anemia Flashcards
Anemia
Lack of rbc (quantity or quality) -> less o2 transport (causes cm)
Hemoglobin: provide o2 carrying capacity, heme unit with iron, reversible binds o2 and co2 for transport
Anemia due to decreased Fe or key nutrient
Sickle cell = abn shaped
Decreased hbg content (hypochromic/pale) = low Fe, low nutrient
Decreased number of circulating erythrocytes = decreased production, destruction, loss
Morphological abn
Macrocytic - normochromic: large normal [], low b12 and folate (needed for DNA synthesis of rbc), MCV increased, immature erythrocytes (reticulocytes)
Micro cystic abn: smal, decreased [], hypochromic, lighter color (pale), decreased Fe, MVC decreased
Normocytic-normochromic: normal size, normal function, blood loss, sickle cell, aplastic anemia
Cm
Due to decreased o2, speed of decrease can play a role
Mild: may have none
Mild-mod: fatigue (E production), weakness (muscles), tachy, dyspnea (SOB)
Mod-severe: tachy and tachypnea (compensatory), hypoT, pallor (blood redsit), faintness, chest pain and HF exp with exertion
Fe deficit
Deacreased intake, impaired abs, increased demand, excessive loss (GI bleed - occult, menstruation)
Cm: smooth tongue/gloss it is, mouth ulcers, cheilosis, koi loony chia (spoon nails), pica (ice, dirt, hard peppermint)
B12
Megaloblastic
Elderly!
Causes: atrophic gastritis
Thinned stomach lining -> dont produce IF needed to abs b12)
Conditions that affect SI: chron’s, celiac bacteria, parasite
Autoimmune = pernicious anemia
Cm: neuropathy, ataxia, gloss it is, dementia/psychosis
Folate
B9
Pregnant with decreased folate = babies with lbw and neural defects
No problem with abs -> decreased intake (diet, alcoholism - stored in liver, cirrhosis, increased need in preg
Decreased production
CKD: impaired erythropoietin - released to tell bone marrow to make rbc
Hbg and hct correspond with degree of kidney insufficiency
Cm = general s/s of anemia
Aplastic
Bone marrow failure -> all blood cells decrease (pancytopenia
Autoimmune -> blood cells in bone marrow attacked
Congenital or acquired
Tm: blood transfusion, bone marrow transplant, immunosuppressants, corticosteroids, drugs to stimulate erythropoiesis
Causes: idiopathic, high dose toxic agents (radiation, benzene, insecticides, chemo), autoimmune (complication of infection)
Increased destruction
Abn hgb-> acquired hemolytic anemia -> sickle cell, thalassemia = absent or decreased production, alpha or beta
Premature destruction from external agent
Causes: autoimmune, blood incompatibilities, drug reaction, physical agents (burn), microangiopathies
Immune complexes form -> lysis (type 2 and 3 rxn)
Cm: low hgb, high reticulocyte, mild jaundice, hemoglobinuria
Sickle cell
Genetic disorder, dont bind normally (hemoglobin s) - shape distorted esp when low o2, deliver low o2
Easily clog vessels, break, disrupt BF -> ischemia and necrosis
Cm: swelling of hands and feet (bc occlusion) with fever
Painful episodes = crisis from ischemia and necrosis (stress and physical activity, dehyd, high altitude, fever, extreme temp)
Tm: o2, hydrate, pain, infection control, blood transfusions, bone marrow transplant, CRISPR, genetic counseling; anti metabolite = hedroxyurea -> increase hgb F
Thalassemia
Genetic anemia (auto rec, Mediterranean descent)
Early death (30s)
Lack of alpha or beta globin
Microcytic, hypochromic
Tm: blood transF, bone marrow transplants, splenectomy
Cm: delayed growth, fatigue, dysp, hepatomegaly, splenomegally, bone deformities, jaundice
Acute blood loss
Hemorrhage, manifestations depend on speed of blood loss (acute v rapid, can’t compensate, complication, slow = less S)
Gross or occult
Polycythemia
Too many rbc
Relative = hemo [] = dehyd = plasma volume decreased, just need to correct issue
Primary and secondary = absolute, need to do something
Rf: chronic hypoxia (COPD), high altitude (chronic mountain disease), long term cig, familial and genetic predisposition, long term exposure to CO2 (tunnels, increased pollution, garage attendants)
Primary
Polycythemia Vera
Slow growing blood cancer or stem cell disorder -> abn proliferation of rbc, wbc, plt
>60 yr, M
1 stem cell mutates into cell that over produces all blood cells except lymphocytes
Cm: HA, fatigue, weight loss, dyspnea, htn, clotting issues, ruddy color, intense/painful itch exacerbated by heat and water (aqua genie pruritis), CV/stroke/HA
Secondary
Compensatory response to tissue hypoxia
COPD or restrictive lung disorder, not lacking rbc, just bad gas exchange
Cm: high blood viscosity nad volume leads to htn (HA, decreased [], ruddy face, cyanosis) and decreased BG (DVT, hemorrhage, angina, cerebral insufficiency, TIAs)
Hypermatabolic state: night sweats and weight loss
High rbc and H+H: itch, pain in fingers and toes
