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Undeleted > Anemia - CC3 > Flashcards

Anemia - CC3 Flashcards

1
Q

3 components to blood

A
  1. plasma -55%

2. WBC/plateles -

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2
Q

3 steps to CBC review

A
  1. review Hb and MCV
  2. review WBC and DDx
  3. review platelet count
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3
Q

what does a marrow problem look like

A

loss of all cell lines

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4
Q

3 ways a single cell line can be low

A
  1. low prod
  2. destruction
  3. sequestration
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5
Q

what is anemia

A

low RBC

  • very common
  • abnormalities often found before Sx
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6
Q

what is too much RBC

A

polycythemia/erythrocytosis
- much less common
-

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7
Q

sign and Sx of anemia

A
  • faigue
  • HA
  • lightheaded
  • nausea
  • chest pain
  • SOB
  • tachycard.
  • HF
  • hypotension
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8
Q

2 key part to approach to anemia

A
  1. cell size - MCV

2. retic count - underprod vs. destruction/sequestration

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9
Q

how to ID retics

A
  • inceased color
  • larger
  • increased central pallor
  • have RNA
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10
Q

DDx for microcytic

A
  • Thallasemia
  • Anemia of chronic disease
  • Iron def
  • Lead poisoning
  • Sideroblastic
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11
Q

how is iron moved in body

A
  • absorbed in duod
  • transported by transferritin
  • stored by ferritin in heart and liver and in Hb
  • no excretion mechanism
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12
Q

how is Fe regulated

A
  • taken up by ferrroportin
  • ferroportin blocked by hepcidin
  • ## hepcidin produced in liver
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13
Q

3 measures of Fe in body

A
  1. ferritin - primary storage
  2. transferritin
  3. serum iron/transferritin - used to assess Fe overload
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14
Q

what would be seen in Fe def. (5)

A
  1. low ferritin
  2. low MCV

also, but don;t need to measure

  1. low retic
  2. low serum Fe
  3. high transferritin (TIBC)
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15
Q

what to do in Fe def.

A
  • in male and non-mens. females, always look for blood loss
  • diet, bleeds
  • treat Fe def., even if not anemia in women of child bearing age
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16
Q

2 types of Fe

A
  1. oral - may not be tolerated well

2. IV

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17
Q

def. anemia of chronic disease

A
  • can be micro or normo
  • due to acute or chron. inflammation
  • caused by cytokines increasing hepcidin
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18
Q

5 things seen in anemia of chronic disesase

A
  1. high ferritin
  2. retics inapproriately low
  3. low serum Fe
  4. low TIBC
  5. low transferritin sat.
  6. low EPO
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19
Q

2 treatments of anemia of chronic disease

A
  1. treat underlying cause

2. EPO

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20
Q

what is thallasemia and 2 types

A
  • abnormal prod. of Hb

- can be a or B

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21
Q

2 types of macrocytic

A
  1. megalobalstic - cells cannot mature

2. non-megaloblastic

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22
Q

4 causes of megaloblastic

A
  1. B12 def.
  2. folate def.
  3. cytotoxic drugs
  4. genetics
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23
Q

what is B12

A
  • cobalamin
  • found in animal products
  • absorbed via inrinsic factor
  • needed for blood
24
Q

4 causes of B12 def.

A
  1. strict veganism
  2. unable to absorb - terminal ileum
  3. pernicious anemia - no intrisic factor
  4. Gi infection
25
Q

4 nonmegaloblastic causes

A
  1. myelodisplastic syndrome
  2. retics bleeding or hemolysis
  3. liver disease - target cells
  4. hypothyroidism - uncommon
26
Q

what do we need to check in normocytic

A

retics

27
Q

2 causes of low retics

A
  1. primary or secondary bone marrow failure

2. low EPO

28
Q

what is term when RBC destroyed too soon

A

hemolysis

29
Q

2 causes

A
  1. extravascular - RBC don’t make it full life and destroyed

2. intravascular - lose all the good stuff inside liek FE

30
Q

4 things that happen with hemolysis

A
  1. incr. retics
  2. incr. bili
  3. incr. LDH
  4. dec. haptoglobin
31
Q

2 tests for intra vs. extravascular hemolysis

A
  1. DAT antiglobin tests

2. blood film spertocytes (EV) vs. schistocytes (IV)

32
Q

3 intrinsic RBC factors causing hemolysis

A
  1. hemoglobin - sickle cell
  2. enzymes
  3. cytoskeleton problem
33
Q

5 external factors causing hemolysis

A
  1. drug!
  2. infection
  3. ABs against RBC antigens
  4. structural probs - mechanical valves ets
  5. DIC
34
Q

2 treatments of hemolyssi

A
  1. underlying cause

2. suportive care

35
Q

2 other causes of anemia

A
  1. dilution

2. sequestration in spleen

36
Q

when is transfusion reccomended

A

HB

37
Q

what is Hct formula

A

Hb x 3

38
Q

what does retic count indicate

A

2% excessive destruciton

39
Q

signs of hemolysis

A
  1. signs of anemia
  2. signs of underlying disease
  3. dark urine
  4. jaundice
  5. hepatoplenomeg, cholelith, lymphadenopathy
40
Q

test findings in hemolysis

A
  1. HB levels depend on degree
  2. elevated retics
  3. peripheral smear
    - schistocytes - intravasc
    - pherocytes or helmet - extravasc.
  4. haptoglobin
    - low - normally binds to Hb
  5. high indirect bili
  6. high LDH
  7. direct coombs - +ve in autoimmune
41
Q

Tx of hemolysis

A
  1. Tx underlying cause
  2. PRBCs
  3. folate suppluments
42
Q

patho of sickle cell

A

HbA replaced by mutant hemoglobin

- under reduced O2 times, they sickle and obstruct

43
Q

4 complications of SCC

A
  1. severe, lifelong hemolytic anemia
  2. occlusions Sx
  3. infections
    - functional asplenia
  4. delayed growth and maturation
44
Q

Sx of SCC oclusion

A
  1. bone pain - most common
  2. hand-foot syndrome - dactylitis
  3. acute chest
    - similar to PNA
  4. repeated splenic infarcts
  5. avasc. joint necrosis
    - most common in hip
  6. priapism
  7. CVAs
  8. optho infarcts
  9. leg ulcers
45
Q

Dx for SCC

A
  1. anemia

2. sickle smear

46
Q

Tx for sickle

A
  1. avoid low O2
  2. early vaccinations
  3. prophylactic pen for kids
  4. folic acid supplements
  5. mgmt of crises
  6. hydroxyurea
  7. transfusions
  8. marrow transplant
47
Q

what is spherocytosis

A

hereditary

  • defect in spherin gene
  • loss of RBC membrane area without loss of volume
  • get trapped and destroyed by spleen
48
Q

Sx of spherocytosis

A
  1. hemolytic anemia
  2. jaundice
  3. splenomegaly
  4. gallstones
    5
49
Q

Tx

A

splenectomy

50
Q

what is G6PD def.

A

X-linked - male

  • get H2O2 that breaks down RBCs
  • preciptated by certain ABx and fava beans
51
Q

Sx of G6PD

A
  • episodic anemia that is drug induced

- dark urine and jaundice on Phx

52
Q

what is seen on smear

A
  1. bite cells

2. heinz bodies

53
Q

what is autoimmune hemolytic anemia (AIHA)

A
  • produce autoantibodies to RBCs

- more fulminant in childs

54
Q

2 types of AIHA

A
  1. warm
    - due to IgG which binds at 37
    - extravascular hemolysis
    2 cold
    - due to IgM
    - intravasuclar - in liver
55
Q

Sx of AIHA

A
  1. anemia

2. jaundice if sig

56
Q

Dx of AIHA

A
  1. direct coombs
    - IgG or cpmplement
  2. cold agglutinatin
57
Q

Tx of AIHA

A

often none

  1. warm
    - steroids
  2. cold
    - avoid cold
    - transfusions

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