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Patho II > Anemia > Flashcards

Anemia Flashcards

1
Q

Anemia: A deficiency in the …

A
  • Number of erythrocytes (red blood cells [RBCs])
  • Quantity of hemoglobin
  • Volume of packed RBCs (hematocrit)
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2
Q

Anemia: Gerontological Considerations

A
  • Common in older adults
  • Chronic disease
  • Nutritional deficiencies
  • Signs and symptoms may go unrecognized or mistaken for normal aging changes
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3
Q

Anemia: Causes

A

Blood loss
Impaired production of erythrocytes
Increased destruction of erythrocytes

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4
Q

Anemia: Groups

A 
Morphological:
• Cellular characteristics
• Descriptive, objective laboratory
information 
Etiological:
• Underlying cause
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5
Q

Anemia: Clinical manifestations

A
  • Caused by the body’s response to tissue hypoxia

* Hemoglobin (Hb) levels are used to determine the severity of anemia

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6
Q

Anemia: Clinical manifestations, Mild + Moderate

A 
Mild = Hb 100-140 g/L
• May exist without symptoms 
• Possible symptoms
• Palpitations, dyspnea, diaphoresis 
Moderate = Hb 60-100 g/L
• ↑ Cardiopulmonary symptoms
• Experienced at rest or during activity
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7
Q

Anemia: Clinical Manifestations, Severe (Body Systems)

A

Severe = Hb

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8
Q

Anemia: Integumentary Manifestations

A
  • Pallor
  • ↓ hemoglobin
  • ↓ blood flow to the skin
  • Jaundice
  • ↑ concentration of serum bilirubin
  • Pruritus
  • ↑ serum and skin bile salt concentrations
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9
Q

Anemia: Cardiopulmonary Manifestations

A
  • Additional attempts by the heart and lungs to provide adequate O2 to the tissues
  • Cardiac output maintained by ↑ the heart rate and stroke volume
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10
Q

Iron-Deficiency Anemia

A
  • One of the most common chronic hematological disorders
  • Iron is present in all RBCs as heme in hemoglobin and in a stored form
  • Heme accounts for two thirds of the body’s iron
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11
Q

Iron- Deficiency Anemia: Etiology

A
  • Inadequate dietary intake
  • 5-10% of ingested iron is absorbed
  • Malabsorption
  • Blood loss
  • Hemolysis
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12
Q

Iron-Deficiency: Clinical Manifestations

A
  • General manifestations of anemia
  • Pallor is the most common finding
  • Glossitis is the second most common
  • Inflammation of the tongue
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13
Q

Iron-Deficiency Anemia: Diagnostics

A
  • Laboratory findings
  • Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets
  • Stool test for occult blood
  • Endoscopy
  • Colonoscopy
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14
Q

Megaloblastic Anemias

A
  • Group of disorders caused by impaired DNA synthesis
  • Characterized by the presence of large RBCs (megaloblasts)
  • Majority result from deficiency in • Cobalamin (vitamin B12)
  • Folic acid
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15
Q

Megaloblastic Anemias: Classification

A
  • Cobalamin (vitamin B12) deficiency
  • Folic acid deficiency
  • Drug-induced suppression of DNA synthesis
  • Inborn errors
  • Erythroleukemia
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16
Q

Cobalamin Deficiency

A

• Intrinsic factor (IF)
• Protein secreted by the parietal cells of the
gastric mucosa
• IF is required for cobalamin absorption in the small intestine

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17
Q

Cobalamin Deficiency: Causes

A
  • Pernicious anemia
  • Insidious onset
  • Nutritional deficiencies
  • Hereditary enzymatic defects
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18
Q

Cobalamin Deficiency: Etiology

A 
• Absence of IF
• Acid environment required for IF
secretion
• GI surgery
• Long-term users of H2-histamine receptor blockers
19
Q

Cobalamin Deficiency: Clinical Manifestations

A
  • General symptoms of anemia
  • Sore tongue
  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal pain
20
Q

Cobalamin Deficiency: Neuromuscular Manifestations

A
  • Weakness
  • Paresthesias of the feet and hands
  • ↓ Vibratory and position senses
  • Ataxia
  • Muscle weakness
  • Impaired thought process
21
Q

Cobalamin Deficiency: Diagnostics

A
  • RBCs appear large
  • Abnormal shapes
  • Structure contributes to erythrocyte destruction
  • ↓ Serum cobalamin levels
  • Normal serum folate levels and ↓ cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency
  • Schilling test
22
Q

Folic Acid Deficiency

A
  • Also a cause of megaloblastic anemia
  • Folic acid is required for DNA synthesis
  • RBC formation and maturation
23
Q

Folic Acid Deficiency: Common Causes

A
  • Poor nutrition
  • Malabsorption syndromes
  • Drugs
  • Alcohol abuse and anorexia
  • Lost during hemodialysis
24
Q

Folic Acid Deficiency: Clinical Manifestations

A
  • Clinical manifestations are similar to those of cobalamin deficiency
  • Insidious onset
  • Absence of neurological problems
  • Treated by replacement therapy
  • Encourage client to eat foods with large amounts of folic acid
25
Q

Anemia of Chronic Disease

A
  • Underproduction of RBCs

* Mild shortening of RBC survival

26
Q

Anemia of Chronic Disease: Causes

A
  • End-stage renal disease
  • Primary factor, ↓ erythropoietin
  • Chronic liver disease
  • Chronic inflammation
  • Malignant tumours
  • Chronic endocrine diseases
27
Q

Anemia of Chronic Disease: Findings

A

Anemia of chronic disease findings:
• ↑ Serum ferritin
• ↑ Iron stores
• Normal folate and cobalamin levels

28
Q

Anemia of Chronic Disease: Treatment

A
  • Treating underlying cause is best
  • Rarely blood transfusions
  • Erythropoietin therapy
29
Q

Aplastic Anemia

A
  • Pancytopenia
  • ↓ of all blood cell types
  • RBCs
  • White blood cells (WBCs)
  • Platelets
  • Hypocellular bone marrow
30
Q

Aplastic Anemia: Etiology

A
  • Low incidence
  • Affecting 4 of every 1 million persons
  • Manageable with erythropoietin or blood transfusion
  • Can be a critical condition
  • Hemorrhage
  • Sepsis
31
Q

Aplastic Anemia: Clinical Manifestations

A
  • Gradual development
  • Symptoms caused by suppression of any or all bone marrow elements
  • General manifestations of anemia
  • Fatigue, dyspnea
32
Q

Aplastic Anemia: Diagnostics

A
  • Confirmed by laboratory studies

* Normocytic, normochromic anemia

33
Q

Acute Blood Loss

A

Result of sudden hemorrhage
• Trauma
• Complications of surgery
• Disruption vascular integrity

34
Q

Acute Blood Loss: Concerns

A
  • Hypovolemic shock
  • ↑ Plasma volume
  • ↓ O2 due to ↓ RBCs available
35
Q

Acute Blood Loss: Clinical Manifestations

A
  • Cause
  • Body’s attempt to maintain an adequate blood volume and O2
  • Pain
  • Internal hemorrhage
  • Retroperitoneal bleeding
  • Shock is the major complication
36
Q

Acute Blood Loss: Diagnostic Tests

A

• Laboratory data do not adequately assess RBC problems for 2-3 days

37
Q

Chronic Blood Loss: Decreased Iron

A

↓ Iron stores
• Bleeding ulcer
• Hemorrhoids
• Menstrual and post-menopausal blood loss

38
Q

Hemolytic Anemia

A
  • Destruction or hemolysis of RBCs at a rate that exceeds production
  • Third major cause of anemia
  • Intrinsic hemolytic anemia
  • Abnormal hemoglobin
  • Enzyme deficiencies
  • RBC membrane abnormalities
39
Q

Hemolytic Anemia

A

• Jaundice
• Destroyed RBCs cause ↑ bilirubin
• Enlarged spleen and liver
• Hyperactive with macrophage phagocytosis
of the defective RBCs
• Accumulation of hemoglobin molecules can obstruct renal tubules
• Tubular necrosis

40
Q

Sickle Cell Disease (SCD)

A
  • Group of inherited, autosomal recessive disorders
  • Presence of an abnormal form of hemoglobin in the erythrocyte
  • Hemoglobin S (HbS), abnormal
41
Q

Sickle Cell Disease (SCD)

A
  • HbS causes the RBC to stiffen and elongate
  • Sickle shape in response to ↓ O2 levels
  • Substitution of valine for glutamic acid on the β-globin chain of hemoglobin
  • Genetic disorder
  • Incurable disease, often fatal
42
Q

SCD: Clinical Manifestations

A
  • Typical client is asymptomatic, except during sickling episodes
  • Symptoms can be
  • Pain and swelling
  • Pallor of mucous membranes
  • Fatigue
43
Q

SCD: Complications

A
  • Gradual involvement of all body systems
  • Usually fatal by middle age from renal and pulmonary failure
  • Prone to infection
  • Pneumonia, most common infection
44
Q

SCD: Diagnostics

A
  • Peripheral blood smear
  • Sickling test
  • Electrophoresis of hemoglobin
  • DNA testing
  • Skeletal x-rays
  • Magnetic resonance imaging (MRI)

Patho II (9 decks)

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