Anemia Flashcards
What cell is a biconclave disc with no nucleus and contains hemoglobin which colors the cell red?
The Red blood Cell
Anemia is just a ________, the way you get anemia is the diagnosis.
Symptom
What is the definition of anemia?
blood oxygen levels are too low to support normal metabolism; lower than normal oxygen-carrying capacity
icrocytic
small cells
macrocytic
where the cells are too big
deficiency related anemia
from lower than needed levels of something (ie. bleeding may cause iron deficecny anemia)
Congenital anemia
Born with it (sickle cell)
hypochromic
less than pale red blood cell
production releated anemia
inability to produce cells, low in EPO
destruction related anemia
hemolytic anemia the cells lyse
What is the normal cycle of Erythropoiesis from the stimulus of Dec blood oxygen?
When the kidneys sense low blood oxygen it inc the production of erythropoietin (EPO) which travels to the bone to inc the production of red blood cells, which contain hemoglobin to carry more oxygen
What are the 7 factors needed for erythropoiesis?
EPO, Iron, Vit B12, Folic Acid, Ascorbic Acid, Pyridoxine, Amino Acids
What is normal hematocrit?
Just the Red blood cells, not the plasma or WBC or platelets; it normally around 50 for males and 45 for females
When diagnosis anemia you should first take labs and then ask about symptoms because the symptoms can be very general
True
What are some clinical symptoms of iron deficiency?
pallor of the face, lips, and tongue; atrophic glossitis and angular stomatitis
Iron deficiency anemia results from 3 things, list them.
1) a secondary result of bleeding
2) inadequate intake of iron-containing foods
3) Impaired iron absorption
What is pernicious anemia and what does it result from? What type of diet can contribute to this type of anemia?
a deficiency of vit B12 in the serum;
Results from: 1) deficiency of vit B12
2) lack of intrinsic factor needed for absorption of B12
Vegan diets
How can you get folic acid deficiency anemia?
From dec intake or absorption
What two types of anemia cause abnormal hemoglobin?
Thalassemias and Sickle-cell anemia
What causes Thalassemias?
absent or faulty globin chain in hemoglobin
What do the RBCs in thalassemias look like?
thin, delicate, and deficient in hemoglobin
What is skickle cell anemia and what causes it?
RBCs are sickle shaped in low oxygen conditions because it has a defective gene coding for an abnormal hemoglobin called hemoglobin S (HbS) that is a since amino acid subsitiution in the beta chain
What is polycythemia?
excess RBCs which cause viscosity
What are some risk factors of iron deficiency anemia?
age, sex, reporduction, renal fialure, GI tract issues, apsiran and NSAIDs, diet (vegetarians), pregnancy, infancy, breast feeding
Does iron def anemia affect: males or females more; young or old more; accompanies cancer or CDK?
females>males
old>young
Cancer and CDK
When iron intake is low, where does the body get the neccessary iron first?
The iron stores, then the circulating iron, then the red blood cell iron.
What happens to the serum ferritin as you begin to lose all your iron stores?
it begins to go down
What happens to the total iron binding capacity as you lose iron?
it begines to go up
In what order is iron restored to the body?
The RBCs first, then the serum ferritin, then the bone marrow stores.
What happens if you get too much iron in your system?
You begin to overflow your stores and you being to have symptoms of anemia but your arent anemic
Too much iron is called ____________-
hematochromotosis
What is normal Hgb?
13-14
What is normal MCV?
80-100
If someone is low MCV what is the next thing that needs to be done?
Check for ferritin stores
What could cause iron deficiency anemia?
blood loss
What does RDW tell us?
Variation of size of cells this can tell us that regular cells are mixedi n with abnormal cells and can tell if the anemia is early on
What is normal hemoglobin for males?
15.2 +/- 2 mg/dl
What is normal hemoglobin for females?
13.5 +/- 2 mg/dl
Low HgB indicateds ______ while high HgB indicates ________.
1) anemia
2) polycythemia
WHat is the normal hematocrit for males an females?
males: 46 +/- 6%
females: 41.0 +/- 6%
What is the normal RBC for females and males?
males: 4.3-5.9 million/uL
females: 4.0-5.2 million/uL
What is the normal MCV for makes and females?
Males: 80-96
females: 82-98
Large cells are caused by _______ and small cells are caused by _______.
B-12 or folate deficiecny
Fe deficiency
If you have microcytic you could have _______ deficiency or _______ or _________
iron; thalassemias, underlying chronic disease
What is MCH?
mean Cell hemoglobin
Iron deficiecny has low MCH and low MCHC. TRUE or FALSE?
TRUE
In folate decificecy is MCH inc or dec?
increased
What are reticulocytes?; take about 1 day to mature. Under the influcence of EOP take 2-3 days longer because of early release
young RBC that still conatins a small amount of RNA
The retic count should be ____ of total RBC count.
1/120th
What is normal ferritin levels? This is the most sensitive lab test for iron
30-400ng/ml for males
13-150ng/ml
What is Total iron binding capactiy (TIBC)?
shows if there is too much or too little iron in the blood.
What is the normal TIBC?
240-450 mcg/dL
Iron is carried in the blood attached ot the protein ________.
transferrin
High values of TIBC mean what?
Fe deficiency, pregnancy
What are the normal values of Serum Iron?
60-170mcg/dL
When are serum iron levels the highest?
In the morning
80% of normal bilirubin production is a result of the degradation of ________.
hemoglobin
In the absence of liver disease, indirect bilirubin is an ecellent indicator of RBc destruction. T or F?
True
What is the normal Serum Iron?
115 ug/dL
What is the normal Total iron binding capacity?
330
What is the normal Transferrin satuation %?
35
What is normal Serum Ferritin?
100
Erythrocytes
Normal
Stainable marrow Iron
2+
For oral replacement, ___ mg elemental Iron/day is best because only 5-20% is absorbed in the iron-deficient state.
200mg
Ferrous fumarate has how much ferrous iorn?
200mg (65 elemental)
Ferrous gluconate has how much Iron?
300mg (35mg)
If nausea, with iron how do you aleviate it?
Give with food
How much Iron is in the following:
Ferrous Sulfate
Ferrous gluconate
Ferrous fumarate
65mg
39mg
33mg
What are the oral Iron products ADRs?
Abdominal pain Nausea Heartburn Constipation Dark stools
Should u use child-proof caps for pts taking iron?
Yes, 8 caps to a child is leathal
How long is therapy for Iron therapy?
4-6 months
How long can it take for iron therapy to respond?
7-14 days; Anemia begins to correct after 3wks; Hg correction takes about 2 months
What are some causes of tx failure with oral iron?
poor compliance
poor absorption or oral iron
wrong diagnosis
What are some IV options for Iron?
Ferrus Dextan
Iron Saccharate
Ferric Gluconate
When are IV doses of Iron used?
When pt doesnt respond to Oral doses or can’t tolerate oral products
What are the dosses of Iron Dextran, Iron sucrose and ferric gluconate?
Iron Dextran: InFED: 50mg/ml
Iron sucrose: Venofer: 20mg/ml
Ferric gluconate: Ferrlecit: 62.5mg/5mL
For chronic kidney disease, which IV formulations are approved?
Dextran
iron sucrose
ferric gluconate
For Iron deficiency which IV iron product is approved? How long is it infused over? Is a test dose required and what do you monitor for?
Iron Dextran; 4-6 hours
Yes 0.5mL of iron dextran test dose is needed an you monitor for anaphylaxis for 1 hour
What three values will really let you know if it is Iron Deficeecy Anemia or Anemia of Chronic Disease?
Serum Ferritin
Serum Iron
TIBC
MCV?
What are the two main types of megaloblastic anemia?
Folate Vit B12 (pernicious, deficient)
What are some symptoms of megaloblastic anemia?
LARGE CELLS Low retic count bilirubin is inc Fatigue sore pale constipation diarrhea anorexia edema urticaria worsening of pulmonary or cardiac conditions smooth tongue
Lack of ____ or _____ prevents formation of DNA so RBC production does not occur or occurs abnormally
Folate or Vit B12
What is pernicious anemia?
anemia caused by an autoimmune disease that destroys the parietal cells of the stomach that then doesn’t product intrinsic factor to help absorb vit B12
How do your test if its B-12 or folic acid anemia?
Serum B12 levels
or
Serum Folate levels
Red Cell folate
What is big beefy tongue a side effect of?
Vit B12 or folic acid
How do you tx Pernicious Anemia?
replace B12 stores with 30-100mcg of cyanocobalamin IM or SQ daily for 2-3 weeks
Long term replacement therapy with IM cyanocobalamin every 2-4 weeks (dose is 100-200mcg)
Oral B12 is not available in US
What is prevention of pernicious anemia?
post-gastrectomy pts should be given replacement therapy to prevent deficiency
What are some medications that alter B12?
Colchincine KCl PPIs Anticonvulsants neomycin
What causes Folic acid macrocytic anemia?
inadequate folate intake alcoholics teenagers some infants malabsorption impaired metabolism
What drugs cause malabsorption of folic acid?
barbituarates
phenytoin
oral contraceptives
What drugs cause impaired metabolism of oflic acid?
methotrexate
Do you need folate during pregnancy?
yes
How do you increase your folate consumption?
Green leafy veggies
How do you replace Folic acid deficiency?
You need 5-10mg of folic acid
Oral folic acid 1mg PO QD for 2-3 weeks will replace stores
how long does it take to inc retic and Hct?
retic - 5-10 days
Hct - 2-4 weeks
What drugs cause a dec in absorption of folate?
PEP BIC Phenytoin Ethanol Primadone Barbiturates INH COC with mestranol
What drugs antagoize folate?
PPTTM Pyrimethamine Pentamidine Triamterene Trimethoprim Methotrexate
What is a common cause of microcytic anemia?
Thalassemai and iron deficiency
Is thalassemia deadly?
if homozygous, yes
How do you tell the difference between IDA and Thalassemia?
Iron in marrow
and low iron levels (iron is normal for Thalassemia)
What are some adverse effects of Epogen?
HTN,Seizures,Allergic reactions, thrombosis
how fast should your Hgb inc when on EPOGEn?
1g/dL ever 2 weeks
If GFR declines does the dose requirement for EPOGEn increase?
yes (kidney produces EPO)
What do you monitor when on EPO?
HTN, Hgb, Iron
