Anemia Flashcards
1
Q
What is anemia?
A
the major pathophysiological condition affecting RBCs; defined as the reduction in the total number of circulating erythrocytes or a decease in the quality or quantity of hemoglobin
2
Q
what does a CBC do?
A
measures all RBCs & RBC characteristics
3
Q
different types of _______ produce different CBC results
A
anemia
4
Q
the size and color of RBCs can be defined as?
A
normocytic
microcytic
microcytic
anisocytic
poilocytic
5
Q
What does anisocytic mean?
A
cells vary in size
6
Q
what does poilosytic mean?
A
cells varying in shape
7
Q
what does a mean corpuscular volume (MVC) indicate?
A
size of RBCs
8
Q
What does a mean corpuscular hemoglobin (MCH) indicate?
A
color of RBC
9
Q
what does a mean corpuscular hemoglobin concentration (MCHC) indicate?
A
color of RBC
10
Q
What does hematocrit levels measure?
A
percentage of blood made up of RBCs
11
Q
What is the average hematocrit level?
A
45%
12
Q
What is the range for hematocrit in males?
A
45 to 52%
13
Q
What is the range for hematocrit in females?
A
37 to 48%
14
Q
What is hematocrit at in those with anemia?
A
around 15%
15
Q
What is hematocrit around in those with polycythemia?
A
around 65%
16
Q
What is included in a CBC?
A
hemoglobin
hematocrit
number of RBCs
reticulocyte count
mean corpuscular volume
mean corpuscular hemoglobin
mean corpuscular hemoglobin concentration
17
Q
What does reticulocyte count indicate?
A
bone marrow activity
18
Q
the dx of anemia cannot be made only looking at the ________ and _________
A
hemoglobin and hematocrit
19
Q
What does the reticulocyte count measure?
A
number of new RBCs in the blood
20
Q
what does the reticulocyte count tell you?
A
helps to determine whether the bone marrow is producing new RBCs at an appropriate rate
21
Q
what does increaased reticulocyte numbers associated with anemia suggest?
A
accelerated destruction or loss of RBCs
22
Q
what is a normal reticulocyte count?
A
appoximately 1% of total RBCs
23
Q
What can polycythemia vera be described as?
A
the opposite of anemia
24
Q
What labs are elevated in polycythemia vera?
A
H & H
25
What is an overabundance of RBCs referred to as?
polycythemia vera
26
Is the cause known in primary polycythemia?
no
27
What happens in primary polycythemia?
there is hyperproliferation of all blood cells; blood becomes viscouse
28
What is there an increased risk of in primary polycythemia?
thromboembolism
29
Is the cause known in secondary polycythemia?
yes
30
is primary or secondary polycythemia more common?
secondary
31
What happens in secondary polycythemia?
hyperproliferation of the RBCs in response to chronic blood hypoxia (like in COPD)
32
about 98% of all cases of polycythemia are related to a mutation in the ____ gene
JAK2
33
polycythemia causes RBC crowding which may cause an increased risk of ______, ______, & increased risk of _______ due to blood escaping the vessel.
clots; brusing; bleeding
34
What is one way that polycythemia can be treated?
therapeutic phlebotomy; taking blood out of the body
35
What lab testing can be done to diagnose anemia?
- CBC
- peripheral blood smear
- iron
- folic acid
- bone marrow aspiration and/or biopsy
* additional test based on type of anemia
- fecal occult blood test
- vitamin B12 levels
36
What other testing can be done to help diagnose anemia?
- echocardiogram
- electrocardiogram(EEG)
37
What are the 3 major causes of anemia?
- decreased erythrocyte production
- increased erythrocyte destruction
- blood loss
38
Can you have more than one cause of anemia?
yes; can have a combination of any of the 3 causes
39
What are the 4 classic S & S of anemia?
- pallor
- fatigue
- dyspnea on exertion
- dizziness
40
What are compensatory mechanisms that are manifestations of anemia?
- tachycardia
- palpitations
- vasoconstriction
41
What are respiratory manifestations of anemia?
- tachypnea
- increased depth
42
What are other manifestations of anemia?
- increased interstitial fluid into vascular space
- cold hands/feet
- chest pain
43
how much blood can an adult lose without serious or lasting effects?
500ml
44
What can happen if blood loss reaches 1000ml or more?
serious adverse effects like hypovolemia shock & cerebral hypoperfusion
45
What is acute blood loss?
a rapid ;loss of blood as in hemorrhage
46
What can cause acute blood loss?
- trauma
- childbirth
- rupture of a major blood vessel or organ
47
in what disorders can severe GI bleeding occur?
- esophageal varices
- penetrating peptic ulcers
48
What do those with bleeding due to esophageal varices often exhibit?
hematoemesis
49
What is coffee ground emesis?
blood mixed with stomach acid & mucus in vomit
50
What is melena?
blood mixed in stool causing dark, tarry stool
51
What is hematoachezia?
bright red blood in stool
52
What are the most common causes of anemia due to chronic blood loss?
- peptic ulcers
- Inflammatory bowel disease
- colon cancer
- menorrhagia (heavy or prolonged menstrual cycles)
- chrones
- ulcerative colitis
53
What is the most common type of anemia?
iron deficiency anemia
54
in what gender is iron deficiency anemia more common?
females
55
iron deficiency anemia is _______- ________
microcytic- hypochromic
56
What are the 8 possible causes of iron deficiency anemia?
- poor dietary intake
- menses
- pregnancy
- ulcerative colitis
- certain medications
- parasitic infections
- neoplasms
- can also occur in lead poisoning
57
What is the main nutritional element needed for hemoglobin sythesis?
iron
58
What is iron composed of?
a heme & globin compound
59
balance is maintained between iron used as __________ and iron placed in ________
hemoglobin; storage
60
Can iron be recycled?
yes
61
iron is in ________ demand
constant
62
How many grams of iron is in the body at all times?
3-4
63
How much of iron is held in hemoglobin?
60%
64
how much iron is stored as ferritin in the macrophages, liver, spleen, and bone marrow?
35%
65
What is the rest of iron found in?
in myoglobin and bound to transferrin
66
why is there very little free iron?
it it toxic to the cells
67
What does serum iron test for?
the level of circulating iron in the blood; % saturated
68
What is TIBC?
total iron binding capacity; percentage of cells that are actually filled with transferrin
69
What is the normal serum iron level?
25 -45%
70
What is the serum iron in those with iron deficient anemia?
less than 20%
71
What is ferritin?
protein for iron stores (like a bank or pantry)
72
What is happening in iron deficient anemia?
- pt is using more iron than what is being saved so pt needs to go to stores
- iron needs exceed intake & stores are depleted
- there are no stores & daily intake is not adequate to maintain hemoglobin levels
73
How do iron deficiency anemia symptoms usually come on?
onset of sx are gradual & appear at different times based on the individual
74
when may some people begin to experience sx?
when hemoglobin is around 7-8 g/dl
75
What are some manifestations of iron deficiency anemia?
- non-specific sx
- pica
- epithelial tissue damage occurs
- koilonychia
- pallor of conjunctiva
76
What is koilonychia?
the "spooning" of the nail bed
77
What do you check to dx iron deficient anemia?
- hemoglobin
- MCV/MCH/MCHC
- bone marrow biopsy/aspirate
serum iron profile
- iron
- TIBC
- transferrrin
- ferritin
78
what lab may be affected initially in iron deficient anemia?
ferritin
79
What may the MCV, MCH, & MCHC results be in iron deficient anemia?
MCV will be low (less than 80)
MCH/MCHC will also be low
80
How can you treat iron deficient anemia?
- iron salts: ferrous sulfate, ferrous gluconate
- orange juice to improve absorption
- carbonyl iron: pure elemental iron
- IV iron: dextran
81
What is the most common oral form of iron used?
ferrous sulfate
82
How much elemental ron does ferrous sulfate contain?
65mg
83
What are the side effects of ferrous sulfate?
- nausea
- heartburn
- constipation!
- black/dark green stool
- teeth staining
84
should you take ferrous sulfate with or without food?
with food
85
how can you help mitigate teeth staining when taking ferrous sulfate?
dilute in juice or other beverage
drink with straw
rinse mouth afterward
86
what should you avoid when taking ferrous sulfate?
avoid coffee, tea, soda, and all calcium-containing foods
87
concurrent administration of ferrous sulfate with antacids or tetracycline (increases/decreases) absorption
decreases
88
PPl and H2 blockers (decrease/increase) ferrous sulfate absorption
decrease
89
while slow-release ferrous sulfate is easier on the stomach, it is less effective. Why is that?
the acid in the duodenum protects the iron but the HCO3 from the pancreas can destroy it
90
What are the two options for IV iron?
- low molecular weight iron dextran
- ferric gluconate
91
how is IV ferric gluconate administered?
diluted in NNS & infused over 20-60 minutes depending on dose
92
What is done before a full dose of ferric gluconate is given?
a test dose (over 5 min) to be sure there is no reaction
93
What can ferric gluconate cause?
can cause prodromal sx & if bad, infusion is stopped & then often resumed
94
What are indications to receive IV iron?
- abnormal uterine bleeding
- postpartum
- inflammatory bowel disease
- chronic kidney disease
95
What are adverse effects that may occur with IV iron?
- hypotension
- anaphylaxis (triggered by dextran): less incidence with other forms of IV iron
96
What is the cause of megaloblastic anemia?
due to impaired DNA synthesis that causes ineffective erythropoiesis
- results in large stem cells that mature into large but fragile erythrocytes
- defective cells dying too early which decreases numbers in the circulation
97
What are CBC characteristic in megaloblastic anemia?
- anemia
- macrocytic
- normo or hyperchromic
98
What is megaloblastic anemia usually related to?
deficiencies in vitamin B12 & folic acid
99
When do megaloblastic anemia sx usually present?
when advanced, megaloblastic anemia has a slow progession
100
What is pernicious anemia a deficiency in?
vitamin B12
101
pernicious anemia is ____ if left untreated
fatal
102
why is pernicious anemia rare in the US?
vitamin B12 comes from animal products, milk & eggs
103
What is pernicious anemia thought to be?
an autoimmune disorder
104
What causes pernicious anemia?
- conditions that cause malabsorption of B12
- decreased intake of B12 products (vegans)
- defective gastric secretions of intrinsic factor from parietal cells of the gastric mucousa
- excessive alcohol use
105
B12 is needed for ____ ______ and nuclear maturity
DNA synthesis
106
What prevents abnormal fatty acids from affecting neural lipids which could result in myelin breakdown?
B12
107
Where does B12 come from?
animal sources
108
What does B12 bind to?
binds to intrinsic factor which is made from parietal cells in the stomach
109
What is necessary for B12 absorption?
intrinsic factor
110
Where is B12 released from intrinsic factor and crosses over to the blood stream?
the ileum
111
What does B12 bind to that takes it to the storage sites?
transcobalamin
112
What does type A chronic gastritis do?
destroys all cells that produce secretions in the stomach; affects B12 absorption
113
how do proton pump inhibitors affect vitamin B12?
decrease absorption; decrease in HCL-HCL needed for absorption
114
What are things that reduce or eliminate B12 absorption?
- anything that affects parietal cells
- autoimmune disorders or genetic changes
-H pylori infections
- excessive ETOH
- smoking
- hot tea ingestion
- gastrectomy
- gastric bypass
115
What are the clinical manifestations of pernicious anemia?
- classic S & S of anemia
- slow development so sx appear in advanced disease
- fatigue; mood swings
- anorexia; weight loss
- hyperbilirubinemia
- hepatosplenomegaly (in severe cases)
116
What are the neurologic sx with severe anemia (hbg <7)?
- parethesia of hands & fingers
- ataxia
- memory loss
- vision changes
- weakness, clumsiness, & an unsteady gait
- loss of proprioception
117
how can pernicious anemia be dx?
CBC w diff
- low H & H
- MCV will be >100
- MCHC/ MHC will be normal
vitamin B12 levels
intrinsic factor
antibodies to parietal cells & IF will be found
bone marrow aspiration
118
How do you tx pernicious anemia?
vitamin B12
oral, if deficiency is not the problem
- prefered route
injection, if deficiency is the problem
- can be SQ, IM, or intranasal
119
How do you know treatment for pernicious anemia is working?
will know treatment working by rising reticulocyte count and should normalize in 6 weeks
120
What kind of anemia is caused by folic acid deficiency?
megaloblastic anemia (macrocytic & normochromic)
121
What is folic acid needed for?
DNA synthesis & red cell maturation (thymine & adenine)
122
is folic acid or B12 deficiency more common?
folic acid
123
What does folic acid deficiency lead to?
large ineffective RBC
124
In what foods is folic acid found?
- vegetables
- fruits
- cereals
- meat (lost in cooking)
125
How much folic acid is stored in the body?
500-20,000 mcg
126
How much folic acid is needed per day?
50-100 mcg/day
127
how quickly does dietary deficiency of folic acid result in anemia?
within a few months
128
Who are at risk for folic acid deficiency?
- pregnant & lactating women
- alcoholics
- fad diets
- individuals with celiacs or IBS
- those with chronic inflammatory disorders
129
Why are pregnant/ lactating women at risk for folic acid deficiency?
need increaes 5-10x. folic acid is needed for neural tube development
130
Why are alcoholics at risk for folic acid deficiency?
interferes with folate metabolism
131
why are those on fad diets at increased risk for folic acid deficiency?
decrease folate intake
132
What kind of chronic inflammatory diseases can result in folic acid deficiency?
- rheumatoid arthritis
- tuberculosis
- psoriasis
- bacterial endocarditis
- systemic infections
133
What are clinical manifestations are seen in megaloblastic anemia related to folic acid?
classic S&S of anemia
no neurologic sx
manifestations r/t malnourishment
- cheilosis
- stomatitis
- burning mouth syndrome
- dysphagia
- flatulence
- GI disturbances
undiagnosed IBD
134
how is folic acid deficiency diagnosed?
CBC
- changes in indices before hemoglobin
- MCV> 100
- MCHC & MHC normal
folic acid levels will be low
135
What is required for folic acid to be converted to active form?
B12
136
What are the two forms of folic acid that can be given?
active
inactive
137
is active or inactive folic acid more commonly given?
inactive
138
how can inactive folic acid be given?
folate (oral)
can be PO, IV, SQ, IM
treat with supplementation
139
What should you be monitoring when treating folic acid deficiency?
hemoglobin & reticulocyte count
140
What does aplastic anemia result from?
- breakdown in production in bone marrow stem cells that inhibit growth of RBC, WBC, & platelets
- a failure of the marrow to replace the senescent red cells as they are destroyed & leave the circulation
141
What is the cell size and color like in aplastic anemia?
normal size & normal color
142
What does aplastic anemia usually present as?
infection or bleeding
143
Why does aplastic anemia present as infection or bleeding opposed to anemia?
since WBC & platelets have a shorter life span
144
What is the onset of aplastic anemia usually like?
can be abrupt or gradual
145
What are causes of aplastic anemia?
- radiation exposure
- chemotherapy: inhibits hematopoiesis
- chemicals: benzene
- viral illness such as hepatitis, mono, HIV
- pregnancy
cytokines suppress normal stem cell development
146
cause of aplastic anemia is unknown in about _____ of cases
2/3
147
How is aplastic anemia dx?
CBC shows pancytopenia
WBC count <200: increasing risk for opportunistic infections
RBC: normocytic & normochromic
148
How do you treat aplastic anemia?
treat the cause
149
What may be needed to treat aplastic anemia?
BM transplant
immunosuppressive therapy
prophylactic antibiotics
platelet, RBC, or WBC transfusions
150
What are symptoms of aplastic anemia?
- infection
- present with fatigue, weakness, pallor
- petechiae/purpura
- ecchymosis
- bleeding from body orifices
151
who are the ideal donors for bone marrow transplants?
siblings
152
What are the two bone marrow stimulants that can be used to treat aplastic anemia?
filgrastim (Neupogen)
epoetin-alfa (epogen)
153
How long do bone marrow stimulants take to work?
about a month
154
What are the 4 ways hemolytic anemia is aquired?
- drug reactions
- infections
- transfusion reactions
- ABO or Rh factor incompatibility of mother or fetus
- autoimmune disease
155
What is hemolytic anemia cause by?
premature or accelerated destruction of RBCs
156
What are the inherited forms of hemolytic anemia?
structure deficits
enzyme deficiencies
defects in globin synthesis or stucture
- sickle cell
- thalassemia
157
How many people are affected by sickle cell in the US?
over 70k
158
What ethnicities have the highest concentration of sickle cell?
black people, middle eastern people, and Mediterranean people
159
How many births result in sickle cell?
1: 400-500
160
What is the cause of sickle cell?
inherited defect of hemoglobin S leads to hemolytic anemia & chronic organ damage
161
if someone has a defective sickle cell gene from 1 parent what are they considered?
a carrier; they do not have sickle cell
162
What must happen for someone to have sickle cell anemia?
must inherit the defective gene from both parents
163
sickle cell usually causes little problem when properly ___________
oxygenated
164
What happens when oxygen drops in sickle cell?
fluid polymers realign and cause cells to sickle
165
What does sickle cell depend on?
- hydration
- PH
- oxygenation
166
What do sickled cells do?
plug the blood vessels; increase the viscosity
167
What can sickled cells lead to?
- occlusion of the vessels
- pain
- infarction
- pool in the spleen and hemolysis & can infarct vessels in the spleen
168
Sickling is not always _________ as the other chains are normal and will produce ___________ ___
permanent; hemoglobin A
169
When do sickled cells return to normal?
after rehydration & oxygenation
170
What happens if plasma membrane damage occurs in sickle cell?
cell is irreversibly sickled
171
The higher the number of cells with hgb S the higher the risk for ___________ sickling - up to even __%
irreversible; 30%
172
do people with the sickle cell trait experience sx?
NO
173
Are infants affected by sickle cell anemia?
infants are initially okay because the primary component of their hemoglobin is Hgb F. it takes a few months for hbg S to take over
174
What are the three main crisis' that result from sickle cell?
vaso-occlusive crisis
sequestration crisis
aplastic crisis
175
What happens during a vaso-occlusive crisis?
- sickling in microcirculation
- obstruction of blood flow
- creates a log jam; no blood can move through the vessel
176
what can a vaso-occlusive crisis cause?
severe pain
can lead to CVA or MI
177
How long can a vaso-occlusive crisis last?
days to weeks
178
What happens during a sequestration crisis?
- large amounts of blood pool in the liver & spleen
- causes CV collapse as 20% of blood can pool in the liver/spleen
179
in what age group do sequestration crisis' occur?
small children
180
what is an aplastic crisis?
- extreme anemia from decreased RBC count
- sickled RBC only lives for 10-20 days
- compensatory mechanism in place but if dysfunctional aplastic anemia occurs
181
How is sickle cell dx?
- mandatory screening at birth using electrophoresis which identified the HB F from the hb A and hbS
- mandatory screening in college athletes NCAA regulations
182
How can you treat sickle cell?
- prevent complications & crisis
- hydroxyurea: produces more hbF & therefore displaces the hbS
- anticoagulants
- decrease inflammatory response
- pain management
