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NURS 6512 > Anemia > Flashcards

Anemia Flashcards

1
Q

Hemoglobin concentration in adult male (anemia)

A

Less than 13.6 g/dL

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2
Q

Hemoglobin concentration in adult female (anemia)

A

Less than 12.0 g/dL

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3
Q

Most common etiology of anemia in young children and pregnant women

A

Iron deficiency anemia (IDA)

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4
Q

Anemia is more common in individuals older than ___ years

A

65

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5
Q

Most common type of anemia in elderly

A

Anemia of chronic disease (ACD)

Followed by nutritional deficiencies (iron, B12, folate) and decreased marrow response to erythropoietin

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6
Q

Sickle cell anemia most common in which ethnicity

A

African ancestry

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7
Q

Thalassemia most common in which ethnicity

A

People from the geographic regions of the Mediterranean, the Middle East, Southeast Asia, and parts of India and Pakistan

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8
Q

Hemoglobin’s major function

A

Transport O2 to tissues

(Anemia is a condition that results in too little O2 being transported to the tissues)

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9
Q

Anemia is defined as a reduction in the number of _________, __________ concentration, or ____________.

A

Red blood cells
Hemoglobin
Hematocrit

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10
Q

Three major etiologies of anemia

A
  1. RBC production disorder
  2. RBC destruction disorder
  3. Blood loss (acute or chronic)
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11
Q

The production of erythrocytes (RBCs)

A

Erythropoiesis

Limited to axial skeleton and proximal ends of the long bones in the adult. Any condition that interferes with bone marrow function can cause anemia.

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12
Q

Most important factor in the body’s ability to increase RBC production is ______

A

Iron

Without adequate iron stores, the marrow cannot increase erythropoiesis.

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13
Q

Chronic kidney disease can result in the ____ production and ____ of erythropoietin.

A

Under (production)
secretion (of)

Suppressing an essential signal trippering RBC production

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14
Q

RBC destruction disorders

Mechanisms involved in the increased hemolysis or destruction of RBCs resulting in anemia

A

Sickle cell trait
Hereditary spherocytosis
Hereditary elliptocytosis

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15
Q

RBC destruction disorders

RBC enzyme defects

A

G6PD deficiency

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16
Q

RBC destruction disorders

Autoimmune antibody production

A

Autoimmune hemolytic anemia

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17
Q

Blood loss from trauma or hemorrhage which may result in life-threatening anemia with significan syptoms of hemodynamic cardiovascular compromise

Sudden and profound drop in hemoglobin level

A

Acute blood loss

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18
Q

Occurs slowly, over time, and from as little as a few teaspoons of blood loss per day, especially from the GI tract

Also mild to moderate menorrhagia, chronic microscopic hematuria, or chr

Body compensates for this type of slowly evolving anemia

A

Chronic blood loss

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19
Q

Healthy patient with gradual anemia onset - when do signs or symptoms generally appear

A

When hemoglobin falls below 7.5 g/dL

Initial symptoms: fatigue, malaise, HA, dyspnea, irritability, mild decrease in exercise tolerance

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20
Q

Nonspecific findings that accompany long-term, moderate to severe anemia

A

Wide pulse pressure, midsystolic or pansystolic murmur, confusion, lethargy, brittle nails, glossitis, angular chelitis, and spoon shaped nails.

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21
Q

Common signs of anemia

A

Pallor of mucous membranes, lips, conjunctivae, nail beds, and palmar creases

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22
Q

When palmar creases are as pale as the surrounding skin, the patient usually has a hemoglobin value of:

A

<7 g/dL

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23
Q

What diagnostic should be obtained initially when evaluating for anemia

A

CBC with differential

24
Q

RBC index that quantifies RBC cell size

A

Mean corpuscular volume (MCV)

25
Q

RBC indices that quantify RBC hemoglobin concentration

A

Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)

26
Q

RBC index that quantifies variation of cell size across the specimen

A

RBC distribution width (RDW)

27
Q

RBC index that reflects the average RBC size

Referred to as microcytic, normocytic, or macrocytic

A

MCV

Most useful of the RBC indices

28
Q

Immature RBCs

Have nucleus when they enter circulation (larger in size than mature RBC)

A

Reticulocyte

Extrude their nucleus within a few days and decrease in size (assume the classic concave disc shape of the mature RBC)

29
Q

Most easily accessible method of evaluating bone marrow production of RBCs

Marrow biopsy requires an invasive procedure

A

Reticulocyte count

Provides an assessment of whether the causative factor of anemia is related to either decreased production or increased loss

30
Q

Reticulocyte count

Normal absolute reticulocyte count (ARC) ____
Above ____ is considered a marrow that is responding normally to anemic conditions.

Low ARC is considered consistent with impaired RBC production.

A

25,000-75,000/ul (normal)
>100,000/ul

31
Q

What lab testing should be obtained if concerned for hemolysis as a source of anemia?

A

Serum bilirubin levels (marker of hemoglobin cataboslism)
Serum lactate dehydrogenase (LDH) (indicative of direct cellular injury)
Serum haptoglobin (low with intravascular hemolysis)

Hemolytic anemias are complex to evaluate and diagnose - if suspected, immediate hematology referral is indicated

32
Q

Variations in RBC size and shape as well as abnormal cell populations too small to change the indices can be directly visualized with which diagnostic?

A

Peripheral blood smear

Sickle cell shape or sperocytes
Evidence of hemolysis

33
Q

Significant variations in size of cells in a specimen is described as ____ on a peripheral blood smear.

A

Anisocytosis

34
Q

Significant variations in cell shapes in a specimen is described as ____ on a peripheral blood smear.

A

Poikilocytosis

35
Q

What is the first lab value to become abnormal when iron stores are becoming depleted?

A

Serum ferritin

Even before IDA is reflected in RBC morphology
<12ng/mL indicates absence of iron stores

36
Q

____ is an acute phase reactant and may be elevated due to inflammation

A

Serum ferritin

Inflammation causes the release of tissue ferritins resulting from damage to the liver and other ferritin-rich tissues.

ESR and/or CRP can establish the presence of general inflammation.

37
Q

Condition with low serum ferritin

A

IDA

38
Q

Condition with normal to elevated serum ferritin

A

ACD

Anemia of chonic disease

39
Q

Conditions with elevated serum ferritin

Aside from ACD

A

Iron overload (transfusion dependent or hereditary hemochromatosis)
Inflammatory disorders
Alcoholism

40
Q

Normal values for serum iron concentration

A

65-165 mcg/dL

41
Q

Indicates the availability of binding sites on the protein for iron transport.

Normal values are ____

A

Total iron-binding capacity (TIBC)

300-360mcg/dL

42
Q

What are the priority differentials for anemia?

A

Blood loss (acute hemorrhage, hemolysis; chronic - GI/GYN causes)
Bone marrow failure or disease
Malignancy
Renal failure

43
Q

MCV <80 fL

Classification of anemia

A

Microcytic

IDA most common but may be associated with ACD, thalassemia, and sideroblastic anemia

44
Q

Most common type of anemia in the world and most common nutrient deficiency

A

IDA

Predominantly affects women of reproductive age and older adults

45
Q

Most common cause of IDA?

A

Chronic blood loss

GI blood loss or menorrhagia

Chronic GI blood loss should be suspected as a cause of IDA in adult men and postmenopausal womeny.

46
Q

Most common cause of IDA in children and pregnant women?

A

Inadequate nutrition and increased iron requirements

Anemia prevalence in pregnant women = 38%; >50% is a result of iron def

Preterm infants are at greater risk for IDA during infancy as fetal iron stores are established in the last trimester of pregnancy.

47
Q

Normal adult male has a total body iron content of ____
Woman of childbearing age has a total body iron content of ____

A

4000mg (male)
2000mg (woman of childbearing age)

Average adult loses ~1mg iron each day through natural losses (adult woman loses an additional 1mg through normal menstruation)

48
Q

As body iron stores are depleted, the transerrin saturation decreases, leading to a reduced supply of iron to the RBC precursors, resulting in ____?

A

Impaired (iron-deficient) erythropoiesis

Once iron stores are truly depleted and no iron is available for erythropoiesis, an overt microcytic, hypochromic anemia is present.

49
Q

In IDA, MCV, MCH, and MCHC are the last to change; however the ____ may be elevated well before the MCV decreases as it reflects the newer, smaller RBCs entering the circulation.

A

RDW

50
Q

Early IDA

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Normal
MCV: Normal
MCHC: Normal
RDW: Increased
Serum Iron: Normal
Serum Ferritin: Normal
TIBC: Normal
Transferrin saturation: Normal

51
Q

Intermmediate IDA

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Normal
MCV: Normal
MCHC: Normal
RDW: Increased
Serum Iron: Decreased/Normal
Serum Ferritin: Decreased
TIBC: High normal
Transferrin saturation: Decreased

52
Q

Late IDA

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Decreased
MCV: Decreased
MCHC: Decreased
RDW: Increased
Serum Iron: Decreased
Serum Ferritin: Decreased
TIBC: Increased
Transferrin saturation: Decreased

53
Q

Thalassemia minor

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Low normal/Decreased
MCV: Decreased
MCHC: Normal/Decreased
RDW: Normal
Serum Iron: Normal
Serum Ferritin: Normal
TIBC: Normal
Transferrin saturation: Normal

54
Q

Chonic Disease

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Low normal
MCV: Normal/Decreased
MCHC: Normal/Decreased
RDW: Normal
Serum Iron: Decreased
Serum Ferritin: Increased
TIBC: Decreased
Transferrin saturation: Increased

55
Q

Sideroblastic anemia

Lab values in microcytic anemias

Hemoglobin, MCV, MCHC, RDW, Serum iron, Serum ferritin, TIBC, Transferrin saturation

A

Hemoglobin: Decreased
MCV: Decreased
MCHC: Decreased
RDW: Variable
Serum Iron: Increased
Serum Ferritin: Increased
TIBC: Normal
Transferrin saturation: Increased

56
Q

Clinical presentation of IDA:
Mild to moderate
Severe

A

Mild to moderate: no clinical symptoms
Severe: fatigue, decreased exercise tolerance, weakness, palpitations, irritability, and HA. Systolic flow murmur, forceful apical pulse, tachycardia with exertion.

May also see paresthesias, sore tongue, brittle nails, spoon-shaped nails, and pika for starch, clay, ice.

Older adult may present with signs of CHF.

NURS 6512 (1 decks)

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