Anemia Flashcards
What is the formation of hemoglobin
succinyl coA and glycine form Pyrroles -> 4 pyrroles form protoporphyrin IX -> Addition of iron forms Heme -> Addition of globin polypeptide completes a subunit -> **4 subunits usually 2 alpha, 2 beta in adults combine to form hemoglobin
Define anemia
Abnormally low number of circulating red blood cells or level of hemoglobin, or both, resulting in diminished oxygen-carrying capacity; a sign NOT a disease
What is the manifestations of Reduced O2 Carrying Capacity
1] Impaired oxygen transport, 2] Reduced red cell indices/Hgb, 3] Signs and symptoms of disease causing anemia
What is the red cell indices
indicators of red cell health and function, done w Hgb…this is a special test
What are the typical causes of anemia?
1] red cell loss (hemolysis/hemorrhage), 2] deficient erythropoiesis, 3] deficient hemoglobin production
What is an example of deficient erythropoiesis
*CKD, bc lack of EPO and red cell production. Too few cells.
What is an example of Low hemoglobin and red count.
GI bleed, fecal occult blood. hemophilia, GIB, women of reproductive age who bleed
If hemoglobin is abnormal what can that indicate?
there is a production issue. eg) Fe deficiency, B12, folate deficiency
What is Hereditary spherocytosis
round red cells are round instead of biconcave –> get trapped more often causing hemolysis
What are the effects of hypoxia
1] Fatigue, 2] Weakness, 3] Dyspnea, 4] Angina, 5] HA (morning), faintness, dim vision (tunnel or less acuity)
Why does angina occur due to hypoxia
body response to low oxygen, incr HR, resp drive, metabolic demand (including on the cardiac muscle), murmurs and angina may show up.
What is the manifestation of blood redistribution when oxygen starved
force blood into the core to support vital organs results in Pallor of skin, mucus membranes, conjunctiva, nails
What is blood loss
Can be Acute or chronic, Fluid enter compartment, dilutes blood, Hgb/Hct fall with normal cell morphology
What is acute blood loss
think hypovolemic/shock due to bleeding
What is chronic blood loss
Chronic loss leads to iron deficiency anemia over time, no volume depletion (microcytic anemia), the slower the blood loss the more you can tolerate it, their hemoglobins will go very low. GIB HgB of 4 compared to trauma pt with HgB of 10.
What is Hemolytic anemia
1] Usually normocytic/normochromic, 2] Increased reticulocyte count, 3] Possible jaundice
What is the pathophysiology of hemolytic anemia
loss of red cells results in the body pushing more of the reticulocytes into the bloodstream faster
What is Hereditary spherocytosis
Autosomal dominant transmission that results in Deficiency of red cell membrane proteins (spectrin, ankyrin). Red cell loses surface area throughout lifespan. Characteristic shape lost, spheres remain, Spherical shape leads to destruction = shorter lifespan/faster turnover =anemia
What are the signs of Hereditary spherocytosis
jaundice, splenomegaly, bilirubin stones
What is aplastic crisis
Aplastic crisis when red cell production disrupted as by virus or metabolic crisis and the bone marrow shuts down
What is the treatment of Hereditary spherocytosis
Tx with splenectomy, bc this is where the cells are getting degraded to frequently, so if you take out the spleen, the cells will last longer.
What is Sickle Cell Anemia
transmitted by recessive pattern results in Point mutation in beta chain of hemoglobin, abnormal substitution. 40% sickling with heterozygotic trait; 80-95% sickling in homozygote
What causes the sickling?
Low oxygen tension, can be brought on by Cold, Stress, Exertion, Infection, Hypoxia, Dehydration, Acidosis
What are the 2 results of sickle cell anemia?
chronic hemolytic anemia, blood vessel occlusion
What is thalassemia A
result of deletion of alpha subunit on Chromosome 16. In severe disease Hgb H formed.
What is thalassemia B
usually caused by point mutations in β subunit. Relative increases in *Hgb A2 and F. Excess alpha chains unstable and precipitate causing cell damage. Prevalent in Mediterranean ppl.
