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572 GEN MED > Anemia part 1 and 2 > Flashcards

Anemia part 1 and 2 Flashcards

1
Q

anemia

A

• Decrease in hemoglobin (Hb) level or decreased red blood cells (RBC)
• Hb < 13 mg/dL in men
• Hb < 12 mg/dL in women
May lead to psychomotor and cognitive dysfunction

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2
Q

rbc transport what? from where to where

A
  • RBC transport oxygen from lungs to the rest of the body

* RBCs are formed in bone marrow released into bloodstream and survive ~ 120 days.

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3
Q

Erythropoietin EPO

A
  • Erythropoietin (EPO)- regulatory hormone produced in kidney
  • EPO released when tissue oxygen levels decrease
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4
Q

• Classification by size and hemoglobin content of RBC

mean corpuscular volume-

A

size of the red blood cells

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5
Q

MCV < 80fL = Microcytic

A

Defects in Hb synthesis
• Iron deficiency
• Thalassemia
• Chronic inflammation

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6
Q

MCV 80 -100 fL= Normocytic

A
  • Acute bleed
  • Hemolysis
  • Chronic inflammation
  • Chronic kidney disease
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7
Q

MCV > 100 fL= Macrocytic

A
  • DNA synthesis defects
  • Vitamin B12/folate deficiency
  • Drugs
  • Alcohol
  • Liver/thyroid disease
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8
Q

Pathophysiologic Classifications of
Anemia
• Classifies based on the mechanism of

A

anemia development like blood loss, Inadequate RBC

production, or excessive rbc desctruction

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9
Q

blood loss

A
  • Acute: trauma

* Chronic: ulcer, vaginal bleeding, aspirin ingestion

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10
Q

Inadequate RBC production

A
  • Nutritional deficiency:
  • Bone marrow failure
  • Lack of EPO
  • Chronic diseases
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11
Q

Excessive RBC destruction

A
  • Intrinsic factors: hereditary (G6PD deficiency)

* Extrinsic factors: autoimmune rxn, drug rxn, infections

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12
Q

• S/sx are unreliable in predicting the degree

A

of anemia.

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13
Q

gradual onset of anemia

A
  • can tolerate lower Hb
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14
Q

acute onset of anemia

A
  • Tachycardia
  • Shortness of breath (SOB)
  • Lightheadedness
  • Irritability
  • Decreased mental acuity
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15
Q

chronic onset of anemia

A
  • Weakness/Fatigue
  • Decreased exercise tolerance
  • Paleness of the mucous membranes
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16
Q

diagnosis of anemia

A

CBC with differentials

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17
Q

Mean Corpuscular Hemoglobin (MCH)

A

Average amount of Hb per RBC
• ↓ MCH: microcytosis and hypochromia (i.e IDA)
• ↑ MCH: macrocytosis (i.e vitamin B12 deficiency)

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18
Q

• Mean Corpuscular Hemoglobin Concentration

MCHC

A

• Average mount of Hb per unit volume • Concentration of Hb inside a single RBC

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19
Q

Reticulocytes

A

• Immature RBC
• Indicator of ability of bone marrow to produce
new RBC
• Has lifespan of 1 day before becoming mature
RBCs

20
Q

positive occult blood

A

gi bleeding

21
Q

Transferrin

A

transport protein that delivers iron to the bone marrow where it’s incorporated into Hb

22
Q

Ferritin

A

Stored form of iron
• Reflects total body iron storage
• Low ferritin = iron deficiency anemia (IDA)

23
Q
  • 2 categories of IDA

* Absolute iron deficiency:

A

lack of total body iron

• Low Tsat and ferritin

24
Q

• 2 categories of IDA

Functional iron deficiency:

A

iron availability is not sufficient for intended use

• Low Tsat but normal ferritin

25
Q

Causes of IDA

• Blood loss

A
  • Acute

* Chronic loss: peptic ulcer disease, hemorrhoids, menstruation

26
Q

Causes of IDA

• Malabsorption

A
  • Gastric bypass surgery, celiac disease

* Heme iron vs. plant iron

27
Q

Causes of IDA

• Poor nutrition

A

• Children/vegan/vegetarian diet

28
Q

Causes of IDA

• Increased requirement

A

• Infancy, pregnant/lactating women

29
Q

signs and symptoms

A
  • smooth tongue
  • Brittle or spoon-shaped nails
  • Pica- craving for non-food items
  • Pagophagia- craving for ice
30
Q

most sensitive indicator of iron

deficiency?

A

ferritin levels

< 30 ng/mL indicate IDA

31
Q

low iron levels results in

A

high Total Iron-Binding Capacity (TIBC)

32
Q

Transferrin saturation (Tsat):

A

Iron immediately available for use bone
marrow for erythropoiesis
• < 20% indicate IDA

33
Q

severe IDA

A

Hb, Hct and RBC:
• May remain at normal values until iron levels
significantly fall
Low MCV, low MCHC
• Typically maintain normal values until Hb < 10
g/dL
Low reticulocyte count

34
Q

iron deficiency anemia

ups and downs

A 
↓ Hgb
↓ Hct
↓ MCHC
↓ Fe
↑ TIBC
TSat: < 20%
35
Q

Which of the following lab values is

NOT specific to PK’s diagnosis?

A

hemoglobin, because it is low in all types of anemia

36
Q

Which of the following signs/symptoms

is/are consistent with your diagnosis?

A

pallor and lack of energy

37
Q

What is the most likely cause of his

anemia?

A

GI bleed

PPI could contribute

38
Q

Ferrous

fumarate

A

most elemental iron per tablet

• 2 tabs~ 200 mg Fe2+

39
Q

ferrous sulfate

A

• 3 tabs~ 200 mg Fe2+

40
Q

ferrous gluconate

A

5 tabs~ 200 mg Fe2+

41
Q

how do you take iron

A 
on empty stomach
• Separate from food, especially diary
• Separate from antacids
Dose: 65-200 mg elemental iron per daily
in divided doses 
start at lower dose and titrate up
42
Q

iron dextran

A 
• IVP: 100 mg undiluted at ≤ 50 mg/min
• IVPB : 500-1000 mg in 250 mL of NS infused
over 3-4 hours (for a larger dose) 
Adverse effects
• Anaphylaxis
• 25 mg test dose required
• Monitor for 1 hour
43
Q

Sodium ferric

gluconate

A 
• 125 mg IV over 1 hour
• Off label: 250 mg but associated with higher
incidence of adverse effects
Adverse effects
• Cramps
• Nausea/vomiting
• Hypotension
44
Q

blackbox warning for ferumoxytol (feraheme)

A

serious hypersensitivity/anaphylaxis reactions

45
Q

total iron deficit in mg

A

= [total body weight in kg X (target Hb-actual Hb in g/dL) x 2.4] +500

46
Q

blood transfusions

A

Patients with active bleeding
unstable hemodynamics
• Hb < 7 g/dL
temporary solution

572 GEN MED (16 decks)

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