Anemia Study Guide (complete) Flashcards
How does folic acid deficiency relate to anemia? Clinical manifestations? treatments?
- Megaloblastic anemia (macrocytic and normochromic)
- is needed for DNA synthesis and red cell maturation (thymine and adenine)
- more common than B12 deficiency
- leads to large ineffective RBC
– anemia with occur within few months from dietary deficiency
Manifestations:
- classic signs of anemia
- no neurological symptoms
- manifestations r/t malnourishment:
– cheilosis
– stomatitis
– burning mouth syndrome
– dysphagia
– flatulence
– GI disturbances
- undiagnosed IBD
labs:
- folic acid levels will be low
- MCV >100
- MCHC and MHC normal
treatment:
- folic acid requires B12 to be converted to active form
- inactive is more common - can be given PO, IV, SQ, IM; treat with supplementation
- monitor hemoglobin and reticulocyte count
Complications of sickle cell anemia
severe pain, CVA, MI
vaso-occlusive crisis, sequestration crisis, aplastic crisis
Clinical manifestations of sickle cell anemia? Are lab studies high or low?
vaso-occlusive crisis:
- sickling in microcirculation
- obstructs blood flow
- creates a log jam and no blood can move through the vessel
results in severe pain
can last for day to weeks
can lead to infarcts such as CVA and MI
sequestration crisis:
- usually only in small children
- large amounts of blood pool in the liver and spleen
- causes CV collapse as 20% of blood can pool in the liver/spleen
aplastic crisis:
- extreme anemia from decreased RBC count
- sickled RBC only lives for 10-20 days
- compensatory mechanism in place but if dysfunctional aplastic anemia occurs
Which type of anemia is megaloblastic?
usually related to deficiencies in vitamin B12 and folic acid; pernicious anemia
CBC characteristics:
- anemia
- macrocytic
- normo- or hyperchromic
Anemia results from defective cells dying too early which decreases numbers in the circulation (eryptosis); slow progression
What is aplastic anemia? Clinical manifestations? Lab studies high or low? Treatment?
Results from breakdown in production in bone marrow stem cells that inhibit growth of RBC, WBC, and platelets
- anemia results as a failure of marrow to replace senescent red cells as they are destroyed and leave circulation
- disease often presents with infection or bleeding as opposed to anemia
- can be abrupt or gradual onset
Lab values:
- CBC shows pancytopenia
- WBC <200 increasing risk for opportunistic infections
- RBCs: normocytic and normochromic
Symptoms/Clinical manifestations:
- infection
- present with fatigue, weakness, pallor
- petechiae/purpura
- ecchymosis
- bleeding from body orifices
Treatment:
- treat underlying cause
- bone marrow transplantation from sibling donor is preferred treatment
- prophylactic antibiotics and platelets, RBC, WBC transfusions may be needed
bone marrow stimulants:
- filgrastim
- epoetin-alfa
What does hyperchromic mean
MCHC higher
RBC darker than normal
What is a reticulocyte? What is its role?
reticulocyte count indicates bone marrow activity
- measures the number of new RBCs in the blood and helps determine whether the bone marrow is producing new RBCs at an appropriate rate
increased reticulocyte numbers associated with anemia suggest accelerated destruction or loss of RBCs
- normal count is approx 1% of total RBCs
Immature RBC in bone marrow
What happens in hemolytic anemia?
Can be acquired or hereditary
Acquired:
- drug reactions
- infections
- transfusion reactions
- ABO or Rh factor incompatibility of mother or fetus
- autoimmune disease
- caused by premature, accelerated, or destruction of RBCs
Hereditary:
- structure deficits
- enzymes deficiencies
- defects in globin synthesis or structure:
– sickle cell
– thalassemia
What does normocytic mean
RBC are normal size
MCV 80-100
What is the pathophysiology of anemia related to acute blood loss?
- if blood loss reaches 1000mL or more: serious adverse effects such as hypovolemic shock and cerebral hypoperfusion can occur
- acute blood loss is a rapid loss of blood as in hemorrhage caused by trauma, childbirth, rupture of major blood vessel or organ
What does macrocytic mean
MCV > 100
RBCs are larger than normal
How does ferritin lab study relate to anemia
a protein that stores iron; like a bank or pantry
What does hypochromic mean
MCHC low
RBCs lighter than normal
How does mean corpuscular hemoglobin concentration (MCHC) lab study relate to anemia
indicates color of RBC (amount of Hgb per volume of the cell)
measuring the average concentration of hemoglobin within red blood cells
How does mean corpuscular hemoglobin (MCH) lab study relate to anemia
indicates color of RBC (amount of hemoglobin/red cell)
How does hematocrit lab study relate to anemia
% of RBCs in the whole blood:
- average is 45%
- males: 45-52%
- females: 37-48%
anemia: about 15%
polycythemia: about 65%
amount of free iron in blood
What is hemoglobin S?
- usually causes little problem when properly oxygenated
- when oxygen drops, fluid polymers realign and cause the cell to sickle
- depends on:
– dehydration
– pH
– oxygenation - sickled cells plug the blood vessels, increase the viscosity
– leads to occlusion of the vessels
– pain
– infarction - pool in the spleen and hemolysis and can infarct vessels in the spleen
How does iron lab study relate to anemia
looks at serum iron and ferritin
serum iron:
- level of circulating iron in the blood
- percentage saturated:
– TIBC (Transferrin and iron binding capacity): percentage of cells are actually filled with transferrin
– normal: 25-45%
– less than 20%: iron deficient anemia
ferritin:
- protein for iron stores (bank or pantry)
- more iron is used than what is saved in anemia and stores are depleted
What is pica?
- tendency or craving to eat substances other than normal food; often during childhood, pregnancy, or as a symptom of disease
- clinical manifestation of iron deficient anemia
What are the top 3 clinical manifestations of anemia?
- pallor
- fatigue
- dyspnea on exertion
What is sickle cell anemia
Genetic condition
Inherited defect of Hemoglobin S leads to hemolytic anemia and chronic organ damage
- most inherit defective gene from both parents to have disease
Name 3 causes of anemia
- decreased erythrocyte production
- increased erythrocyte destruction
- blood loss
Treatment for sickle cell anemia
- mandatory screening at birth using electrophoresis which identifies the Hb F from the Hb A and HbS
– also doing mandatory screening in college athletes
Goal of treatment: to prevent complications and crisis
- hydroxyurea: produces more HbF and therefore displaces HbS
- decreases the inflammatory response
- anticoagulation
- pain management
What does normochromic mean
RBC are normal color; MCH and MCHC good
What is pernicious anemia? Clinical manifestations? Lab studies high or low? Treatment?
Deficiency in vitamin B12
- thought to be autoimmune disorder
- fatal if untreated
Clinical Manifestations:
- classic signs of anemia
- slow development so symptoms appear in advanced disease
- usually vague: fatigue, mood swings
- anorexia, weight loss, hyperbilirubinemia
- neurologic with severe anemia (Hbg <7)
– paresthesia of hands and fingers
– ataxia
– memory loss
– vision changes
– weakness, clumsiness, unsteady gait
– loss of proprioception
- hepatosplenomegaly (severe cases)
Lab:
- CBC w/ diff (possible low H&H, MCV>100, MCHC MHC normal
- low vitamin B12
- check intrinsic factor
- antibodies to parietal cells and IF found in pernicious anemia
- bone marrow aspiration
Treatment: vitamin B12 (cobalamin or cyanocobalamin)
How does hemoglobin lab study relate to anemia
concentration of hemoglobin in the whole blood
male: 13.5-17.5
female: 12-15.5
is low in anemia
What does microcytic mean
MCV < 80
RBC is smaller than normal
What is iron deficiency anemia? Clinical manifestations? Lab studies high or low? Treatment
- most common type of anemia; more common in females
- is microcytic-hypochromic
causes: poor dietary intake, menses, pregnancy, UC, certain meds, parasitic infections, neoplasms, lead poisoning
ferritin is low; not stores and daily intake not enough to maintain hemoglobin levels
lab values:
- check hemoglobin, MCV/MCH, MCHC
- initially ferritin affected; hgb affected as progresses
- MCV will be low (less than 80)
- MCH/MCHC will also be low
manifestations:
- onset gradual
- non-specific symptoms
- PICA
- progresses -> epithelial damage occurs
- koilonychia
- pallor of conjunctiva
treatment: oral iron preparations
- iron salts: ferrous sulfate, ferrous gluconate
- orange juice to improve absorption
- carbonyl iron: pure elemental iron
- IV iron: dextran
What is polycythemia vera? How is it treated?
Elevated hematocrit and hemoglobin levels
- there is an overabundance of RBCs in polycythemia
primary polycythemia (unknown cause): there is hyperproliferation of ALL blood cells
- blood becomes viscous which can increase risk of thromboembolisms
secondary polycythemia (known cause): more common; is a hyperproliferation of the RBCs in response to chronic blood hypoxia (as in COPD)
- about 98% of all cases related to a mutation in the JAK2 gene
treatment: phlebotomy (regular bloodloss essentially), low dose aspirin, JAK inhibitor, cytoreductive therapy, anticoagulants
How does mean corpuscular volume (MCV) lab study relate to anemia
indicates size of RBC
