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Surgery EOR > Anemia Part 2 > Flashcards

Anemia Part 2 Flashcards

1
Q

Cause of aplastic anemia

A

Failure of hematopoietic bone marrow due to suppression of or injury to stem cells

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2
Q

What can cause injury or suppression to the stem cells?

A

Radiation
Pregnancy
Toxins
Chemotherapy

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3
Q

Pathology of aplastic anemia

A

Hypoplasia of hematopoietic bone marrow leads to decrease in all types of blood cells

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4
Q

Presentation of aplastic anemia

A

Pallor
Purpura
Petechiae

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5
Q

Treatment of aplastic anemia

A

Red cell transfusions
Platelet transfusions
Bone marrow growth factors
Bone marrow transplant

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6
Q

MOA of epogen

A

EPO made via recombinant DNA technology which stimulates division and differentiation of erythroid precursors

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7
Q

Erythroid precursors

A

Reticulocytes and RBC

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8
Q

Indications for epogen

A

Anemia due to CKD and chemo

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9
Q

Contraindications for epogen

A

Uncontrolled HTN

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10
Q

Monitoring for epogen

A

Iron status (making new RBC so we are using up all our iron)

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11
Q

Darbepoetin MOA

A

EPO recombinant that stimulated division and differentiation of erythroid precursors

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12
Q

Indications for darbepoetin

A

Anemia due to CKD and chemo

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13
Q

Contraindications for darbepoetin

A

Uncontrolled HTN

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14
Q

Monitoring for darbepoetin

A

Iron levels

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15
Q

Sideroblastic anemia

A

Anemia caused by inability to use available iron to manufacture hemoglobin

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16
Q

Cause of sideroblastic anemia

A

Congenital (X-linked)
Acquired (alcoholism MC)

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17
Q

Etiology of sideroblastic anemia

A

Decreased Hbg synthesis due to inability to make protoporphyrin which is a precursor to heme

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18
Q

Presentation of sideroblastic anemia

A

Pallor of conjunctiva
Palmar creases

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19
Q

What must you perform to make a sideroblastic anemia diagnosis?

A

Bone marrow aspirate

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20
Q

Erythroid hyperplasia indicates ___

A

Ineffective erythropoiesis

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21
Q

Prussian blue stain

A

Shows ringed sideroblasts (erythrocytes with iron deposits in mitochondria encircling the nucleus)

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22
Q

Treatment of sideroblastic anemia

A

Correction of underlying cause
Transfusions
Stop medication if it is drug induced

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23
Q

Most common anemia worldwide

A

Iron deficiency anemia

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24
Q

Ferroportin

A

Major iron transporter

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25
Q

Hepcidin

A

Promotes ferroportin breakdown and iron release

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26
Q

Causes of iron deficiency anemia

A

Deficient diet
Chronic blood loss
Malabsorption disorder
Increased requirements

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27
Q

Presentation of iron deficiency anemia

A

Pallor of conjunctiva
Fatigue
Cheilosis
Smooth tongue
Pica

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28
Q

Treatment of iron deficiency anemia

A

Transfusions
Iron replacement

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29
Q

Iron dextran

A

Older form of parenteral iron that was infused slowly and caused iron staining

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30
Q

Newer forms of parenteral iron

A

Don’t have as severe of side effects and are infused over minutes

31
Q

MOA of ferrous sulfate

A

Replaces iron found naturally in the body

32
Q

Indications for ferrous sulfate

A

Iron deficiency anemia

33
Q

Side effects of ferrous sulfate

A

N/V
Constipation
Stool color changes

34
Q

Dosing considerations for ferrous sulfate

A

Best absorbed on an empty stomach

35
Q

Cause of anemia of inflammation

A

Proinflammatory cytokines increases hepcidin which decreases iron absorption and availability

36
Q

Presentation of anemia of inflammation

A

Mimics iron deficiency anemia

37
Q

How to differentiate between iron deficiency anemia and anemia of inflammation?

A

Ferritin is increased in anemia of inflammation, where it is decreased in iron deficiency anemia

38
Q

Cause of anemia of chronic kidney disease

A

Failure to secrete adequate EPO by kidneys

39
Q

Presentation of anemia of chronic kidney disease

A

Known history of CKD
Anemic symptoms

40
Q

What type of anemia is related to decreased protein intake?

A

Anemia of starvation

41
Q

What type of anemia is related to cholesterol deposits in RBC membrane?

A

Anemia of chronic liver disease

42
Q

Cause of anemia in the elderly

A

Resistance to EPO, decreased EPO secretion, and chronic low-level inflammation

43
Q

Treatment of anemia of chronic disease

A

Correction or management of underlying disease
Transfusions
EPO

44
Q

Role of vitamin B12

A

Involved in DNA synthesis and erythroid precursor production

45
Q

Source of vitamin B12

A

Animal foods and fortified foods

46
Q

What is needed to absorb B12?

A

Intrinsic factor

47
Q

T/F - a plant based diet can lead to B12 deficiency

A

True

48
Q

Causes of B12 deficiency

A

Dietary deficiency
Decreased intrinsic factor
Malabsorption issues

49
Q

What are possible reasons for decreased intrinsic factor?

A

Pernicious anemia
Gastric bypass surgery

50
Q

Pernicious anemia

A

Autoimmune Ig to gastric parietal cells, intrinsic factor, or both

51
Q

Presentation of B12 deficiency

A

Anemia
Glossitis
Cheilosis
Fatigue
Neuropathy

52
Q

Schilling test

A

A diagnostic analysis for pernicious anemia

53
Q

Tests for pernicious anemia

A

Gastrin levels
Anti-intrinsic factor antibodies
Gastric biopsy
Anti-parietal cell antibodies

54
Q

Treatment of B12 deficiency

A

B12 injections
Oral B12
Folic acid
Transfusions

55
Q

How long do we continue B12 therapy?

A

If the patient is diet deficient, they would only need to be on it until their diet is controlled
Most patients are on it indefinitely since there’s no harm

56
Q

MOA of cyanocobalamin

A

Replaces cobalamin found in the human body

57
Q

Indications of cyanocobalamin

A

Management of B12 deficiency

58
Q

Monitoring of cyanocobalamin

A

CBC and B12 level every 3-6 months

59
Q

Role of folic acid

A

Conversion of homocysteine to methionine and involved in DNA synthesis in erythroid precursors

60
Q

Source of folic acid

A

Fruits and vegetables

61
Q

Absorption of folic acid

A

Upper small intestine

62
Q

Causes of folic acid deficiency

A

Diet
Increased requirement
Malabsorption

63
Q

mnemonic for metabolite absorption sites

A

Dude Is Just Feeling Ill Bro
Duodenum - iron
Jejunum - folate
Ileum - B12

64
Q

Presentation of folic acid deficiency

A

Anemia
Glossitis
Cheilosis
Fatigue
NO neuropathy

65
Q

Treatment for folic acid deficiency

A

Replacement
Preventative supplementation

66
Q

What do you need to monitor while your patient is taking folic acid?

A

Hgb

67
Q

Myeloproliferative disorders

A

Diverse group of disorders categorized by excessive growth of one or more hematopoietic stem cell lines

68
Q

Polycythemia vera

A

Excessive production of all blood cells

69
Q

Myelofibrosis

A

Excessive production of collagen or fibrous tissue in the marrow

70
Q

Chronic myelogenous leukemia

A

Excessive production of granulocytes

71
Q

Presentation of myeloproliferative disorders

A

Splenomegaly
Hepatomegaly
Easy bruising
Petechiae

72
Q

How do myeloproliferative disorders affect anemia?

A

They can suppress the erythroid precursors

73
Q

Treatment of myeloproliferative disorders

A

Myelosuppression

Surgery EOR (6 decks)

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