Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hem/Onc > approach to adult patients with anemia > Flashcards

approach to adult patients with anemia Flashcards

1
Q

the production of RBC

A

erythropoiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 steps of erythropoiesis

A
  1. low O2 delivery
  2. EPO stimulation
  3. RBC proliferation and maturation
  4. reticulocyte release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

EPO binds to marrow erythroid precursors (proerythroblasts) which causes ____

A

cell maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what 2 things assist in proliferation of erythroblasts

A
  1. folate
  2. vit B12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what assists in the accumulation of hemoglobin that binds O2 to hgb

A

iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

an immature RBC that contains RNA, lifespan of 4-5d, not biconcave, appears slightly bluer

A

reticulocyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

reticulocyte spends __ days in bone marrow and ___ days in blood

A

3, 1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3 optimal conditions for erythropoiesis

A
  1. normal EPO production
  2. normal erythroid marrow function
  3. adequate hgb accumulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2 approaches to anemia

A
  1. kinetic approach - addresses mechanism responsible for the fall in hgb concentration
  2. morphologic approach - categorizes anemias based on alterations in RBC characteristics and reticulocyte response - MCV, MCH, MCHC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 kinetic approach mechanisms that can cause anemia

A
  1. decreased RBC production
  2. increased RBC destruction
  3. blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

under steady state condition, RBC production is directly related to ?

A

RBC destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

avg daily RBC production =

A

1% of red cell mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5 common causes of decreased RBC production

A
  1. lack of nutrients - iron, B12, folate
  2. bone marrow disorders - reduce RBC precursors
  3. bone marrow suppression - reduces RBC precursors
  4. low levels of trophic hormones - decrease stimulation of RBC production
  5. acute/chronic inflammation - affects iron conc, reduces EPO and decreases RBC life span
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3 causes of increased RBC destruction

A
  1. inherited hemolytic anemias
  2. acquired hemolytic anemias
  3. hypersplenism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the main cause of anemia (kinetic approach)

A

blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 types of blood loss

A
  1. gross blood loss
  2. occult blood loss
  3. iatrogenic blood loss
  4. under-appreciated menstrual blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

why would reticulocytosis result in higher MCV?

A

reticulocytes are larger than mature RBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

5 causes of macrocytic anemia

A
  1. folate and B12 deficiency
    - prevents adequate proliferation of erythroblast resulting in abnormally large RBC
  2. drugs
    - can interfere with NA synthesis (lack of intracellular RNA degradation)
  3. abnormal RBC maturation
  4. alcohol abuse
    - folate deficiency
  5. liver disease
    - lipid deposits on RBC = increases SA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

2 causes of microcytic anemia

A
  1. iron deficiency
  2. alpha or beta thalassemia minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

normocytic anemia often requires

A

evaluation by peripheral smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 causes of normocytic anemia

A
  1. CKD
  2. anemia of chronic disease/inflammation
  3. mild iatrogenic “hospital” anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

physiology of anemic symptoms is directly related to ___

A

decreased oxygen delivery to tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

acute, moderate-severe blood loss will also cause ___ and more severe clinical presentation

A

hypovolemia

24
Q

2 body compensations of anemia

A
  1. increase in oxygen extraction - maintains normal oxygen delivery until Hgb reaches 8-9 g/dL
  2. increase stroke volume and HR - maintains O2 delivery, at rest, until Hgb falls below 5 g/dL
25
Q

steady state - tissues extract ___% of oxygen from hgb
maximum - anemia/hypoperfusion can increase oxygen extraction from hbg up to ___%

A

25%
60%

26
Q

8 common s/s associated with anemic patient

A
  1. varying degrees of fatigue
  2. unusual exertional tachycardia/dyspnea
  3. tachycardia/dyspnea at rest
  4. palpitations
  5. audible pulsations
  6. bounding pulses
  7. pallor
27
Q

5 common s/s associated with anemia complicated by volume depletion

A
  1. easy fatigability
  2. muscle cramps
  3. dizziness/syncope
  4. lethargy
  5. progressive hypotension/shock/death
28
Q

4 questions to ask when you suspect anemia

A
  1. Is the patient bleeding (past or present)? If so where?
  2. Is there evidence of increased RBC destruction (intravascular or extravascular)?
  3. Is there bone marrow suppression? If so why?
  4. Is the patient nutrient deficient in iron, folate or B12? If so why?
29
Q

new onset most often related to an __ d/o

A

acquired

30
Q

lifelong anemia w/wo fhx is likely

A

inherited

31
Q

Recent unintentional weight loss, loss of appetite, fever, night sweats
can be caused from

A

infection or malignancy, causing anemia

32
Q

6 symptoms of or hx of medical condition associated with anemia

A
  1. Melena - Upper GI bleed, bleeding ulcer
  2. Large hematochezia - Lower acute GI bleed
  3. Menorrhagia - Dysfunctional uterine bleeding
  4. Renal failure
  5. Rheumatoid arthritis
  6. CHF
33
Q

during the PE, youre observing the skin for:

A
  1. pallor
  2. jaundice
  3. petechiae
  4. bruising
34
Q

during the PE, youre observing the eyes for:

A
  1. pale conjunctiva
  2. scleral icterus
35
Q

4 additional findings during PE

A
  1. Lymph nodes
  2. Abdomen - Hepatosplenomegaly (HSM)
  3. Bony tenderness (sternum/anterior tibia)
  4. Stool for occult blood
36
Q

2 ways volume status can affect interpretation of CBC

A

hgb, hct, RBc count are all contrations and dependent on red cell mass (RCM)
1. If RCM is decreased and/or plasma volume is increased the RBC and H&H will be low
2. If plasma volume is decreased, RBC and H&H will be elevated

37
Q

which allows for more accurate assessment, manual vs automatic counting? (reticulocyte count)

A

automatic

38
Q

what provides a more accurate reflection of retic count in anemia patients?
what is the formula?

A

reticulocyte index (RI) calculation
RI = reticulocyte % * (pt’s HCT/nrm HCT)
normal RI = <3%

39
Q

increased retic count is indicative of

A

hemolysis

40
Q

3 additional labs to further evaluate anemia

A
  1. ↑ Serum lactate dehydrogenase (LDH)
    - LDH is highly concentrated in RBCs - therefore destruction of the RBC will increase LDH
  2. ↑ Indirect bilirubin (unconjugated) = total bilirubin - direct bilirubin(conjugated)
    - Bilirubin is the orange-yellow pigment derived from the breakdown of hgb
  3. ↓ Serum haptoglobin
    - Haptoglobin binds free hgb that is released from hemolyzed RBC
41
Q

Assesses the presence of antibodies on the surface of RBC’s, which ultimately causes RBC destruction

A

Coombs test, direct
negative test is normal

42
Q

3 ways the body loses iron

A
  1. perspiration
  2. epithelial cell desquamation
  3. menstruation
43
Q

body’s major iron storage protein and releases it in a controlled manner

A

ferritin

44
Q

iron storage complex that works to bind free iron that is released from hemolyzed RBCs

A

hemosiderin

45
Q

protein that carries and stores oxygen specifically in muscle tissues

A

myoglobin

46
Q

___is transported to the bone marrow for the production of hemoglobin and portions of erythrocytes

A

iron bound to transferrin

47
Q

Measures the amount of circulating iron bound to transferrin

A

serum iron

48
Q

the body absorbs too much iron from the food you eat

A

Hereditary hemochromatosis

49
Q

the major plasma transport protein for iron largely synthesized by the liver

A

transferrin

50
Q

transferrin carries iron from ___ to ____

A

duodenum to marrow

51
Q

Calculates how much of the transferrin is being bound by iron

A

Transferrin saturation
decreased = iron-deficiency anemia
increased = hemochromatosis, iron overload, thalassemia, RBC transfusions

52
Q

Measures the blood’s capacity to bind iron with transferrin; indirectly measures transferrin

A

total iron binding capacity (TIBC)

53
Q

what is the most reliable indicator of total-body iron status

A

ferritin
bone marrow is the only test that is more accurate

54
Q

Requires intrinsic factor (produced in the stomach) for absorption in the ileum

A

vit B12

55
Q

majority of b12 is stored in the ?

A

liver

56
Q

Requires the normal functioning of intestinal mucosa for absorption
Absorbed in the upper ⅓ of the intestine and stored in the liver

A

folic acid (folate)

57
Q

Serum folate levels may be elevated in ?

A

vit B12 deficiency
B12 is needed to move folate into tissue cells

Hem/Onc (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions