Anemia Flashcards
Macrocytic, megaloblastic anemia
-Lack of B12 or folate leads to lack of DNA blueprints, preventing normal cell division from occuring, leading to bigger red blood cells (AKA macrocytes)
-Very few macrocytes survive, leading to decreased red blood cell count
- Megaloblasts (abnormally developed red blood cell precursors) are produced to compensate, which either don’t survive or become macrocytes.
Pernicious anemia
-autoimmune anemia associated with B12 deficiency; schilling test.
-Antibodies may attack parietal cells, resulting in decreased intrinsic factor.
-Also associated with gastrectomy and autoimmune atrophic gastritis.
Microcytic anemia
Iron deficiency anemia
-RBCs are full of hemoglobin (bind to oxygen; provides red color)
-Hemoglobin has an iron containing ring
-lack of iron - abnormal RBCs are prodcued with less hemoglobin.
-Less hemoglobin- RBCs are smaller (microcytic) and paler (hypochromic)
-Both B6 and Copper deficiency have also been associated with microcytic anemia.
Hemolytic Anemia
-Vitamin E functions as an antioxidant protecting RBCs, Lack of vitamin E leads to lack of protection, so RBCs get destroyed.
Blood composed
Red blood cells (RBCs)
white blood cells (WBCs)
Platelets
Transport proteins
Nitrogenous waste
Nutrients
Minerals
Electorlytes
Plasma
cellular components
Plasma: 55% of total blood volume
91% water
7% blood protiens (fibrinogen, albumin, globulin)
2 % Nutrients (amino acids, sugars, lipids, hormones, electrolytes (sodium, potassium, calcium)
Cellular components: 45% of total blood volume
Buffy Coat: WBC and Platelets
REd Blood CElls (RBCs)
Erythrocytes (K, E, Protein)
contain hemoglobin and are the largest percent of blood volume.
LEad and cadmium can interfere with erythropoiesis
K, E, and Protein needed.
WBCs (A, Zinc, Iron, B vitamins, Protein)
include granulocytes, monocytes, and lymphocytes produced in bone marrow.
-A, Zinc, B vitamins, protein are essential for leukocytopoiesis.
- Invloved in inflammation, immunity, and work in conjuction with cytokines.
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Platelets (thrombocytes)
comprise less than 1 % of total. blood volue and are activated by cytokines (form clots)
Erythropoiesis
regulated by kidneys
reduce oxygen stimulate kidneys, erythropoeisis Occurs, developing red bone marrow, increased oxygen carrying capacity.
Biochemistry Bite Coenzymes of Heme synthesis
ALA synthetase- requires Pyridoxal 5’ Phosphate (PLP), also known as B6
ALA Dehydrogenase- requires ZINC
Anemia
Deficiency in the number of red blood cells or in the amount of hemoglobin they contain. Decrease in the Oxygen carrying capacity of the blood.
Marrow anemias
Hypoplastic anemias
Dyshemopoietic anemias
HA: decrease in productive marrow due to hypoplasia, aplasia, or tumor.
DA: Marrow cannot produce enough normal red cells (deficiency of Iron, Vitamin B12)
Circulation anemias
1. acute posthemorrhagic anemia
2. Hemolytic anemia
APA: Excess loss of RBCs due to acute hemorrhage.
HA: Excessive destruction of RBCs
Sickle Cell Anemia
sickle cell shaped RBCs that get caught in capillaries adn do not carry oxygen well. Increase mictonutrient intake due to increased energy expenditure associted with crisis.
symptoms: Leg ulcers, severe abdominal pain, gallstones, impaired liver function, strokes, thrombi, priapism, retinal infarctions and infections , INCREASED IRON IN LIVER.
Lower homocysteine levels due to decreased vitamin B6.
MNT: adequate hydration and nutritional support.
Oral glutamine (for rapidly dividing cells)
Folate, B12, Pyridoxine (B6)
Zinc to increase the oxygen
Butyrate can decrease sickling,
Protein, calories, folate, zinc, copper, vitamins A, C, D, E, calcium and fiber.
Avoid IRon from fortified foods, and iron supplements should be avoided.
Alcohol, vitamin C should also be avoided.
Thalassemias (microcytic) anemia
-severe anemia due to defective globin formation.
-Mediteranean regions.
-inherited disorder
MNT: Transfusions are standard treatment.
-Iron chelators to address iron overload
-Ascorbic acid (vitamin C) given to improve efficacy
Signs and symptoms: Splenomegaly, skeletal changes (due to bone marrow, expansion) Accumulation of iron in the body can lead to dysfunctions of the heart, liver, endocrine glands.
Thorough lab: HCT, RBC, Degree of microcytosis and hypochromia, MCH, Serum iron, ferritin.
Polycythemia
increase in circulating RBC and can be Spurious (due to a decreased plasma volume) or real (due to dysregulated feedback and increased RBC synthesis in the marrow).
Sings/Symptoms:
Very low or high erythropoietin levels Plethoric face
itchy after a hot shower
clotting
Gi bleeding
Interventions:
Treatment for polycythemia involves routine phlebotomy and subsequent increased consumption of iron rich foods and avoid hihg dose supplements.
Hemoglobin Anemia
RBC destruction and mayb e caused by inherited or autoimmune disease, severe or sustained trauma, sickle cell phenotype or hemorrhage leading to increased production of RBCs.
Signs/Symptoms:
HIgh total body iron
Normal or high HB depends on if extravascular or intravascular hemolysis, Jaundice, gallstones,
Intervention: Intravascular hemolysis can respond to vitamin E. Splenomegaly.
Labs: HIgh Reiculocyte count
Interventions:
Treatment may involve apheresis (RBC exchange/tranfusion). Nutrition Therapy involves treating the underlying cause (removing toxic compound or immunosuppressive medication), supplementing with iron, folate, and protein, hemolytic anemia can be caused by autoimmine disease (LUPUS, cancers, medications)
Hypochomic MIcrocytic Transient Anemia (sports anemia)
-Athletes are more prone to anemia early on in training.
-Iron deficiency in female athletes
Anemia of chronic disease
Inflammation, infection or malignancy.
Plenty of iron in body but not available for use.
-Treat the underlying cause, DO NOT GIVE IRON.
Primary aplastic anemia (Fanconi’s anemia)
inherited failure of the marrow.
S/S: petechiae, Infection, Pancytopenia
Intervention : Nutrition and MEdical therapy for aplastic ( and rare anemias ) involves maintanence of macro and micronutrients.
For patients taking high doses of coricosteroids (maintanence of fluids, electrolytes, calcium, and vitamin D recommended)
Anemia of permaturity
premature infants due to low levels of erythropoietin as a result of underdeveloped kidneys.
MNT: vitamin E supplementation to protect RBC membranes and to decrease hemolysis.
Anemia of protein energy malnutrition
Copper deficiency anemia
Sideroblastic (Pyridoxine-Responsive Anemia)
Vitamin E-Responsive Hemolytic Anemia
Iron Deficiency Anemia
Folate deficiency anemia
Vitamin B12 deficiency Anemia
Microcytic vs macrocytic anemia
