wounds at the angle of the mouth
angular cheilitis
spooning of the nails
koilonychia
eating disorder where patient craves for unusual things
pica
common lab pattern in iron deficiency anemia
low serum ferritin (<20)
low serum iron
elevated tibc (>400)
gold standard for iron deficiency anemia diagnosis
demonstrating that bone marrow no longer has iron
- bone marrow exams are not required for all patients
t/f serum iron is initially low in negative iron balance and decreases as disease progresses
false, initially normal in negative iron balance
t/f total iron binding capacity is low in iron deficiency anemia
false, it’s elevated because transferrin still has a large capacity for iron to be transported
best treatment for very symptomatic patients of iron deficiency anemia
transfusion to immediately correct the symptoms
iron deficiency anemia treatment with patients without or with bearable symptoms
tablets of ferrous sulfate, ferrous gluconate, or ferrous fumarate
at least 300 mg of elemental iron per day
best taken without food and with something acidic, once a day
side effects of iron tablets
bloatedness, abdominal pain, nausea, vomiting, constipation, black tarry stools
iron deficiency anemia treatment for patients with ckd or unbearable side effects
iv iron (iron dextran/sucrose/ carboxylase) - adverse effects: anaphylaxis, tattoo
dietary advise for patients with iron deficiency anemia
intake of food rich in iron (red meat, liver, vegetables, limit intake of tea)
composition of hemoglobin
2 alpha subunits, 2 beta subunits
consequences of malformed hemoglobin
inefficient in transporting oxygen -> hold on to oxygen -> negatively affects tissue perfusion
alpha vs beta thalassemia
alpha = dont make enough adult hemoglobin with a chains beta = dont make enough adult hemoglobin with b chains
product when only producing a and gamma chains
hgbf
what happens to pure a chains
precipitation –> destruction of rbc precursors or hemolysis causing splenomegaly
effects of anemia (thalassemia)
- more epo produced
- bone marrow produces more blood
- marrow expansion
- bone deformity, increased metabolic rate, wasting, gout, folate deficiency
effects of transfusions
iron overload = endocrine deficiencies, cirrhosis, cardiac failure, death
clinical manifestations of thalassemia
frontal bossing chipmunk facies hydrops fetalis (stillborn with hg barts, bloated) splenomegaly hair on end appearance on xray
required to diagnose thalassemia
hemoglobin electrophoresis
treatments for thalassemia
rbc transfusion
iron chelating agents
bone marrow transplant (best)
other advice
indication and problem with rbc transfusion
indication: symptomatic
problem: iron overload
t/f 1 L of blood = 1 g of Fe
false, 1 mL blood = 1 g of Fe
example of iron chelating agent
deferasirox
binds to excess iron
best treatment for thalassemia major
bone marrow transplant: hematopoietic stem cell transplant
allogenic stem cell transplant for thalassemia major
