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old patho 154 > anemia > Flashcards

anemia Flashcards

1
Q

acute anemia

A

is a rapid loss of blood (RBC and Hgb)

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2
Q

acute hemmorhagic anemia: severity depends on

A

site, rate and volume lost

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3
Q

Chronic hemmorhagic anemia: is?

etiology

A

gradual ongoing loss of blood
(it may not be very noticeabe)

Et:

  • prolonged or heavy menses
  • bleeding peptic ulcers
  • cancerous lesions in GI tract
  • hemmorhoids
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4
Q

Tx of hemmorhagic anemia

A

eliminate cause

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5
Q

what is it: sickle cell anemia

A

it is a genetic problem.
Recessive homozygous trait
If heterozygous it is sickle cell trait

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6
Q

what are the three types of HB

A

fetal hemoglobin has a higher affiity for oxygen
adult hemoblogin also exists
sickle cell hemoglobin (in his notes HB S)

It is the globin that varies (the amino acid)

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7
Q

how is HB S differe;nt than HB A

A

Hb S is 50x less soluble

HB S has valine instead of glutamic acid in the beta chain

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8
Q

what is the problem with HB S

A

no problem binding to oxygen in lungs
dissociation nthe tissues is normal
the problem occurs after the oxygen dissociation. The HB crystallizes.

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9
Q

How does the HB S change to sickle

A

the HB S crystallizes on dissociation at low P02->RBC deforms and sickles->chronic hemollysis->vessel occlusion->ischemia->infarction->obstructed capillaries->hypoxia->more sickling

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10
Q

how is SCA lead to a vicious cycle

A

inc viscosity->impaired circulation->occlusion and further hypoxia->more RBCs sickle->vicious cycle

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11
Q

once the Hb has changed shape and sickled what happens to it

A

it will have difficulty moving through the capillaries. Because the cells are abnormal the will be destroyed by hemolysis. All problems from hemolytic anemia will apply

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12
Q

in SCA is there a problem in the marrow? how is RBC production affected

A

no problem there. RBC production wont increase

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13
Q

mnfts of SCA

A

hemolysis
thrombosis and infarction (nonloacalized)
inc bilirubin

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14
Q

SCA Tx

A
  • supportive (rest, oxygen, analgesics, IV fluids and electrolytes)
  • hypertransfusion when pt is at inc risk (eg during surgery, pregnancy) give until pt has 75% donor blood in circulation
  • hydroxyurea. Ths is hepatotoxic and toxic to marrow. It is used for cancer but it is also known to cause leukemia. When used in SCA
    1. it facilitates the transformation of HB
    2. it prevents hemolysis and sickling
  • marrow or stem cell transplant
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15
Q

what is the most common blood disorder

A

anemia

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16
Q

whats anemia

A

hgb or RBC deficiency

17
Q

etiology of anemia

A
  • defective erythropoiesis
  • high hemolysis
  • high loss
18
Q

patho of anemia

A

abnormal Rbc number, structure or fx which causes dec oxygen carrying capacity and leads to hypoxia

19
Q

mnfts of anemia

A

-hypoxia (underying problem that is systemic)
-moderate:
dyspnea (whenver youve hypoxia you will end up with dyspnea which is beneficial, you will also have tachycardia which is beneficial but may cause
palpitations
chronic fatigue

-severe: chronic exhaustion, more palpitations, profound weakness, dizziness & headache (rt the hypoxia), sensitivity to cold (this is because of the lack of energy that would normally be produced in 3 or 4 steps of aerobic cellular respn. 70% of the metabolic heat produced is used to heat the body. the other 30% are for ATP produced

20
Q

what complications could arise from anemia

A

potential acidosis

21
Q

iron deficiency anemia what would you test in the blood

A

ferritin levels

22
Q

why does a lack of iron cause anemia

A

iron is part of the Hb molecule

23
Q

why is CBC not a useful test for iron def anemia

A

it will tell you the number of cells and the difffeerential but it doesnt have info abt iron

24
Q

tx for iron deficiency anemia

A

underlying cause

iron PO for 4-6 months

25
Q

folic acid and vitamin b12 deficiency how does this lead to anemia?
-tx?

A

B12 and folic acid are nec for DNA synthesis and cell division
->abnormal DNA synthesis and cell division-> impaired RBC, WBC and platelets

Tx: vitamin B12 and folic acid

26
Q

where are erythrocytes produced

how long do they survive

A

they are produced int he red bone marrow of long bones

survive 120 days

27
Q

how many RBCs do we produce

A

180x10^6 per minute (million)

28
Q

what do RBCs transport and not transport

A

they transport 02 which is not a nutrient. they dont transport nutrients

29
Q

Pernicious anemia

what is it

A

damaged gastric mucosa->no intrinsic factor->poor or no vitamin B12 absorption->RBC rpoduction is impaired

30
Q

what is intrinsic factor

A

its a glycoprotein prod by parietal cells of stomach nec for absorption of B12 in the ileum (sm intestine)

31
Q

what might cause P.anemia

A

stomach ulcers, infection in stomach,

32
Q

P. anemia Tx

A

they used to give small doses and? or? parenterally
now they give high dose of vitamin B12 by mouth

its given IM only if there are neurologic symptoms present

33
Q

aplastic anemia

A

all the nec components are present but there is a marrow failure which affects all blood cells
1/3 of the itme it is dt autoimmune issues, radiation, toxic chemicals
2/3 are idiopathic

34
Q

aplatic anemia tx

A

mgmt is difficult

underlying cause
transfusions? (cant continuously transfuse)
marrow transplant in severe cases (they would remove the existing marrow and completely replace)

35
Q

hemolytic anemia is…

Et

A

premature or excessive hemolysis
1/2 acquired (eg autoimmunity, drugs)
1/2 genetic (eg in thalassemia)

36
Q

thalassemia

A
  • is an autosomal recessive blood disorder

- affects either the alpha or beta globin chains-> hgb isnt formed properly. There is an enzyme missing

37
Q

hemolysis process

A

older RBCs make less ATp and cant maint membrane->fragile->get trapped in narrow vessels of spleen->engulfed by macrophages then get broken into iron, heme, globin.
The globin is reused but the heme and iron are taken to liver and transformed there.
The heme which as transformed into bilirubin can deposit in tissues if theres excess hemolysis.

38
Q

how does hemolysis present clinically

A

presents in sclera, skin may be yellow

spleenomegaly and liver inc in size

39
Q

how do yu Tx hemolyti anemia

A

underlyiing cause
give oxygen if hypoxic
transfuse
steroids-inhibits hemolysis
renal fx (precipitation in renal tubule dt hemolysis)
splenectomy???-if hemolysis is occurring here

old patho 154 (18 decks)

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