Anemia Flashcards
Deficiency in the number of RBCs or in
the amount of hemoglobin they contain
anemia
anemia limits the exchange of _________ between the blood and the tissue cells
oxygen & carbon
dioxide
cell size classification of anemia
Microcytic (small)
Normocytic (normal)
Macrocytic (large)
Hemoglobin (Hgb) content in classification
Decreased=>Hypochromic (pale color)
Normochromic
biochemical data to look at anemia
Red Blood Cell Count (RBC)
Hemoglobin (Hgb)
Hematocrit (Hct)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)
Hemoglobin (Hgb) is the ___________
Protein in RBC that carries O2
Index of the blood’s O 2 carrying capacity
Decreased levels of hemoglobin indicate anemia
Normal levels:
Men: _______ g/dL
Women: ______ g/dL
14-17
12-15
what is democrat (Hct)
Percentage of the total blood volume
that is made up by RBC
Decreased levels indicate anemia
Normal levels:
Men: ______%
Females: ______%
42-52
35-47
M ean Corpuscular Volume (MCV)
A measure of the average volume or
size of a RBC
Normal values of MCV: ______ fL
Decreased MCV=> ______RBC=> __________
Increased MCV=> ______ RBC=> ___________
80-95
small
microcytic anemia
large
macrocytic anemia
Causes of Anemia
Nutritional deficiencies
Hemorrhage
Genetic abnormalities
Chronic disease states: cancer, renal disease
Medications
Smaller than normal size RBC with less Hgb content
Microcytic, Hypochromic Anemia
Microcytic, Hypochromic Anemia
Due to decreased production of _____
Biochemical data=> decreased ________; decreased ____
Hgb
Hgb & Hct
MCV
microcytic hypo chromic anemia is caused by
Iron deficiency anemia
Thalassemia
Sideroblastic Anemia
Copper deficiency
Macrocytic or Megaloblastic Anemias occur from ________ and produce ______ with ______ Hgb, ______ Hct, and _____ MCV
Defective DNA synthesis
abnormally large, immature RBC
decreased Hgb & Hct; increased MCV
microcytic or megaloblastic anemias are cause by _______ deficiency, _______ deficiency, or ________ such as ________
vitamin B12
folate
drug induced disorders of DNA synthesis
chemo
Normocytic, normochromic anemias cause ___________ with ________.
____ RBC count
_____ Hgb
______ Hct
______ MCV
destruction of RBC
decreased RBC production
low
low
low
WNL (within normal limits)
Normocytic, normochromic anemias can be caused by
hemorrhage
aplastic anemia
anemia of chronic disease
hemolytic anemia
pregnancy
anemia of chronic disease for normocytic anemia includes
chronic kidney disease (decreased erythropoietin production)
leukemia
nutritional anemias include what nutrients ?
iron
vitamin B12
folic acid
protein
pyridoxine
copper
Iron Deficiency Anemia (IDA) is a ______________ anemia
Iron deficiency is the most common and widespread nutrition deficiency in the world
- Affects _____% of the world’s population
Microcytic, hypochromic anemia
25%
high risk groups for iron IDA
- Menstruating women
- Pregnant & lactating women
- Infants & children
- Conditions which cause blood loss=>peptic ulcer disease, ulcerative colitis, colon cancer, chronic aspirin therapy
- Children living at or below the poverty level
iron deficiency can occur from
- Inadequate ________ of iron
- Inadequate absorption
_________________________ - Increased excretion=>_________
- Increased iron _________ for growth of blood volume
- Defective release from storage
dietary intake
achlorhydria, intestinal disease, medications
blood loss
requirement
Stages of IDA
- early negative iron balance
- iron depletion
- iron deficient erythropoiesis
- IDA
Stage 1 of IDA
Iron needs or losses exceed intake=> moderately depleted iron stores
- Serum ________ decreases (Best indicator of early negative iron balance)
Hgb is _________
Compensation:
_________________
_______________
ferritin
normal
Rate of GI absorption enhanced
Increase in the concentration of serum transferrin
stage two of IDA
iron stores are __________
if iron deficiency is treated in stage 1 or 2 ________
severely depleted
no dysfunction
Stage 3 of IDA
Iron Deficiency=> inadequate _____ iron
_________ but no ________
Decreased serum ______
Transferrin saturation is _______
body
Dysfunction
anemia
iron
<15%
stage 4 of IDA
what occurs
displaying symptoms
symptoms of anemia
muscle weakness
fatigue
anorexia
pale skin
abnormal cognitive development in children
growth abnormalities
pica
reduced immunocompetence
defects in structure and function of epithelial cells
cardiac failure
defects in structure and function of epithelial cells can include ?
glossitis (inflamed tongue)
Koilonychia (thin spoon shaped fingernails)
Angular Stomatitis (inflamed and cracking of mouth corners)
in diagnosis of IDA are these high or low
serum ferritin
serum iron
serum transferrin
transferrin saturation
hemoglobin & hematocrit
MCV
low
low
high
high
low
low
For treatment of IDA, Identify & treat the ____________
Repletion of iron stores=> _____ iron
supplementation in the _______ form
- _____________ most common (contains ____%
elemental iron)
- Best absorbed if taken on an empty stomach;
however, can cause _________
underlying cause
oral
ferrous
Ferrous sulfate
20%
gastric irritation
GI side effects of iron: _____________
Daily dose:
Continue supplementation for _____ months to replete stores
Adults: _______ mg of elemental iron per day
Children: __________ of body weight
nausea
GERD
constipation
3-6 months
150-200 mg
2-6 mg/kg
reasons for iron supplementation failure
Non-compliance due to GI side effects
Bleeding continues
Iron supplement is not being absorbed
Heme examples of iron
liver
beef
pork
poultry
clams, oysters
non-heme iron examples
fortified foods
dried peas and beans
tofu
spinach
nuts and seeds
lentils
baked potato with skin
what are some factors that increase iron absorption?
heme iron better absorbed than nonheme iron
vitamin C increased absorption if taken with iron source
heme-iron sources increase absorption of non-heme iron in other foods
inhibitors of iron absorption
tannins (tea and coffee)
phytates (whole grain breads, cereals, legumes)
oxalates (dark leafy greens)
phosphates
calcium
phosvitin (egg yolks)
MNT to increase iron
increase intake of dietary iron
include source of meat, fish, or poultry at every meal if possible
include source of vitamin C at every meal
avoid drinking large amounts of tea or coffee with meals
Folate is needed for __________________
Deficiency can cause=>_______________
Body stores are depleted within __________ on a folate-deficient diet
synthesis of DNA and maturation of RBC
macrocytic, megaloblastic anemia
2-4 months
causes of folate deficiency
Inadequate ingestion from ____________
Inadequate absorption from __________
Poor quality diet
Celiac disease
Medications=>sulfasalazine
Alcohol
causes of folate deficiency
Inadequate utilization from _____________
Drugs=> anticonvulsants, methotrexate
Vitamin B12 deficiency=> methylfolate trap
Alcoholism
Methylenetetrahydrofolate reductase (MTHFR) gene mutation
causes of folate deficiency
increases requirements for growth such as _________
increased excretion from ___________
Pregnancy
Infancy
Increased hematopoiesis
Dialysis
Vitamin B12 deficiency
clinical sign of folate deficiency
fatigue
dyspnea (difficulty breathing)
glossitis
diarrhea
irritability
forgetfulness
anorexia and weight loss
Diagnosis of Folate Deficiency
Very low serum folate levels (<_____ ng/mL)
Low RBC folate (<_____ ng/mL)
Both serum folate and______ levels should be measured to differentiate deficiencies
Folic acid supplementation can mask __________ deficiency
3
140
vitamin B12
vitamin B12
Treatment
- Determine & treat the cause of deficiency
- Replenish folate stores with supplementation:
_________ per day for _________ - If long-term supplementation needed
due to alcoholism, medications, malabsorption
________ folic acid daily
1 mg folic acid
2-3 weeks
0.5-1 mg
MNT for Folate Deficiency
Increase dietary folate sources
- Consume multiple servings of __________ or a glass of fruit or vegetable juice daily
- Fortified ___________
fresh fruits and/or dark green vegetables
grain products, fish, legumes
what is pernicious Anemia
A type of macrocytic, megaloblastic anemia caused by a deficiency of vitamin B 12
vitamin B12 is needed for _____________
synthesis of DNA and maturation of RBCs
Causes of Vitamin B 12 Deficiency
Inadequate absorption from ________
Inadequate intake
Increased excretion=>_________
Lack of intrinsic factor (IF)
- Gastric surgery, bariatric surgery, atrophic gastritis
Ileal disease
Pancreatic insufficiency
liver disease
Clinical Signs of Vitamin B 12 Deficiency
Pernicious anemia:
- Fatigue
- Irritability
- Glossitis
- N/V/D/C
- Anorexia; weight loss
-inadequate myelination of nerves
Inadequate myelination of nerves can cause ?
Paresthesia
Poor muscular coordination & weakness
Ataxia
Depression
Poor memory
Hallucinations
Paraplegia
- If untreated, may be irreversible
Diagnosis of B12 deficiency
Serum vitamin B 12 <____ pg/mL
_________ value <____ pg/mL is a sign of early B12 deficiency
200
A holo TCII
40
treatment of pernicious anemia
first ____________
After initial response=>_______________
Can also give very large doses (_______ µg/d) of oral vitamin crystalline B12 even in the absence of IF because 1% will be absorbed by diffusion
________________ are also available
Intra-muscular (IM) injection of 1000 µg of vitamin B 12 once per week
Monthly injections of 1000 µg
1000-2000
Nasal sprays & sublingual tablets
MNT for pernicious anemia
Increase dietary sources of Vitamin B12
High protein diet: 1.5 g/kg
Food Sources of Vitamin B12
Liver
Beef
Pork
Fish
Eggs
Dairy products
Fortified cereals
Decreased MCV=> ____________=> __________
microcytic anemia
possible Iron deficiency anemia
Increased MCV=> __________ anemia=>______________
macrocytic
possible vitamin B12 or folate deficiency anemia
Sick Cell Anemia is not caused by _________ but can cause ______________
nutrition
nutrition problems
what is sickle cell anemia ?
Inherited condition
Affects ~_______ Americans
Occurs in about _______ Black American births in the U.S.
Chronic hemolytic anemia caused by defective hemoglobin synthesis
100,000
1/365
Clinical Manifestations of sickle cell anemia
Deformed RBC=> do not carry O2 well
- fragile, & _______- capillaries
Severe _________ anemia
Pain crises=> often severe_______
_______ due to hemolysis of RBC
Impeded blood flow
- Organ failure=>liver, kidney
- Stroke
occlude
hemolytic
abd. pain
Jaundice
Medical Management of sickle cell anemia
- _____________
- Medication=>______________
- ______ management
- Providing ______
- _______ supplementation, which increases the _______ of RBC and is Needed for growth
Blood transfusions
hydroxyurea
Pain
oxygen
Zinc
oxygen affinity
Nutrition Implications of sickle cell anemia
Children=> poor _______
- Decreased intake due to frequent _________
- Increased ____
- _________ is common
growth
abdominal pain
REE
Malnutrition
MNT for Sickle Cell Anemia
Well-balanced, high ______/high _____ diet;
______% DRI for kcal & protein
Drink plenty of fluids
Increase dietary _______ sources
Avoid _____ supplements
May need to reduce dietary______ intake
kcal
protein
120-150
folate
iron
iron
