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Blood & Lymph > Anemia Clinical Care 2 > Flashcards

Anemia Clinical Care 2 Flashcards

1
Q

Folic acid deficiency is almost always due to _____.

A

Decreased oral intake

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2
Q

Folate deficiency is common is conditions where the skin turns over often, such as ______ (4).

A
  1. pregnancy
  2. desquamating skin disorders
  3. sickle cell anemia
  4. chemotherapy
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3
Q

Folate is normally absorbed in the ______ part of the intestines.

A
  1. duodenum
  2. proximal jejunum

(wider area than B12 absorption in the ileum)

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4
Q

Diseases that decrease folate absorption

A
  1. celiac
  2. regional enteritis
  3. amyloidosis
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5
Q

Folic acid deficiency will show _____ in the blood smear

A
  1. macrocytosis
  2. hypersegmented neutrophils

(same as B12 deficiency)

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6
Q

In general, thalassemia is ____

A

defect in hemoglobin synthesis (alpha or beta chain)

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7
Q

How is thalassemia dx made?

A

electrophoresis

(these are the other findings in the image)

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8
Q

alpha thalassemia and beta thalassemia are prevalent in the Mediterranean and Asia, which locations are specific to alpha-thalassemia? Beta-thalassemia?

A
  • alpha: Africa & Middle East
  • beta: India & Pakistan
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9
Q

Thalassemias show _____ on blood smear

A
  1. Target cells
  2. Heinz bodies

(microcytic & hypochromic)

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10
Q

Thalassemia tx

A

folate (support cell wall synthesis)

(anemia will remain)

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11
Q

Thalassemia produces a ______ anemia

A
  1. microcytic
  2. hypochromic
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12
Q

How can you tell the difference between a thalassemia & iron deficiency anemia?

A
  1. Thalassemia: ⇣ RDW
  2. Iron deficiency: ⇡ RDW

(both are microcytic; major has an increased RDW)

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13
Q

List the 5 causes of hemolytic anemia, in addition to spherocytosis, trauma, infection and sickle cell.

A
  1. pyruvate kinase deficiency
  2. G6PD deficiency
  3. TTP
  4. HUS
  5. Autoimmune
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14
Q

______ is the MC enzyme defect in RBCs.

A

G6PD Deficiency

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15
Q

G6PD Deficiency is a _____ (genotype) disease that affects which populations?

A
  • X-linked
  • Mediterranean/African
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16
Q

G6PD Deficient patients may experience Brisk Hemolysis when exposed to _____ (3)

A
  1. infections
  2. drugs
  3. toxins

(oxidative stressors)

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17
Q

TTP is a microangiopathic hemolytic anemia that presents with _______ (3 sx).

A
  1. renal insufficiency
  2. neurologic sx (AMS)
  3. fever
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18
Q

Which 3 symptoms do TTP & HUS have in common

A
  1. thrombocytopenia (used in clots)
  2. microangiopathic hemolytic anemia
  3. renal insufficiency (damage to vessels)
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19
Q

2 types of autoimmune hemolytic anemia

A
  1. Warm-antibody mediated
  2. Cold agglutinin disease
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20
Q

Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)

A
  • Warm-antibody: IgG
  • Cold-agglutinin: IgM
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21
Q

What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?

A
  • Warm antibody: corticosteroids, splenectomy, immunosuppression
  • Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.
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22
Q

Hemolytic anemia will show ______ on blood smear

A

schistocytes

(broken up RBCs)

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23
Q

Autoimmune hemolytic anemia is diagnosed by ______

A

direct Comb’s test

(must wait until you know they are hemolyzing already! It’s not part of the workup)

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24
Q

4 Lab findings for hemolytic anemia?

A
  1. indirect bilirubin in urine (urobilinogen)
  2. LDH ⇡ (this is sensitive, not specific)
  3. reticulocyte ⇡ (>3%)
  4. haptoglobin ⇣

(direct = from liver problem)

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25
Q
A

sickle cell anemia

(SS, SC, Sickle thalassemia)

26
Q

Sickle cell disease is characterized by chronic _____

A

hemolytic anemia from mutant hemoglobin → clog vessels

27
Q

4 major presentations of sickle cell crisis complications

A
  1. Hyper hemolytic crisis/ acute hemolytic anemia
  2. Vaso-occlusive crisis
  3. Splenic sequestration crisis
  4. Aplastic crisis
28
Q

What is acute chest syndrome?

A
  1. Second most common complication of sickle cell (25% of deaths)
  2. vaso-occlusive crisis of lungs
29
Q

Why is it important to ask patients with sickle cell anemia about difficulty breathing?

A
  • acute chest syndrome (25% of sickle cell deaths)
  • CP, fever, pulmonary infiltrate & hypoxemia
30
Q

What is splenic sequestration crisis and sickle cell crisis?

A

Splenic sequestration of defective and ruptured cells (schistocytes lead to infection)

31
Q

aplastic crisis is due to ______

A

parvovirus 19 in sickle cell patients

32
Q

Sickle-cell precipitants

A
  1. Physical or emotional stress
  2. Hypoxia
  3. Infection
  4. Dehydration

(retic count may reach 25%)

33
Q

Acute Sickle cell crisis tx (4)

A
  1. morphine (opens vessels→prevent infarct)
  2. O2
  3. ABX
  4. IV fluids

(folic acid & stop infarction)

34
Q

Why is it important to use caution with transfusion in Sickle Cell crisis and thalassemia patients?

A

They absorb iron better than the average patient → iron overload

(hemochromotosis)

35
Q

Maintenance Sickle Cell tx

A
  1. Hydroxyurea
  2. Folic acid
  3. Hydration
  4. Avoid high altitude
36
Q

Cure for sickle cell anemia

A

children can be cured with bone marrow transplant in childhood

37
Q
A

spherocytosis

38
Q
A

TTP/HUS - microangiopathic hemolysis w/schistocytes

(little pacwomen)

39
Q
A

Malaria

40
Q
A

Malaria

41
Q
A

babesiosis

42
Q

Hemoglobin and hematocrit values to dx anemia

A
  • female = Hgb < 12 or Hct < 36
  • male = Hgb < 13.5 or Hct < 41
43
Q

4 medical conditions that can lead to anemia?

A
  1. sickle cell disease
  2. thalassemia
  3. renal disease
  4. hereditary spherocytosis
44
Q

If white count and platelets are both low it is _____ until proven otherwise!

A

aplastic anemia

45
Q

If you have a patient with anemia and low platelets, consider _____ (2 diseases)

A
  1. TTP
  2. HUS

(check for schistocytes; sign of microangiopathic hemolytic anemia)

46
Q

If a patient has low platelets, renal failure, and E coli exposure, the diagnosis is _____

A
  • HUS
  • toxin attaches to WBC → carried to glomerular vessels → toxins cause apoptosis

(may have fever; may look like TTP)

47
Q

If a patient has low platelets, renal failure, neurologic changes, the diagnosis is _______.

A

TTP

(may have fever; looks like HUS)

48
Q

If an anemic patient has high platelets consider _____ (dx)

A

iron deficiency

(especially in microcytic anemia)

49
Q

Anemic patient with low hemoglobin and hematocrit but RBC count is normal or high, it is ______ (dx).

A

thalassemia

(they make normal amount of cells, but they are small - normal count)

50
Q

Hematochezia is _____; while melena is _____.

A
  • bright red blood per rectum
  • black tarry stool

(either way - consider colonoscopy)

51
Q

If a patient is anemic and has abdominal pain or recent femoral vein/artery manipulation (stent placement) or trauma, the cause may be _____.

A

bleeding into the retroperitoneal or thigh compartment hematoma

52
Q

If other cell lines are ok, and MCV < 80 check _______ (3)

A
  1. serum iron
  2. ferritin
  3. TIBC
53
Q

In iron-deficiency anemia, look for _____

A

sources of chronic bleeding: menstrual

(consider colonoscopy)

54
Q

In iron-deficiency anemia consider ________ 3 causes in addition to chronic bleeding.

A
  1. lead poisoning
  2. copper deficiency
  3. thalassemia
55
Q

If a patient has normocytic anemia (MCV 80-100), check ______ (4 lab values)

A
  1. indirect bili
  2. LDH
  3. haptoglobin
  4. retic
56
Q

Iatrogenic causes of macrocytic anemia (3)

A
  1. Hydroxyurea
  2. AZT
  3. Methotrexate
57
Q

______ is the MC enzyme defect in RBCs.

A

G6PD Deficiency

58
Q

G6PD Deficiency is a _____ (genotype) disease that affects which populations?

A
  • X-linked
  • Mediterranean/African
59
Q

2 types of autoimmune hemolytic anemia

A
  1. Warm-antibody mediated
  2. Cold agglutinin disease
60
Q

Warm-antibody mediated autoimmune hemolytic anemia is due to ______ (IgG/IgM antibodies); while cold-agglutinins is caused by _____ (IgG/IgM antibodies)

A
  • Warm-antibody: IgG
  • Cold-agglutinin: IgM
61
Q

What is the difference in treatment between warm antibody mediated autoimmune hemolytic anemia and cold agglutinin disease?

A

Warm antibody: corticosteroids, splenectomy, immunosuppression

Cold-agglutinin: does NOT respond to corticosteroids like warm-ab does.

62
Q

If a patient has a normal Hgb electrophoresis and iron levels, but microcytosis, what is the dx? Why?

A
  • alpha-thalassemia trait
  • there is no increase in Hgb A2

(DNA testing to confirm absence of alpha chain gene deletion)

Blood & Lymph (29 decks)

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