Anemia (slides only) Flashcards
How many people does iron deficiency anemia effect?
1 billion
What hallmark symptoms do we see in severe anemia?
fainting, chest pain, angina heart attack
Do we see in or decreased size of spleen in anemia?
enlarged
What are the 3 major types of anemia?
- Dilutional
- Decreased RBC production
- Increased RBC breakdown
What type of anemia does anemia of prematurity fall under?
Dilutional
- reduced EPO, overzealous laboratory testing
How do we get apparent dilution anemia? 3
- excessive sodium or fluid intake
- sodium or water retention, fluid shift intravascular
- pregnancy
How many days does it take for erythrocyte development?
5.5 days (lasts for 3 months)
How long do reticulocytes stay before becoming erythrocytes?
3 days
Pure red blood cell aplasia is also known as what?
erythroblastopenia
Review the following things that can cause pure red blood cell aplasia.
autoimmune thymoma viral infections (eg HIV, herpes, parvovirus B19) lymphoproliferative congenital
What are the 3 main causes of aplastic anemia?
- Fanconi anemia- problem with DNA repair
- Anemia of Renal failure- insufficient EPO
- Anemia of endocrine disorders
What cell cyle point is megaloblastic anemia stuck in?
G2
what is addisons anemia or biermers anemia?
pernicious anemia- intrinsic factor loss
What is the best indicator of iron deficiency anemia?
Ferritin
What is iron deficiency anemia almost always due to?
insufficient dietary intake of anyone with chronic blood loss (preg women, toddlers, GI bleeds)
What is the most common cause of iron deficiency in the US? in the world?
GI bleed
parasitic infection
True or false- the total iron amount in the body is 3.5 grams in it doesn’t take long to deplete stores?
False- it is 3.5 g but it takes a while to deplete
If I have ferritin of 20 and normal erythrocytes what might I think? what about ferritin of 10 and normal erythrocytes? what about ferritin <10 and microcytic/hypochromatic erythrocytes?
- Iron depletion
- Iron deficient erythropoiesis
- Iron deficiency anemia
Is the oral bioavailability of iron high or low?
Very low
What happens to lactate dehydrogenase, haptoglobin, reticulocyte count and bilirubin in hemolytic anemia?
- increase
- decreae
- increase
- increase
Does warm or cold hemolytic anemia occur by IgM?
Cold excessive rite permits binding in the cold [think viruses or cancer], Warm is IgG [think autoimmune]
If we have anemia with small cells, what should we think about the environment and the genetics?
too little iron
too much lead
thalessemias
If we have anemia with large cells, what should we think about the environment?
too little B12 or B9 or a drug side effect
If we have anemia with normal cells but decreased survival, what should we think about the environment and the genetics?
acute hemorrhage
sickle cells
If we have anemia with normal cells but bad cell development, what should we think about the environment and the genetics?
chronic disease or aplastic anemia
G6PD enzyme
cell shape (spherical)
leukemia
What helps absorption of oral iron?
Vitamin C
Are ferrous salts or ferric salts much better?
ferrous Fe2+
Where is iron absorbed?
duodenum and proximal jéjunum
Sustained release pills don’t work well
Are oral iron supplement pH dependent?
yes! don’t take things that kill the acid
Do we dose by salt weight or iron content?
salt weight
What is the iron RDA does for men and postmenopausal women? pre menopause?
- 8 mg/d
2. 18 mg/d
is heme iron or non-heme iron absorbed better?
heme iron from animal source
What does fiber, dairy, phosphates and tea do to iron absorption?
decreases it
When do we use parenteral iron?
Speed–deficit would take forever to treat orally
What is a big risk to iron injections with erythropoietin?
hypersensitivity and anaphylaxis
Should patients stay on Iron for a long time?
No- chronic iron overload is not good
What are the key points to acute iron toxicity?
- rare except for young children
- can be fatal
- abdominal pain and blood diarrhea in 30 min
- hepatic failure and acidosis, coma,
- necrotizing gastorenteritis
What are the key points to chronic iron toxicity or hemochromatosis?
- excess iron is deposited in heart, liver, pancreas–>organ death
- can happen to patients with excess ability to absorb or those with parenteral iron on multiple transfusions
- do phlebotomy
How do we treat iron overdose?
- gastric aspiration or induced vomiting
- Lavage with iron precipitating salts
- deferoxamine- iron chelator
what is deferoxamine used for?
acute iron poisoning or inherited/acquired hemochromatosis
rapid IV deferoxamine causes what? long term use?
hypotension
neurotoxicity and increased infection
What does B12 deficiency cause? B9
- neurotoxicity and anemia
2. just anemia
Can folate compensate for B12?
yes for anemia no for neurotoxicity
Is blood transfusion recommended for very low Hgb <60 status and no CV instability?
No- need to have instability
Why don’t we use whole blood transfusion?
potassium from lysis is bad
Erythropoiesis stim agent ESA should be used in mild and moderate anemia? what about in chronic kidney disease? what does treatment with ESA require?
- No just to get to lowest acceptable range
- No unless extreme anemia of <10g
- iron delivery
What is used for hemoglobin independent transport to increase oxygen content of plasma?
hyperbaric oxygen
When do we use the hyperbaric chamber?
exceptional blood loss, or when blood transfusions can not be used for various reasons
