Anemia

Question 1

anemia

Answer 1

• most common blood disorder

- RBC and/or Hgb deficiency

Question 2

etiology

Answer 2

• defective erythropoiesis
• excessive hemolysis
• excessive loss (ex. hemorrhage)

Question 3

pathophysiology

Answer 3

• abn RBC number, structure or function = decreased O2 carrying capacity = hypoxia

Question 4

mnfts of mild anemia

Answer 4

• hypoxia causes all S&S

- often not detected

Question 5

mnfts of moderate anemia

Answer 5

• chronic fatigue
• dyspnea
• palpitations

Question 6

mnfts of severe anemia

Answer 6

• chronic exhaustion
• profound weakness
• excessive palpitations
• dizziness
• headaches
• sensitivity to cold

Question 7

iron-deficiency anemia

Answer 7

• high prevalence
• O2 binds to the Fe atom on Hgb, so if this is deficiency there is a reduced O2 carrying capacity of the Hgb
• inadequate intake of Fe (from diet) or excessive loss of Fe

Question 8

iron-deficiency anemia test

Answer 8

• CBC inadequate (determines anemia present but not specific to low Fe)
• Ferritin test –> a blood cell protein that contains iron, determines iron storage

Question 9

iron-deficiency anemia Tx

Answer 9

• treat underlying cause

- supplement Fe w/ oral pills for 4-6mo

Question 10

Vit B12 & Folic acid deficiency

Answer 10

• deficiency in either Vit B12 or Folic acid = abn DNA synthesis –> impaired WBC, RBC, and platelets

Question 11

Vit B12

Answer 11

• a water soluble vitamin required for normal functioning of the CNS nad metabolism of every cell in body (incl RBCs)
• cannot be made by the body, found in animal products/supplements

Question 12

Folic acid

Answer 12

• vitamin essential for body to make DNA, RNA, and metabolize amino acids (required for cell division, incl division of RBCs)
• cannot be made by the body, it is found in the diet with dark green leafy veg
• lack of folate during pregnancy –> neural tube defects

Question 13

Vit B12 & Folic acid deficiency Tx

Answer 13

treat with Vit B12 and folic acid supplements/inc in diet

Question 14

pernicious anemia

Answer 14

• damaged gastric mucosa –> no intrinsic factor (IF) produced
• IF must bind w/ Vit B12 for the vitamin to be absorbed
• IF production dec w/ age and alcohol
• poor or no Vit B12 absorption –> impaired RBC production

Question 15

pernicious anemia Tx

Answer 15

• treat w/ a high dose of Vit B12 PO
• if a large amount consumed, the body can’t help but absorb it even if IF is absent = passive absorption
• IM Fe is given if neuro problems are present (ex dizziness, headache)

Question 16

aplastic anemia

Answer 16

• bone marrow (stem cell) failure –> not making new cells –> deficiency of all types of blood cells (not just RBCs)

Question 17

aplastic anemia etiology

Answer 17

1/3 is autoimmune, radiation, toxic chemicals:
- can manage autoimmunity w/ drugs but it will not fix the problem
- withdraw the chemical or raditation exposure that is destroying the bone marrow and the pt recovers as long we tem cells have not been completely wiped out
2/3 are idiopathic:
- Tx w/ transfusions, immune suppression (ex. steroids) or a bone marrow transplant

Question 18

hemolytic anemia

Answer 18

• premature or excessive hemolysis of RBCs

Question 19

hemolytic anemia etiology

Answer 19

• acquired (ex. autoimmunity, drugs)

- genetic (ex. thalassemia = disease of Hgb synthesis)

Question 20

hemolytic anemia mnfts

Answer 20

• jaundice –> bilirubin build up d/t excessive breakdown of RBCs
• splenomegaly –> inc workload on the spleen
• hepatomegaly –> inc workload on the liver

Question 21

hemolytic anemia Tx

Answer 21

• treat underlying cause
• O2 (to treat hypoxia)
• transfusion
• steroids –> inhibit hemolysis (causes immunodeficiency + SE)
• monitor renal Fx (hemolysis causes precipitation in renal tubule) –> GFR and creatinine
• splenectomy (liver takes over spleen’s Fx)

Question 22

hemorrhagic anemia

Answer 22

• acute = rapid loss of whole blood –> shock (more life threatening but quick to Dx and Tx)
• severity depends on site, rate, and vol lost
• chronic = gradual/ongoing blood loss (hard to Dx and Tx)

Question 23

hemorrhagic anemia etiology

Answer 23

• prolonged/heavy menses, bleeding peptic ulcers, CA lesions in GI tract, hemorrhoids

Question 24

hemorrhagic anemia Tx

Answer 24

eliminate cause (treat the bleed)

Question 25

sickle cell anemia

Answer 25

• genetic - autosomal recessive
• homozygous recessive (2 defective alleles needed for offspring to be affected)
• if heterozygous (1 defective allele transmitted) = sickle cell trait carried by offspring

Question 26

sickle cell anemia Tx

Answer 26

• supportive (rest, O2, analgesics, IV fluids, and electrolytes)
• hypertransfusion in inc risk (ex. Sx, pregnancy) = chronic blood transfusions
• hydroxyurea (drug that prevents crystallization and hemolysis and also causes pt to make fetal Hgb w/ a high affinity of O2)
• steroids & analgesics
• marrow/stem cell transplant

Question 27

sickle cell anemia mnfts

Answer 27

• S&S for regular anemia
• hemolysis overwhelms liver and kidneys, congestion of dead RBCs in vessel –> thrombosis –> impeded flow –> infarction throughout the body
• liver overwhelmed –> bilirubin deposits in tissues –> jaundice
• impacted GFR –> renal failure