Anemias Flashcards
According to WHO, an Hb level of <___ g/L in men and <___ g/L in nonpregnant women can be used to diagnose anemia
<130 men
<120 women
Blood is made up of 3 components:
1.
2. Buffy coat
3.
- plasma
- hematocrit
What are erythrocytes?
Red blood cells
Hemoglobin is part of red blood cell that?
Carries oxygen
Anemia results from decreased level of _______ or RBCs
Hemoglobin
Clinical presentation of someone with anemia:
1.
2.
3.
- Weakness
- Fatigue
- Pale
Short of breath, dizzy, edema, tachycardia
What is hematopoiesis?
Maturation of blood components
What is erythropoiesis?
Development of red blood cells
____ is the regulatory hormone required for RBC production. Kidney’s produce it in response to reduced oxygen levels
EPO, it stimulates the bone marrow
Normal development of RBCs require adequate ____, vitamin ___ and ____
folate vitamin b12 iron
An immature red blood cell is called a:
Reticulocyte, just before a red blood cell is formed (Erythrocyte)
The ratio (%) of total volume RBC to the total volume of blood is called _________
hematocit
Reticulocyte count is the % of ____________ produced and circulating compared to circulating _______
Reticulocytes compared to erythrocytes
The amount of iron bound to transferrin is known as
Serum Iron
_________ is the main protein in the blood that binds to iron and transports it throughout the body.
Transferrin
Transferrin SAT (TSAT) is the ?
% iron-binding sites used on transferrin (aka. how much of your stored iron can be used to make new RBC)
A reduced level (<20%) reflects iron deficiency while an elevated level (>50%) indicates iron overload.
TIBC is the amount of iron that could bind to ________
transferrin
High TIBC + low serum iron = iron deficiency anemia
_____ and _____ are required in erythropoiesis to generate RBC
Vitamin b12 and folate
______ is an iron-storage protein
Ferritin (how much iron stored in the body)
The 3 types of anemia are:
1.
2.
3.
- Microcytic
- Normocytic
- Macrocytic
______________ typically presents as a microcytic anemia with a low MCV
Iron Deficiency anemia (IDA)
A patient with iron deficiency anemia will present with:
1. ______ serum ferritin
2. ______ hemoglobin
3. ______ serum iron
3._______ TIBC
4. Microcytic RBC
Low
Low
Low
Increased (high binding capacity, just not enough iron to bind)
Microcytic anemia occurs as a result of impaired hemoglobin synthesis. It can be caused by:
1. IDA
2.
Thalassemia
Common causes of iron deficient anemia:
1.
2.
- Chronic blood loss
- inadequate intake
pregnancy, poor absorption, chronic renal failure
Symptoms specific to iron deficiency anemia:
1.
2
3. atrophic glossitis (inflammation of the tongue)
4. inflammation around mouth
- Koilonychia (concave nails)
- PICA (cravings for non-nutritive substances such as clay, ice, cornstarch)
Dietary Iron:
Average all males/females:
Menstruating females:
Pregnant females:
10
15
30 elemental
Iron from plant sources (non-heme) is more or less absorbable?
3x less than from animal (heme) sources
First line treatment for IDA?
1.
- Oral Iron supplementation
Second line treatment for IDA ?
2.
- Parenteral iron therapy
reserved for patients who are unresponsive to oral, CKD, malabsorption, need rapid iron, chronic blood loss, gastric resection
careful it can cause anaphylaxis or hypotension
Common side effects of oral iron?
GI, constipation, dyspepsia
These two forms of iron may be better tolerated than iron salts but are less efficacious?
1.
2.
Polysaccharide iron complex (FeraMAX)
Heme iron polypeptide (Proferrin) (bovine source)
Elemental iron in each product:
Ferrous fumarate:
Ferrous sulfate:
Ferrous gluconate:
FeraMax
100
60
35
150
Oral iron therapy is best absorbed on ______, absorption can be increased with ______, and calcium antacids tea coffee red wine ______ absorption
empty stomach (can take with food if unable to tolerate)
vitamin c
decrease
Treatment may continue for 3-6 months once Hb normalizes, sometimes life long
Normocytic anemia is typically due to the following:
1.
2.
3.
- Anemia of chronic disease
- Acute blood loss
- Hemolytic anemias (spherocytosis, sickle cell anemia)
In normocytic anemia, A ___ reticulocyte count is indicative of anemia of chronic disease
LOW
In normocytic anemia,
A ____ reticulocyte count is indicative of:
1. Acute blood loss
2. Hemolytic anemias
HIGH (body is pumping out lots of reticulocytes instead of RBC)
Acute blood loss
or Hemolytic anemias
The following are examples of hemolytic anemias:
1.
2.
Spherocytosis (blood disorder, sphere shaped RBC)
Sickle cell anemia (constant RBC shortage due to abnormal C shape RBC which die early)
Anemia of chronic disease common presentation:
MCV:
CRP:
Ferritin:
Serum Iron:
TIBC:
MCV: normocytic
CRP: HIGH
Ferritin: normal or high
Serum iron: low
TIBC: low
> During inflammation your CRP is elevated, and this causes INC in Hepicidin, it acts to sequester iron from invading bacteria by removing iron from circulation. DEC SERUM iron, INC iron stores.
TIBC is low since already lots stored
Medications that interact with iron include:
1.
2.
3.
4. cholestyramine
5. levodopa
6. sodium bicarbonate
- fq
- tetracyclines
- PPI
Megaloblastic anemias arise because of impaired DNA synthesis of the RBC caused by deficiencies of vitamin ___ or ______
B12 or Folate
Megaloblastic anemia
lab values:
MCV:
Folate:
B12:
INC
Dec
Dec
Folate deficiency anemia specific symptoms include:
1.
2.
Decreased weight due to loss of appetite
swollen red tongue
Duration of folate therapy in folate deficiency anemia is typically up to __ months
4 months (sometimes life long) whereas B12 is usually life long
Vitamin ___ deficiency must be ruled out before starting folic acid
B12 - folic acid supplementation can mask b12 deficiencies which allows the underlying neuropathy to persist
Vitamin b12 deficiency anemia is typically due to alcoholics, vegans and elderly. However it may also be caused by this medication:
Metformin
Vitamin b12 deficiency anemia may present with symptoms like:
1
2
1 fatigue
2 headache
palpitations
SOB
ataxia
vision loss
Vitamin b12 deficiency anemia must be treated ASAP due to:
possible neurological damage
