Anemias Flashcards

1
Q

What is anemia?

A

A blood disorder where there is a deficiency of erythrocytes or hemoglobin.

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2
Q

What are the three basic problems causing anemia?

A

1) defective erythropoiesis (defective production)
2) excessive hemolysis (premature or abnormal destruction)
3) excessive loss (ex. hemorrhage)

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3
Q

What is the pathophysiology or anemia?

A
  • abnormal RBC number, structure or function
  • leads to decreased oxygen carrying capacity
  • leads to hypoxia
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4
Q

What are the manifestations of moderate anemia?

A
  • dyspnea
  • palpitations
  • chronic fatigue
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5
Q

What are the manifestations of severe anemia?

A
  • chronic exhaustion
  • palpitations
  • profound weakness
  • dizziness
  • headache
  • sensitivity to cold (metabolism makes heat)
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6
Q

How many erythrocytes do we make in a minute?

A

180 million

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7
Q

Do RBCs transport nutrients?

A

no, they transport oxygen

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8
Q

What are the components of hemoglobin?

A
  • globin (protein)
  • heme (x4)
  • iron (x4)
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9
Q

What are the different types of anemia?

A
  • iron deficiency
  • vitamin B12 and folic acid deficiency
  • pernicious anemia
  • aplastic anemia
  • hemolytic anemia
  • hemorrhagic anemia
  • sickle cell anemia
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10
Q

Where does oxygen bind to hemoglobin?

A

It binds to the iron.

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11
Q

What causes iron deficiency anemia?

A

inadequate intake of iron or excessive loss of iron, the type of anemia is prevalent in 3rd world countries where there is a lack of meat in the diet

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12
Q

How do you treat iron deficiency anemia?

A
  • treat the underlying cause

- give iron PO for 4-6 months

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13
Q

Why isn’t a CBC the test of choice to detect iron deficiency anemia?

A

because it tells you about the cells and not their iron content

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14
Q

What role do vitamin B12 and folic acid have in hematopoeisis?

A

They are required for DNA synthesis and cell division. If there is a deficiency there will be abnormal production of erythrocytes, leukocytes and thrombocytes.

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15
Q

How are vitamin B12 and folic acid deficiency treated?

A
  • give vitamin B12 (250 micrograms)

- give folic acid

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16
Q

What is pernicious anemia?

A

When the gastric mucosa is damaged and doesn’t produce intrinsic factor and consequently cannot absorb vitamin B12. This impairs RBC production.

17
Q

How is pernicious anemia treated?

A
  • give a high dose of vitamin B12 PO (1000 micrograms) to ensure passive absorption (no intrinsic factor needed)
  • give vitamin B12 IM if there are neurological symptoms
18
Q

What is aplastic anemia?

A

Anemia due to a problem in the bone marrow. This affects RBCs, WBCs and thrombocytes.

19
Q

What causes aplastic anemia?

A

1/3 is from autoimmunity, radiation, toxic chemicals, 2/3 is idiopathic

20
Q

How is aplastic anemia treated?

A
  • treat the underlying cause
  • may need a transfusion
  • if severe, may need a marrow transplant
21
Q

What is hemolytic anemia?

A

When there is premature or excessive hemolysis.

22
Q

What causes hemolytic anemia?

A

It can be acquired (autoimmunity or from drugs) or genetic (thalassemia).

23
Q

What is thalassemia?

A

A group of diseases where there is defective synthesis of hemoglobin. It causes the production of abnormal RBCs and the abnormal cells are destroyed.

24
Q

What are the manifestations of hemolytic anemia (in addition to hypoxia)?

A
  • jaundice (from increase in bilirubin)
  • splenomegaly (from increased workload)
  • hepatomegaly (from increased workload)
25
Q

How is hemolytic anemia treated?

A
  • treat the underlying cause
  • give oxygen for the hypoxia
  • give a transfusion
  • steroids to dampen hemolysis
  • monitor kidney function (excessive hemolysis can cause precipitation to accumulate in renal tubule and lead to renal failure)
  • if problem lies in spleen, splenectomy
26
Q

What is hemorrhagic anemia?

A

Anemia due to rapid or gradual loss of blood (lose both RBCs and Hb).

27
Q

What can cause hemorrhagic anemia?

A
  • prolonged or heavy menses
  • bleeding peptic ulcers (ulcers in stomach and duodenum)
  • CA lesions in gastrointestinal tract
  • hemorrhoids
28
Q

How is hemorrhagic anemia treated?

A
  • find and eliminate the cause (can be tricky)
29
Q

What causes sickle cell anemia?

A

It is a genetic problem. It is a recessive homozygous trait.

If an individual is heterozygous, they are a carrier and may have mild anemia or not be affected.

30
Q

What is the pathophysiology of sickle cell anemia?

A
  • mutated gene codes for Hb S instead of Hb A (adult hemoglobin) [difference is only 1 amino acid]
  • Hb S crystalizes on dissociation (after offloading its oxygen) at low partial pressure of oxygen (in tissues, for example)
  • this causes RBCs to deform and sickle
  • leads to chronic hemolysis
  • leads to vessel occlusion in the capillaries
  • leads to ischemia and infarction
  • obstructed capillaries lead to hypoxia and cause more sickling
  • blood viscosity is also increased, which impairs circulation… causes further hypoxia and more sickling
31
Q

What are the manifestations of sickle cell anemia?

A
  • anemia
  • pain from ischemia (from thrombosis and infarction)
  • jaundice from increased bilirubin (d/t hemolysis)
32
Q

How is sickle cell anemia treated?

A
  • supportive (analgesics, rest, oxygen, IV fluids and lytes)
  • hypertransfusion in those with increased risk (pregnant, sx) = transfusion till blood is 75% donor blood
  • hydroxyurea - causes production of fetal hemoglobin which has a higher affinity for oxygen but this drug also has serious SE (risk for leukemia, hepatotoxic)
  • marrow/stem cell transplant