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Medical Nutrition Therapy > Anemia > Flashcards

Anemia Flashcards

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USMLE® Step 1 flashcards
1
Q

Deficiency in the number of RBCs or in
the amount of hemoglobin they contain

A

anemia

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2
Q

anemia limits the exchange of _________ between the blood and the tissue cells

A

oxygen & carbon
dioxide

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3
Q

cell size classification of anemia

A

Microcytic (small)
Normocytic (normal)
Macrocytic (large)

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4
Q

Hemoglobin (Hgb) content in classification

A

Decreased=>Hypochromic (pale color)
Normochromic

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5
Q

biochemical data to look at anemia

A

Red Blood Cell Count (RBC)
Hemoglobin (Hgb)
Hematocrit (Hct)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)

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6
Q

Hemoglobin (Hgb) is the ___________

A

Protein in RBC that carries O2
Index of the blood’s O 2 carrying capacity

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7
Q

Decreased levels of hemoglobin indicate anemia
Normal levels:
Men: _______ g/dL
Women: ______ g/dL

A

14-17
12-15

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8
Q

what is democrat (Hct)

A

Percentage of the total blood volume
that is made up by RBC

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9
Q

Decreased levels indicate anemia
Normal levels:
Men: ______%
Females: ______%

A

42-52
35-47

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10
Q

M ean Corpuscular Volume (MCV)

A

A measure of the average volume or
size of a RBC

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11
Q

Normal values of MCV: ______ fL

Decreased MCV=> ______RBC=> __________

Increased MCV=> ______ RBC=> ___________

A

80-95

small
microcytic anemia

large
macrocytic anemia

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12
Q

Causes of Anemia

A

Nutritional deficiencies
Hemorrhage
Genetic abnormalities
Chronic disease states: cancer, renal disease
Medications

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13
Q

Smaller than normal size RBC with less Hgb content

A

Microcytic, Hypochromic Anemia

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14
Q

Microcytic, Hypochromic Anemia

Due to decreased production of _____

Biochemical data=> decreased ________; decreased ____

A

Hgb
Hgb & Hct
MCV

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15
Q

microcytic hypo chromic anemia is caused by

A

Iron deficiency anemia
Thalassemia
Sideroblastic Anemia
Copper deficiency

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16
Q

Macrocytic or Megaloblastic Anemias occur from ________ and produce ______ with ______ Hgb, ______ Hct, and _____ MCV

A

Defective DNA synthesis
abnormally large, immature RBC
decreased Hgb & Hct; increased MCV

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17
Q

microcytic or megaloblastic anemias are cause by _______ deficiency, _______ deficiency, or ________ such as ________

A

vitamin B12
folate
drug induced disorders of DNA synthesis
chemo

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18
Q

Normocytic, normochromic anemias cause ___________ with ________.

____ RBC count
_____ Hgb
______ Hct
______ MCV

A

destruction of RBC
decreased RBC production

low
low
low
WNL (within normal limits)

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19
Q

Normocytic, normochromic anemias can be caused by

A

hemorrhage
aplastic anemia
anemia of chronic disease
hemolytic anemia
pregnancy

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20
Q

anemia of chronic disease for normocytic anemia includes

A

chronic kidney disease (decreased erythropoietin production)

leukemia

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21
Q

nutritional anemias include what nutrients ?

A

iron
vitamin B12
folic acid
protein
pyridoxine
copper

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22
Q

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

A

Microcytic, hypochromic anemia

25%

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23
Q

high risk groups for iron IDA

A
  • 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
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24
Q

iron deficiency can occur from

  1. Inadequate ________ of iron
  2. Inadequate absorption
    _________________________
  3. Increased excretion=>_________
  4. Increased iron _________ for growth of blood volume
  5. Defective release from storage
A

dietary intake
achlorhydria, intestinal disease, medications
blood loss
requirement

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25
Q

Stages of IDA

A
  1. early negative iron balance
  2. iron depletion
  3. iron deficient erythropoiesis
  4. IDA
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26
Q

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:
_________________
_______________

A

ferritin
normal

Rate of GI absorption enhanced
Increase in the concentration of serum transferrin

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27
Q

stage two of IDA

iron stores are __________
if iron deficiency is treated in stage 1 or 2 ________

A

severely depleted
no dysfunction

28
Q

Stage 3 of IDA

Iron Deficiency=> inadequate _____ iron
_________ but no ________
Decreased serum ______
Transferrin saturation is _______

A

body
Dysfunction
anemia
iron
<15%

29
Q

stage 4 of IDA

what occurs

A

displaying symptoms

30
Q

symptoms of anemia

A

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

31
Q

defects in structure and function of epithelial cells can include ?

A

glossitis (inflamed tongue)
Koilonychia (thin spoon shaped fingernails)
Angular Stomatitis (inflamed and cracking of mouth corners)

32
Q

in diagnosis of IDA are these high or low

serum ferritin
serum iron
serum transferrin
transferrin saturation
hemoglobin & hematocrit
MCV

A

low
low
high
high
low
low

33
Q

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 _________

A

underlying cause

oral
ferrous
Ferrous sulfate
20%
gastric irritation

34
Q

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

A

nausea
GERD
constipation

3-6 months
150-200 mg
2-6 mg/kg

35
Q

reasons for iron supplementation failure

A

Non-compliance due to GI side effects
Bleeding continues
Iron supplement is not being absorbed

36
Q

Heme examples of iron

A

liver
beef
pork
poultry
clams, oysters

37
Q

non-heme iron examples

A

fortified foods
dried peas and beans
tofu
spinach
nuts and seeds
lentils
baked potato with skin

38
Q

what are some factors that increase iron absorption?

A

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

39
Q

inhibitors of iron absorption

A

tannins (tea and coffee)
phytates (whole grain breads, cereals, legumes)
oxalates (dark leafy greens)
phosphates
calcium
phosvitin (egg yolks)

40
Q

MNT to increase iron

A

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

41
Q

Folate is needed for __________________

Deficiency can cause=>_______________
Body stores are depleted within __________ on a folate-deficient diet

A

synthesis of DNA and maturation of RBC

macrocytic, megaloblastic anemia
2-4 months

42
Q

causes of folate deficiency

Inadequate ingestion from ____________
Inadequate absorption from __________

A

Poor quality diet

Celiac disease
Medications=>sulfasalazine
Alcohol

43
Q

causes of folate deficiency

Inadequate utilization from _____________

A

Drugs=> anticonvulsants, methotrexate

Vitamin B12 deficiency=> methylfolate trap

Alcoholism

Methylenetetrahydrofolate reductase (MTHFR) gene mutation

44
Q

causes of folate deficiency

increases requirements for growth such as _________
increased excretion from ___________

A

Pregnancy
Infancy
Increased hematopoiesis

Dialysis
Vitamin B12 deficiency

45
Q

clinical sign of folate deficiency

A

fatigue
dyspnea (difficulty breathing)
glossitis
diarrhea
irritability
forgetfulness
anorexia and weight loss

46
Q

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

A

3
140

vitamin B12
vitamin B12

47
Q

Treatment

  1. Determine & treat the cause of deficiency
  2. Replenish folate stores with supplementation:
    _________ per day for _________
  3. If long-term supplementation needed
    due to alcoholism, medications, malabsorption
    ________ folic acid daily
A

1 mg folic acid
2-3 weeks

0.5-1 mg

48
Q

MNT for Folate Deficiency

Increase dietary folate sources
- Consume multiple servings of __________ or a glass of fruit or vegetable juice daily
- Fortified ___________

A

fresh fruits and/or dark green vegetables
grain products, fish, legumes

49
Q

what is pernicious Anemia

A

A type of macrocytic, megaloblastic anemia caused by a deficiency of vitamin B 12

50
Q

vitamin B12 is needed for _____________

A

synthesis of DNA and maturation of RBCs

51
Q

Causes of Vitamin B 12 Deficiency

Inadequate absorption from ________

Inadequate intake
Increased excretion=>_________

A

Lack of intrinsic factor (IF)
- Gastric surgery, bariatric surgery, atrophic gastritis
Ileal disease
Pancreatic insufficiency

liver disease

52
Q

Clinical Signs of Vitamin B 12 Deficiency

A

Pernicious anemia:
- Fatigue
- Irritability
- Glossitis
- N/V/D/C
- Anorexia; weight loss
-inadequate myelination of nerves

53
Q

Inadequate myelination of nerves can cause ?

A

Paresthesia
Poor muscular coordination & weakness
Ataxia
Depression
Poor memory
Hallucinations
Paraplegia

  • If untreated, may be irreversible
54
Q

Diagnosis of B12 deficiency

Serum vitamin B 12 <____ pg/mL

_________ value <____ pg/mL is a sign of early B12 deficiency

A

200

A holo TCII
40

55
Q

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

A

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

56
Q

MNT for pernicious anemia

A

Increase dietary sources of Vitamin B12
High protein diet: 1.5 g/kg

57
Q

Food Sources of Vitamin B12

A

Liver
Beef
Pork
Fish
Eggs
Dairy products
Fortified cereals

58
Q

Decreased MCV=> ____________=> __________

A

microcytic anemia
possible Iron deficiency anemia

59
Q

Increased MCV=> __________ anemia=>______________

A

macrocytic
possible vitamin B12 or folate deficiency anemia

60
Q

Sick Cell Anemia is not caused by _________ but can cause ______________

A

nutrition
nutrition problems

61
Q

what is sickle cell anemia ?

Inherited condition
Affects ~_______ Americans
Occurs in about _______ Black American births in the U.S.

A

Chronic hemolytic anemia caused by defective hemoglobin synthesis

100,000

1/365

62
Q

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

A

occlude

hemolytic
abd. pain
Jaundice

63
Q

Medical Management of sickle cell anemia

  • _____________
  • Medication=>______________
  • ______ management
  • Providing ______
  • _______ supplementation, which increases the _______ of RBC and is Needed for growth
A

Blood transfusions
hydroxyurea
Pain
oxygen
Zinc
oxygen affinity

64
Q

Nutrition Implications of sickle cell anemia

Children=> poor _______
- Decreased intake due to frequent _________
- Increased ____
- _________ is common

A

growth
abdominal pain
REE
Malnutrition

65
Q

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

A

kcal
protein
120-150
folate
iron
iron

Medical Nutrition Therapy (12 decks)

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