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Hem/Onc > Approach to the adult patient with anemia- Lecture 2 > Flashcards

Approach to the adult patient with anemia- Lecture 2 Flashcards

1
Q

What are the 4 steps in the process of erythropoiesis

A
  1. low O2 delivery
  2. EPO stimulation
  3. RBC proliferation and maturation
  4. Reticulocyte release
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2
Q

What is flow of an RBC formation

A
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3
Q

EPO binds to _______. What does it induce?

A

marrow erythroid precursors

induces cell maturation

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4
Q

What are marrow erythroid precursors called?

A

proerythroblasts

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5
Q

____ and _____ are needed to assist with proliferation of RBC

A

folate and Vit B12

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6
Q

_____ assists in the accumulation of hemoglobin

A

iron

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7
Q

what is the role of iron?

A

binds oxygen to hgb

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8
Q

Describe the process of erythropoiesis. What do all the stars mean?

A
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9
Q

Name two differentiating factors of reticulocytes as compared to RBC

A

NOT biconcave (more round)
slightly bluer than RBC

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10
Q

T/F: Reticulocytes contain RNA and RBC do not

A

true

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11
Q

What is the total life span of a reticulocyte?

A

4-5 days

3 days in bone marrow
1-2 days in blood

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12
Q

What are the optimal conditions for erythropoiesis?

A

normal EPO production
Normal erythroid marrow function
Adequate Hgb accumulation

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13
Q

What is the end result if any of the physiological processes become defective during erythropoiesis?

A

decreased RBC production

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14
Q

_____ is considered a reduction of one or more of the major red blood cell measurements, what are they?

A

anemia

Hgb
Hct
RBC

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15
Q

What kind of approach includes addresses the mechanism responsible for the fall in hemoglobin concentration

A

Kinetic approach to anemia

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16
Q

What kind of approach includes categorizes anemias based on alterations in RBC characteristics and the reticulocyte response?

A

Morphologic approach to anemia

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17
Q

The kinetic approach address the _____ responsible for the fall in hemoglobin concentration

A

mechanism

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18
Q

Morphologic approach: categorizes anemias based on alterations in ______ and the _______

A

RBC characteristics

reticulocyte response

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19
Q

the kinetic approach to anemia can be caused by one or more of these things, name them.

A

decreased RBC production (erythropoiesis)
increased RBC destruction (hemolysis)
blood loss

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20
Q

T/F: Under steady state conditions, there is more RBC being produced than RBC being destroyed

A

FALSE, production = destruction

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21
Q

on average, what is the daily production of RBC?

A

1% of red cell mass

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22
Q

What are the 5 common causes for decreased RBC production

A
  1. Lack of nutrients (iron, B12, folate)
  2. bone marrow disorders
  3. bone marrow suppression
  4. low levels of trophic hormones
  5. acute/chronic inflammation
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23
Q

What are the 3 reasons for increased RBC destruction

A
  1. inherited hemolytic anemias
  2. acquired hemolytic anemias
  3. hypersplenism
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24
Q

What is the most common cause of anemia?

A

blood loss

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25
Q

What are the 4 types of blood loss?

A
  1. gross blood loss
  2. occult blood loss
  3. iatrogenic blood loss
  4. under appreciated menstrual blood loss
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26
Q

If you damage your bone marrow, what happens to the reticulocyte count?

A

retic count decreases

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27
Q

what happens to the retic count when you have blood loss?

A

retic count increases

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28
Q

what happens to the retic count when you have increased RBC destruction?

A

retic count increases

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29
Q

the morphologic approach classifies anemias based on ????

A

red cell indices (MCV, MCH, MCHC)

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30
Q

reticulocytosis will (increase/decrease) MCV

A

increase

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31
Q

What are some causes of macrocytic anemia?

A

-folate and B12 deficiency
-drugs that interfere with nucleic acid synthesis
-abnormal RBC maturation
-alcohol abuse
-liver disease results in lipid deposits on RBC increasing surface area

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32
Q

microcytic anemia is often associated with low MCHC due to ____ hgb content in the small RBC

A

low/decreased

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33
Q

What is most common cause of microcytic anemia?

A

iron deficiency**
alpha or beta thalassemia minor

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34
Q

How is normocytic anemia diagnosed?

A

with a peripheral smear

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35
Q

What are causes of normocytic anemia?

A

Chronic kidney disease
anemia of chronic disease/inflammation
mild iatrogenic hospital anemia

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36
Q

Name some causes of mild iatrogenic hospital anemia

A

recurrent venipuncture, blood loss from surgery, hemodilution with IV fluids, blunted erythropoiesis due to acute illness

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37
Q

Physiology of anemic symptoms is directly related to ????

A

decreased oxygen delivery to tissues

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38
Q

acute, moderate-severe blood loss will also cause _____ and a more severe clinical presentation of anemia

A

hypovolemia

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39
Q

How does the body compensate for anemia?

A

increase in oxygen extraction
increase in stroke volume and heart rate

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40
Q

symptoms occurring at rest indicate a ______ or the heart’s inability to compensate

A

lower Hbg and Hct

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41
Q

What are the common s/s associated with an anemic patient

A

varying degrees of fatigue
unusual exertional tachycardia/dyspnea
tachycardia/dyspnea at rest
palpitations
audible pulsations
bounding pulses
pallor

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42
Q

Name some signs of anemia complicated by volume depletion

A

easy fatigability
muscle cramps
dizziness/syncope
lethargy
progressive hypotension/shock/death

43
Q

What are the 4 major questions you should ask yourself when considering a anemia patient.

A

-Is the patient bleeding (past or present)? If so where?
-Is there evidence of increased RBC destruction (intravascular or extravascular)?
-Is there bone marrow suppression? If so why?
-Is the patient nutrient deficient in iron, folate or B12? If so why?

44
Q

Name some constitutional symptoms.

A

unintentional weight loss, loss of appetite, fever, night sweats

45
Q

symptoms of hx of medical condition associated with anemia

A

Melena - Upper GI bleed, bleeding ulcer
Large hematochezia - Lower acute GI bleed
Menorrhagia - Dysfunctional uterine bleeding
Renal failure
Rheumatoid arthritis
CHF¹

46
Q

Name some social hxs approach that points to anemia

A

alcohol, asa, nsaids, blood thinners

47
Q

Describe the skin of an anemic pt

A

pallor, jaundice, petechiae, bruising

48
Q

describe the eyes of an anemic pt

A

pale conjunctiva, scleral icterus

49
Q

Name some additional physical exam findings commonly found in anemic patients

A

lymph nodes
Hepatosplenomegaly (HSM)
bony tenderness (sternum, anterior tibia)
stool for occult blood

50
Q

Consider looking at this flow sheet, maybe?

A
51
Q

Hgb, hct and RBC count are all concentrations and dependent on _____

A

red cell mass

52
Q

If RCM is decreased and/or plasma volume is increased, what are the RBC and H&H doing?

A

RBC and Hgb and Hct will be low

53
Q

If plasma volume is decreased, what are RBC and H&H doing?

A

RBC and H&H will be elevated

54
Q

How is retic count reported?

A

reported as a percentage of RBC

55
Q

Why might the retic count be a problem when evaluating an anemic patient?

A

fewer RBC which may falsely increase the retic count

56
Q

What is the most accurate way to count reticulocytes in an anemic patient?

A

retic index calculation

57
Q

How do you calculate Reticulocyte Index Calculation (RI)? What is normal?

A

RI= retic percentage x (patient’s HCT/normal HCT)

RI is <3%

58
Q

Consider maybe looking at this again?

A
59
Q

Increased retic count is indicative of ______

A

hemolysis

60
Q

Name 3 labs that can help you further evaluate hemolysis?

A

serum lactate dehydrogenase (LDH)
indirect bilirubin
serum haptoglobin

61
Q

Destruction of the RBC will (increase/decrease) LDH

A

increase

62
Q

How is indirect bilirubin calculated?

A

Indirect bilirubin (unconjugated= total bilirubin - direct bilirubin (conjugated)

63
Q

bilirubin is the orange-yellow pigment derived from ???

A

the breakdown of hgb

64
Q

______ binds free hgb that is released from hemolyzed RBC

A

Haptoglobin

65
Q

What is the coombs test test for?

A

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

66
Q

What does a positive coombs test indicate?

A

autoimmune hemolytic anemia, hemolytic transfusion reaction, drug sensitizations, hemolytic disease of the newborn

67
Q

Is a normal coombs test positive or negative?

A

negative

68
Q

Name some lab tests associated with microcytic anemia

A
69
Q

Maybe consider looking at this one again??

A
70
Q

name 3 ways the human body can lose iron

A

perspiration
epithelial cell desquamation
menstruation

71
Q

Where is 65% of iron in the body found?

A

bound up in hemoglobin molecules in RBCs

72
Q

Where is 30% of the iron in the body stored?

A

stored as ferritin or hemosiderin in the spleen, bone marrow and the liver

73
Q

Where is 4% of the iron in the body found?

A

bound up in myoglobin molecules

74
Q

Where is < 1% of iron in the body found?

A

throughout the cells in the body

75
Q

Where is < .1% of the iron in the body is found?

A

bound to transferrin (taxicab for iron)

76
Q

What does the serum iron measure?

A

Measures the amount of circulating iron bound to transferrin

77
Q

What does decreased serum iron levels indicate?

A

iron-deficiency anemia, nephrosis¹, anemia of chronic disease and infection, chronic blood loss, malabsorption disorders

78
Q

What does increased serum iron levels indicate?

A

hemochromatosis², excessive iron intake, hemolysis of erythrocytes, liver necrosis³

79
Q

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

A

Transferrin

80
Q

Transferrin carries iron from the _______ to ______

A

duodenum to the marrow

81
Q

What does transferrin saturation calculate?

A

Calculates how much of the transferrin is being bound by iron

82
Q

What does a decreased transferrin saturation indicate?

A

iron-deficiency anemia

83
Q

What does an increased transferrin saturation indicate?

A

hemochromatosis, iron overload, thalassemia, RBC transfusions

84
Q

What does the total iron binding capacity measure?

A

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

85
Q

What is the opposite of transferrin saturation?

A

total iron binding capacity

86
Q

______ is the body’s major iron storage protein

A

ferritin

87
Q

iron molecules not transported to marrow by _____ are bound to _____ for later use

A

transferrin

ferritin

88
Q

______ the most reliable indicator of total-body iron status. What is the MOST ACCURATE?

A

ferritin

bone marrow biospy

89
Q

______ is more specific and sensitive than iron concentration or TIBC for diagnosing iron-deficiency anemia

A

ferritin

90
Q

What things do you need to determine macrocytic anemia?

A

retic count
B12
folate

91
Q

Maybe look at this again idk???

A
92
Q

Vitamin B12 requires ______ and ______.

A

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

93
Q

in order for vitamin b12 to be absorbed normally, what things must be working?

A

requires a normally functioning stomach, exocrine pancreas, and intestinal mucosa

94
Q

Where is the majority of vit B12 stored?

A

stored in the liver

95
Q

folic acid requires normal functioning of ______ for absorption

A

intestinal mucosa

96
Q

Where specifically is folic acid absorbed? Where is it stored?

A

Absorbed in the upper ⅓ of the intestine and stored in the liver

97
Q

What do elevated serum folate levels indicate?

A

B12 deficiency

98
Q

Name a responsibility of B12

A

move folate into tissue cells

99
Q

Maybe consider looking at this again?? who knows?

A
100
Q

What is the main cause of microcytic anemia?

A

iron deficiency

101
Q

What does transferrin saturation measure?

A

how much transferrin is bound to iron

102
Q

What is the pathophysiology behind an anemic patient presenting with jaundice?

A

hemolysis

103
Q

What is the significance of the RDW?

A

acute or chronic

Hem/Onc (14 decks)

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