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AHN 554 > Anemias > Flashcards

Anemias Flashcards

1
Q

Hgb and hematocrit in anemic men

A

Hgb < 13.5 g/dl

Hct <41%

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2
Q

Hgb and hematocrit in anemic women

A

Hgb <12

Hct<36%

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3
Q

Decreased RBC production causes of anemia

A

lack of nutrients, bone marrow disorders, and hypothyroidism

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4
Q

Increased rbc production causes of anemia

A

Inherited/ acquired hemolytic anemias

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5
Q

Blood loss causes of anemia

A

Obvious, occult and induced

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6
Q

Normal MCV

A

80 to 100 fl

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7
Q

Norm MCH

A

26-34 p/ cell

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8
Q

Normal Mean corpuscular hemoglobin concentration

A

32-36 g/dl

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9
Q

Symptoms of anemia

A

Sob, headache, tinnitus, syncope, dizziness, fatigue, sleep and mood disturbances, impaired concentration, neuro manifestations, chest pain, dementia, anorexia, skin pallor, tachycardia, increased pulse pressure, peripheral edema, flame like retinal hemorrhages, jaundice, arrhythmias

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10
Q

Anemia labs

A

Cbc with diff, reticulocyte (absolute), platelet count, Wright stained blood smear, serum ferritin, iron and total binding capacity

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11
Q

What does it mean if absolute retic count isn’t elevated?

A

Marrow failure (most common cause of anemia )

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12
Q

What does it mean if absolute retic count is elevated?

A

Blood loss or hemolysis

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13
Q

Microcytosis

A

MCV less than 80

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14
Q

Normocytosis

A

MCV 80 to 100

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15
Q

Macrocytosis

A

MCV greater than 100

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16
Q

Pernicious anemia: type

A

Megaloblastic, autoimmune

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17
Q

Pernicious anemia caused by?

A

Caused by lack of intrinsic factor produced by parietal cells of the gastric mucosa.

This prevents vitamin b12 absorption, resulting in vitamin b12 deficiency

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18
Q

Incidence/ predisposing factors for pernicious anemia

A
  • most common in northern European
  • rare in Asians and AAs
  • may be caused by atrophic gastritis, antibodies to parietal cells, or autoimmune histamine fast achlorhydria
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19
Q

pernicious anemia S&S

A

pale, icteric, abnormal reflexes, babinski and romberg positive, vibratory sensation decreased in lower extremeties, paresthesia and numbness, ataxia, decreased sense of smell, smooth tongue with tenderness, depression, dementia, splenomegaly, tinnitus, hepatomegaly, tachy, CHF, weakness, asthenia, bleeding gums, nausea, weight loss, decreases appetite, sore tongue, yellowish tinge to eyes and skin, sob, headache, palpitations, chest pain

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20
Q

pernicious anemia MCV

A

macrocytic, 110-140 fl, but can be in normal range if concurrent with iron deficiency or thalassemia.

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21
Q

pernicious anemia RDW

A

increased

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22
Q

HCT in pernicious anemia

A

10-15 ml/dl or lower

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23
Q

blood smear in pernicious anemia

A

macro-ovalocytes, anisocytosis, poikilocytosis, hyper-segmented neutrophils (4 to six lobes)

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24
Q

retic count in pernicious anemia

A

reduced

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25
Q

serum folate in pernicious anemia

A

increased

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26
Q

chance of deficiency based on serum vitamin b12 in pernicious anemia

A

> 300- normal
200-300-borderline, deficiency possible
<200- deficiency likely

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27
Q

serum ferritin in pernicious anemia

A

increased

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28
Q

lactic dehydrogenase in pernicious anemia

A

elevated, mistaken for hemolytic anemia b/c of this

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29
Q

Major lab to affirm b12 deficiency

A

anti IF and anti-parietal cell antibodies. Presence affirms deficiency.

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30
Q

pernicious anemia tx

A

B12 sub q (1mg daily for 7 days then once a week then once a month) for rest of life
OR
or B12 with 2000 u load then 1000 u daily.

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31
Q

Giving folic acid in pernicious anemia

A

don’t give folic acid without B12 b/c of potential for neuro change

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32
Q

electrolyte changes during tx of pernicious anemia

A

HYPOkalemia

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33
Q

Are central nervous changes reversible in pernicous anemia?

A

Yes if tx is aggressive and symptoms lasted less than 6 months

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34
Q

Endoscopy for pernicious anemia

A

every 5 years, even if asymptomatic

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35
Q

What is vitamin b12 deficient anemia

A

Macrocytic, megaloblastic

results from deficiency of hydrochloric acid or pancreatic enzymes that cause inability to metabolize vitamin b12

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36
Q

who is more likely to have vitamin b12 deficient anemia

A

vegans, strict vegetarians, those with dz of ilieum and enteritis, blind loop syndrome, hemodialysis, gastric bypass, fish tapeworm,

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37
Q

drugs that make vitamin b12 deficient anemia more likely

A

alcohol, metformin, anesthetics, nitrous oxide, para-aminosalicyclic acid (anti TB med)

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38
Q

S&S of vitamin b12 deficient anemia

A

same as pernicious anemia; pale, icteric, abnormal reflexes, babinski and romberg positive, vibratory sensation decreased in lower extremeties, paresthesia and numbness, ataxia, decreased sense of smell, smooth tongue with tenderness, depression, dementia, splenomegaly, tinnitus, hepatomegaly, tachy, CHF, weakness, asthenia, bleeding gums, nausea, weight loss, decreases appetite, sore tongue, yellowish tinge to eyes and skin, sob, headache, palpitations, chest pain

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39
Q

labs for vitamin b12 deficient anemia

A

same as pernicious EXCEPT you won’t find anti IF and anti parietal cell antibodies

Serum b12 <100 when symptomatic

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40
Q

normal vitamin b12 deficient anemia tx

A

B12 IM or sub q (100 mcg daily for 7 days then once a week then once a month) for rest of life
OR
or B12 with 2000 u load then 1000 u daily.

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41
Q

vitamin b12 deficient anemia tx when patient has blind loop syndrome

A

also give antimicrobial coverage for 7-10 days

rifaximin, amoxicillin-clavulanate, flagyl, norfloxacin

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42
Q

vitamin b12 deficient anemia tx when patient has fish tapweorm

A

give IF and vitamin B12

common in scandanavian countries

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43
Q

iron deficient anemia type and definition

A

microcytic

iron stores in body inadequate to preserve homeostasis, less than 12 mcg/l

most common anemia worldwide

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44
Q

causes of iron deficient anemia

A

**most important is chronic blood loss: gi bleed, menstruation, repeated blood dontaions

blood loss, decreased iron absorption, celiac dz, certain meds, gastric/small bowel sx, blood donations, pregnancy, long term aspirin use, menstrual bleeding, chronic hemoglobinuria (traumatic hemolysis from abnormal cardiac valve function), repeated pregnancies with breastfeeding, diet deficient

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45
Q

S&S iron deficient anemia

A

pallor, red smooth tongue, spoon shape brittle nails (koilonychia), cracking corners of mouth (cheilosis), tachy, palpitations, peripheral parasthesia, apical systolic hemic murmur, fatigue, sob on exertion, dizzines, HA, exercise intolerance, pica

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46
Q

staging of iron deficient anemia using peripheral smear

A

stage 1: body stores depleted but labs normal
stage 2: hgb normal but iron stores depleted on labs
stage 3: iron depletion, slight anemia, normal MCV
stage 4: severe iron deficiency, hypochromic RBCs, low MCV with marked anemia

47
Q

RDW in iron deficient anemia

A

elevated with absence of any other RBC abnormality

48
Q

retic count in iron deficient anemia

A

decreased

49
Q

ferritin level indicating low iron stores

A

less than 12

50
Q

TIBC in iron deficient anemia

A

increased by > 300 mcg/dl

51
Q

serum iron in iron deficient anemia

A

< 50

iron to TIBC ratio < 15%

52
Q

platelet count in iron deficient anemia

A

elevated up to 1.5 million/mm

53
Q

Gold standard for diagnosing iron deficient anemia when labs not conclusive

A

bone marrow iron stain, look for decreased or absent iron stores. Reported as “prussian blue negative”

54
Q

iron deficient anemia tx

A

tx underlying cause- may need blood transfusion
oral ferrous sulfate (300-325 mg tid, 1 hr before meals for 6 months)

Uncomplicated cases can use polysaccharide iron complex for less adverse affects ( hytinic, niferex, nuiron

55
Q

iron deficient anemia tx followup

A

repeat CBC in 3 weeks

hgb should be normal in 2 months

56
Q

iron amount in PRBCs

A

1 ml of PRBCs has 1 mg iron

1 unit contains 200 mg iron

57
Q

precautions for sodium ferric gluconate

A

can cause anaphylaxis,
rapid infusion can cause hypotension and flushing
keep epi and resuscitation equipment readily available

58
Q

IV and IM iron, when to give and special precautions

A

only for noncompliance and intolernce with oral supplements
watch for anaphylaxis and keep benadryl and epi close by
painful- give in buttock
can cause plebitis when given IV

59
Q

formula for IV/IM iron

A

{(normal hgb-patients hbg) x weight in kg} x 2.21 /1000

60
Q

folic acid deficiency anemia type/definition

A

megaloblastic, macrocytic

decreased RBC and hemoglobin content caused by impaired production related to decreased serum folate

61
Q

folic acid deficiency anemia causes

A

inadequate intake (alcoholism, anorexia special diet, older age), lack of absorption (celiac dz, tropical sprue,gluten sensitve enteropathy), inadequate conversion of folate to tetrahydrofolate, increased utiliztion during pregnancy, cancer and hemolysis

62
Q

drug induced folic acid deficiency anemia caused by

A

methotrexate, pyrimethamine, phenytoin, alcohol, isoniazid, oral contraceptive

63
Q

normal body store of folate

A

5000 to 20000

64
Q

S&S of folic acid deficiency anemia

A

fatigue, pallor, mouth/tongue pain, signs of malnutrition, GI issues

65
Q

serum folate in folic acid deficiency anemia

A

> 4- rule out folate deficiency

<2- diagnostic of folate deficiency in absence of anorexia or fasting

66
Q

RBC folate in folic acid deficiency anemia

A

less than 150, indicative of folate deficiency

67
Q

MCV in folic acid deficiency anemia

A

> 115 gl, macrocytic

68
Q

homocysteine in folic acid deficiency anemia

A

elevated

69
Q

folic acid deficiency anemia tx

A

make sure you have diagnosed correctly because giving folate to someone with b12 deficiency can make neuro symptoms worse

give oral folate 1-5 mg daily for 3-4 months

Total correction should be seen in 2 months

70
Q

anemia of chronic dz definition

A
  • gradual onset, 2nd most common anemia
  • can be normochromic and normocytic, OR hypochromic and microcytic
  • accompanies chronic dz (infection, inflammation,immune activation {rheumatoid}, CKD,malignancies, diabetes, MI, burns, liver dz, and hypo endocrine dzs) and is resolved when underlying dz fixed
71
Q

subjective findings of anemia of chronic dz

A

usually no symptoms until severe, then fatigue, SOB, weight loss, light headedness, loss of appetite

Physical findings will be related to underlying dz

72
Q

RBCs in anemia of chronic dz

A

can be normochromic and normocytic, OR hypochromic and microcytic

RDW normal

73
Q

iron storage in anemia of chronic dz

A

normal or increased, sideroblasts absent in bone marrow

74
Q

retic count in anemia of chronic dz

A

less than 1% or low absolute number

75
Q

serum ferritin in anemia of chronic dz

A

normal or high. >100

76
Q

TIBC in anemia of chronic dz

A

lowered, <250

77
Q

anemia of chronic dz tx

A

tx underlying dz,

  • may try oral iron in premenopausal women
  • Recombinant human erythropoietin (epogen, procrit) to promote hematopoiesis
78
Q

risk for fast HCT rise

A

hct should not be raised more than 4 points during any 2 week period b/c this could cause htn or seizures.

79
Q

Thalassemia definition/type

A

group of inherited disorders that are the result of defective production of the globin portion of hemoglobin

-hypochromic and microcytic

80
Q

Name for severe Thalassemia

A

Cooley’s anemia

81
Q

Thalassemia incidence

A

most common in Mediterranean people (italian, greek)

82
Q

alpha Thalassemia 4 types

A

1: silent carrier, asymptomatic, alpha Thalassemia-2 trait
2: mild microcytic , hypochromic, alpha Thalassemia 1 trait
3: moderately severe hemolytic anemia, usually don’t need transfusions, 3 genes affected
4: nonfunctional: all four genes affected, hydrops fetalis and bart’s hemoglobin

83
Q

Who is most affected by beta Thalassemia in US

A

mediterranean, asian and african descent

84
Q

Who is most affected by alpha Thalassemia in US

A

asian descent

85
Q

S&S and physical findings of Thalassemia

A

Hepatosplenomegaly, cardiac failure/dilatation, jaundice, cooley’s anemia, growth retardation, delayed or absent adolescent growth (late menarche, oligomenorrhea or amenorrhea, delayed sexual characteristics, hypogonadism) pallor, fatigue, dark urine, poor growth

86
Q

Cooley’s anemia findings

A

marked osteoporosis and cortical thining, erythroid overgrowth of the marow may distort bones of head, face, rib cage, and pelvis, predisposed to fxs

87
Q

CBC for Thalassemia

A

Decreased Hgb, hct, MCV, and MCH, increased RBCs

88
Q

Wright stain for homozygous beta Thalassemia and double heterozygous non alpha Thalassemia

A

extreme anisocytosis and poikilocytosis with bizarre shapes, target cells, and ovaloctyes and large number of nucleated RBCs

89
Q

Wright stain for heterozygous beta Thalassemia

A

hypochromic and microcytic cells with mild to moderate anisocytosis and poikilocytosis.
Target cells with basophilic stippling

90
Q

Indirect bilirubin level in Thalassemia

A

increased, 1-6 mg/dl, higher in Thalassemia intermedia

91
Q

test to confirm diagnosis

A

Hgb electrophoresis

  • If HbA2 is elevated= heterozygous beta Thalassemia
  • if HbF and HbA2 levels are normal, microcytosis with minimal or no anemia= alpha Thalassemia
92
Q

skull xray with Thalassemia

A

beta Thalassemia skull xray may show “hair on end” appearance

93
Q

Severe beta Thalassemia tx

A
  • blood transfusions- multiple transfusions pt patient at risk for hemochromatosis
  • Iron chelation therapy: deferoxamine IM or sub q pump or hickman cath. Done to prevent organ damage from iron overload
  • hgb goal 9-10
  • concurrent admin of vitamin c to enhance iron excretion
94
Q

Tx of choice for beta thalassemia major

A

allogeneic bone marrow transplant

this is the only cure

95
Q

what to watch for to indicate spleen issues in Thalassemia

A

look for leukopenia and thrombocytopenia as indicator of splenic enlargement and possible need for spleenectomy

96
Q

Which anemias are microcytic? (5)

A 
Iron deficiency
Thalassemia
anemia of chronic dz
lead toxicity
zinc deficiency
97
Q

Which anemias are macrocytic and megaloblastic (3)

A

Vitamin b12 deficiency
Folate Deficiency
DNA synthesis inhibitors

98
Q

Which anemias are macrocytic and nonmegaloblastic (7)

A 
Aplastic anemia
myelodysplasia
liver disease
Reticulocytosis
Hypothyroidism
Bone marrow failure
Copper Deficiency
99
Q

Which anemias are normocytic

A

Kidney disease
Non thyroid endocrine gland failure
copper deficiency
the mild forms of most anemias start as normoctic

100
Q

Ferritin levels indicating iron deficiency anemia

A

less than 30

101
Q

What happens to transferrin levels when serum iron values drop

A

Transferrin (iron transport protein) increases to compensate leading to transferrin saturation of less than 15%

102
Q

Medication for CKD patients with iron deficiency anemia

A

Ferric pyrophosphate citrate (triferic) is added to diasylate
Maintains hemoglobin without increasing iron stores

103
Q

transferrin levels in iron anemia of chronic dz

A

normal or increased, Saturation may be low

104
Q

Hematocrit in anemia of chronic dz

A

rarely falls <60% of baseline

105
Q

Lab findings in alpha thalassemia trait

A 
mild anemia
hct: 28%-40%
MCV is really low though (60-75)
RBC normal or increased
Blood smear: microcytes, hypochromia, some target cells, acanrhocytes
Normal retic count and iron
106
Q

Hemoglobin H disease labs

A

Hct: 22-32%
MCV: 60-70
Blood smear: hypochromia, microcytosis, target cells, poikilocytosis
Elevated retic count
RBC norm or elevated
-Fast migrating hemoglobin (hemoglobin H) which compromises 10-40% of hemoglobin
Blood smear will show hemoglobin H

107
Q

Beta Thalassemia minor

A

HCT: 28-40%
MCV: 55-75
Retic counr norm or elevated
Blood smear: hypochromia, microcytosis, target cells
***Basophilic stippling present
-Elevation of HEmoglobin A2 to 4-8%, and hemoglobin F elevations to 1-5%

108
Q

Beta thalassemia intermedia

A

Hct: 17-33%
MCV: 55-75
RBC norm or elevated
Elevated retic count
Blood smear: hypochromia, microcytosis, basophilic stippling, target cells
-30% Hemoglobin A1, increase in Hemoglobin A2 up to 10% and elevation of hemoglobin F from 6-10%

109
Q

Beta thalssemia major

A

severe anemia, without transfusion, hct can drop to < 10%
blood smear bizarre: severe poikilocytosis, hypochromia, microcytosis, target cells, basophilic stippling, nucleated RBCs
Little or no hemoglobin A2, predominant hemoglobin seen is hemoglobin F

110
Q

tx for hemoglobin H disease

A

folic acid supplement

AVOID medicinal iron and oxidative drugs such as sulfonamides

111
Q

Normal serum b12

A

> 210

112
Q

red blood cell folic acid level in folic acid deficiency

A

<150 ng/mL

113
Q

Hemolytic anemias

A

RBC survival is reduced, and bone marrow will increase production to compensate until it is impaired

AHN 554 (13 decks)

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