Anemia Flashcards
anemia
- most common blood disorder
- RBC and/or Hgb deficiency
etiology
- defective erythropoiesis
- excessive hemolysis
- excessive loss (ex. hemorrhage)
pathophysiology
- abn RBC number, structure or function = decreased O2 carrying capacity = hypoxia
mnfts of mild anemia
- hypoxia causes all S&S
- often not detected
mnfts of moderate anemia
- chronic fatigue
- dyspnea
- palpitations
mnfts of severe anemia
- chronic exhaustion
- profound weakness
- excessive palpitations
- dizziness
- headaches
- sensitivity to cold
iron-deficiency anemia
- 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
iron-deficiency anemia test
- CBC inadequate (determines anemia present but not specific to low Fe)
- Ferritin test –> a blood cell protein that contains iron, determines iron storage
iron-deficiency anemia Tx
- treat underlying cause
- supplement Fe w/ oral pills for 4-6mo
Vit B12 & Folic acid deficiency
- deficiency in either Vit B12 or Folic acid = abn DNA synthesis –> impaired WBC, RBC, and platelets
Vit B12
- 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
Folic acid
- 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
Vit B12 & Folic acid deficiency Tx
treat with Vit B12 and folic acid supplements/inc in diet
pernicious anemia
- 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
pernicious anemia Tx
- 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)
aplastic anemia
- bone marrow (stem cell) failure –> not making new cells –> deficiency of all types of blood cells (not just RBCs)
aplastic anemia etiology
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
hemolytic anemia
- premature or excessive hemolysis of RBCs
hemolytic anemia etiology
- acquired (ex. autoimmunity, drugs)
- genetic (ex. thalassemia = disease of Hgb synthesis)
hemolytic anemia mnfts
- jaundice –> bilirubin build up d/t excessive breakdown of RBCs
- splenomegaly –> inc workload on the spleen
- hepatomegaly –> inc workload on the liver
hemolytic anemia Tx
- 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)
hemorrhagic anemia
- 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)
hemorrhagic anemia etiology
- prolonged/heavy menses, bleeding peptic ulcers, CA lesions in GI tract, hemorrhoids
hemorrhagic anemia Tx
eliminate cause (treat the bleed)
sickle cell anemia
- 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
sickle cell anemia Tx
- 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
sickle cell anemia mnfts
- 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
