Anemia (Exam 1b) Flashcards
Anemia
Lack of RBC’s
Role of Hemoglobin
What provides the oxygen carrying capacity in a RBC
Within each chain, there is a heme unit with iron at the center
HgB reversibly binds
O2 and CO2 for transport
Functioning hemoglobin is necessary for
Oxygen delivery to the tissues
The Bus Analogy
RBC = Bus
HgB = The seats
Iron = What seats are made of
O2= Passengers
Anemia can be related to either
The quantity or quality of RBC’s
Regardless of the cause all disease of RBC’s mean less o2 is able to be transported to the tissues
Anemia from loss of Iron or Key nutrients
Abnormal Hemoglobin = Sickle Cell Diseae
Decrease HgB content = Hypochromic/pale = Loss of iron and Loss of key nutrients
Decreased number of circulation erythrocytes = decreased production and increased destruction and loss
One way we can tell what time of Anemia is going on is by looking at the red blood cells
Macrocytic - Normochromic
Microcytic - Hypochromic
Normocytic - Nromochromic
Macrocytic - Normochromic
-Large, abnormally shaped erythrocytes
-Hemoglobin concentrations normal
-B12 and folate deficiencies
Microcytic - Hypochromic
Small, abnormally shaped erythrocytes
Reduced Hgb concentrations
Iron deficeincy
Normocytic - Normochromic
-Normal size
-Normal hemoglobin function
-Blood less, sickle cell, aplastic anemia
Iron Deficiency: Cell Morphology
-Iron is essential to normal HgB production
-Is. microcytic, hypochromic
-Is considered a microcytic anemia causes rbcs are smaller than normal. Measured through a MCV (mean corpuscular volume) (decreased)
Vit B12 or Folate deficiency
-They are needed for DNA synthesis of RBC’s
-Megaloblastic / Macrocytic anemias
-MCV increase (MCV should be on CBC)
The main way determine Anemia
HgB levels are the best indicators
Most people do not seek out care or have symptoms until anemia levels…
are very low. Our body is good at compensating
Clinical manifestations of ALL anemias: Mild to moderate
Fatigue - Weakness - Tachycardia - Dyspnea
Clinical manifestations of ALL anemias: Moderate - Severe
Increased HR and RR - Hypotension - Pallor - Faintness - Cardiovascular symptoms
Pathophysiological cause of the clinical manifestation seen with anemia
SS and PPS
Iron Deficiency Anemia
Small and Pale RBC’s
Microcytic Hypochromic
Etiology: Iron Deficiency Anemia
-Most common anemia
-Decreased intake of iron
-Impaired absorption of iron
-Increased demand for iron
-Excessive loss (Gi bleeding or menstruation)
Remember we can’t make hemoglobin without IRON
Who is at risk of iron deficiency anemia
Elderly
Teenage girls
Women childbearing age
Iron deficiency Clinical Manifestations
-Smooth tongue / Glossitis / Mouth ulcers / Cheilosis
-Koilonychia “spoon nails”
-PICA - “Craving non-food items”
-Ice chips
-Hard peppermint Candies
-Dirt
Anemia from B12 deficiency
Megaloblastic
Macrocytic Normochromic
What is megaloblastic anemia?
A condition in which the bone marrow produces unusually large immature RBC’s (megaloblasts)
Leading cause is B12 and folic acid deficiency
Most common in elderly
Causes of Deficiency of V B12 Anemia
-Atrophic Gastritis - The stomach lining has thinned (body is not producing intrinsic factor)
-Conditions that affect the small intestine, such as Crohn’s disease, celiac disease, bacterial growth, or parasite
-Autoimmune system disorder - Pernicious Anemia (very common cause)
Clinical Manifestations Specific to B12 deficiency
-S and S of anemia plus
-Neuropathy
-Ataxia (gait problems)
-Glossitis
-Dementia
Anemia related to Folate Deficiency
Folate is B9 vitamin that is needed for RBC formation
Folate needs increase greatly during pregnancy. Low folate more likely to have babies with low birth weight and neural defects
Not a problem with absorption, but with decreased intake (alc-diet-cirrhosis)
What anemia is most common is malnourished population
Folate Anemia because it is a problem with intake not absorption
Anemia of Chronic Kidney Disease
Impaired erythropoietin production. This tells bone marrow to make RBC’s so when this is broke bone marrow doesn’t make new RBC’s
Hgb/Hct correspond with the DEGREE of kidney insufficiency
Clinical manifestations of chronic kidney disease anemia
General s/s anemia
Aplastic Anemia
Primary condition of BONE marrow stem failure
Rare
Autoimmune most common cause -blood cells in the bone marrow attacked
Classification of aplastic anemia
-Congenital
-Acquired
Aplastic Anemia is characterized by
Pancytopenia
Lack of erythrocytes, leukocytes, and platelets
Aplastic Anemia: Treatment
Whole blood transfusions
Bone marrow transplant
Immunosuppressants
Corticosteroids
Drugs to stimulate erythropoiesis (bold)
Causes of Aplastic Anemia
Idiopathic = don’t know
High dose of exposure to toxic agents: Radiations and chemical/toxins (Bone marrow cancer) (Insecticides)
Autoimmune mechanism: complication of infection
Increased Destruction of RBC’s
Abnormal hemoglobin
Acquired hemolytic anemia
Sickle Cell Anemia (decrease life span)
Thalassemia
Acquired Hemolytic Anemia
Premature destruction of RBC’s caused by some external agent
What are common causes of acquired hemolytic anemia
-Autoimmune attack
-Blood incompatibilities (give wrong blood type)
-Drug reactions
-Severe Burn or Microangiopahties
Hemolytic Anemia: What happens?
-Formation of IMMUNE COMPLEXEs
-These complexes kill normal RBC’s
Hemolytic Anemia: What do you look for?
-Low hemoglobin
-Increase Reticulocyte count (immature red blood cell) (Body starts making more and releasing them young)
-Mild Jaundice
Anemia Abnormal Hemoglobin
Sickle Cell Disease
Thalassemia
Sickle Cell Anemia
-Genetic disorder
-Inability to bind hemoglobin
-Hemoglobin S sitors shape, especially when O2 is low. Fragile sickle shaped cells deliver less O2 to tissues
-Clog blood vessels and break into pieces that disrupt blood flow leading to ischemia and necrosis
Sickle Cell Anemia: Clinical manifestations
Swelling of hands and feet with fever
Painful episodes / crisis from ischemia and necrosis from clogged vessels
Sickle Cell Crisis Triggers
-Dehydration
-Stress
-High altitudes
-Fever
-Extreme temperatures
Sickle Cell Anemia: Treatment
O2 therapy
Hydration
Pain management
Hydroxyurea
Blood transfusions and CRISPR and Bone marrow transplants
Treat pain and increase oxygenations
Thalassemia Anemia: Patho
Genetic disorder occurring mostly in person of mediterranean descent
Severe cases lead to death in childhood from heart failure
Moderate cases with treatment live to 30
Thalassemia: Characterized by
Abnormal hemoglobin
Lack of one of two proteins that make up hemoglobin - alpha and beta globin
Thalassemia: Treatment
Blood Transfusion (weekly)
Bone marrow transplant
Splenectomy
thalassemia: Clinical maifestations
Delayed growth
Fatigue
Dyspnea
Jaundice
Bone deformities
Hepatomegaly
Splenomegaly
Acute blood loss: Anemia
Hemorrhage
Manifestations depends on speed of blood loss
Result from gross or occult
Rate of blood loss is important
Can not compensate with acute and rapid blood loss vs slow
