Blood 2 Flashcards
what plays a major role in IDA?
menstrual blood loss
pregnancy
what is the MC cause of IDA?
chronic blood loss (CBL)
what are some other ways one can develop IDA?
chronic aspirin use
chronic hemoglobinuria
what are some symptoms that differentiate IDA from generalized anemia?
progressive skin amd mucosal changes
Pica (for ice chips)
what lab findings would you have with IDA?
decreased iron
decreased ferritin
increased TIBC
normal platelet count usually
TIBC
total iron binding capacity
protein molecule to bind iron
if there is decreased iron, there is increased TIBC
what kind of anemia is IDA?
microcytic hypochromic
what other cells might someone with IDA have?
anisocytosis
poikilocytosis
target cells
microcytes
what lab findings can one have with anemia of chronic disease?
normal/decreased iron
normal to increased ferritin
low TIBC
DDx for IDA
thalassemia
anemia of chronic disease`
what is the treatment for IDA?
treatment is directed at the cause
iron supplementation may be necessary
ACD lab findings?
low serum iron
low TIBC
normal/increased ferritin
what are examples of diseases that can be because of ACD?
chronic infection inflammation cancer liver disease RA chronic renal disease (ARD)
what is decreased in ACD?
RBC survival
bone marrow fails to compensate
what type of anemia is ACD?
normocytic normochromic (MC) microcytic hypochromic anemia
inhibition of erythropoiesis and altered iron metabolism
(ACD)
what are the treatments for ACD?
may not be necessary
transfuction
receive erythropoietin
patient could also become iron deficient
what is thalassemia?
hereditary disorder
characterized by reduced synthesis of globulin chains of hemoglobin
what kind of anemia is thalassemia
microcytic hypochromic anemia
who primarily get alpha thalassemia?
china
southeast asia
who primarily gets beta thalassemia?
mediterranean origin
thalassemia minor
trait is present, don’t necessarily have it
thalassemia major
lifethreatening anemia with other changes being notes
AKA cooley’s anemia
what are the numerous problems that can be related with thalassemia?
growth failure bone defomrities marrow expansion widened diploic space calverium has a hair on end appearance facial abnormalities pathological fracutres hepatosplenomegaly jaundice gallstones
ddx for thalassemia
other microcytic hypochromic anemias
what is the biggests difference between thalassemia and toher microcytic hypochromic anemias?
lower MCV than IDA
normal TIBC, iron and ferritin
decreased Hgb, Hct, MCV, MCH
may have normal RBCsa
peripheral blood smear shows what for thalassemia?
anisocytosis, poikilocytosis, target cells, ovalocytes, basophilic stippling, nucleated RBCs
marked hypochromia and microcytosis
what is needed to differentiate between alpha and beta thalassmia?
hemoglobin electrophoresis
what are the microcytic hypochromic anemias?
IDA
thalassemia
anemia of chornci disease
chronic blood loss (really an IDA)
IDA serum iron, TIBC, serum ferritin
decreased
increased
decreased
ACD serum iron, TIBC, serum ferritin
decreased
decreased
normal to increased
thalassemia serum iron, TIBC, serum ferritin
normal
normal
normal
types of macrocytic normochromic anemias
vitamin B12 (megaloblastic) folic acid deficiency (megaloblastic) alcoholism (non megaloblastic) liver disease (non megaloblastic)
increased MCV means?
larger than normal RBC
describe macrocytic normochromic anemia
increased MCV
vitamin B12 or B9 deficiency
large RBCs cannot conform to small capillaries, so they fracture and have s hortened life span
describe megaloblastic anemia
changes in RBC and WBC precursors
inhibition of DNA synthesis in RBC production
may need marrow biopsy or B12/folate assay
how can there be nonmegaloblastic anemias?
due to liver disease, alcohol, etc
what is the use of B12 in the body?
converts folic acid to its active form needed in the fomration and function of RBCs
when might someone have decreased intake of B12?
poor diet
strict vegetarian
malabsorption syndromes
fish tapeworm
when might someone need more B12?
pregnancy
malignancy
what is the most common cause of B12 deficiency?
deficiency of intrinsic factor
pernicious anemia?
deficiency of intrinsic factor, causing a B12 deficiency
auto-imune atrophic gastritis
autoantibodies are directed against parietal cells and intrinsic factor
what is the second MC cause of B12 deficiency
lack of gastric acid necessary to separate B12 from its binding proteins
what is the 3rd MC cause of B12 deficiency
diseases of terminal ilium (worm infestation, IBS, malabsorption syndromes, etc
symptoms of B12 defcicency
lemon-yellow skin color premature graying weakness sore tongue GI symptoms (diarrhea, abdominal apin) paresthesia loss of vibratory sensoation irritability emotional instability neuropsychiatric disorders
macrocytic normochromic pernicious anemia
conditioned nutritional deficiency of cobalamin
B12 deficiency caused by gastric mucosa failure to secrete IF
genetically determines
who gets macrocytic normochromic pernicious anemia?
older adults
maybe in strict vegetarians
1 of 4 develop stomach cancer
what is folic acid needed for?
normal function of RBC and WBCs
depends on normal unction of intestinal mucosa
describe RBCs that are abnomrally large
shortened life span and decreased oxygen carrying capacity
what can cause a deficiency folic acid?
poor diet, insufficient vegetable intake, alcoholism, malabsorption syndromes
what makes you need more folic acid?
pragnancy
infancy
malignancy
symptoms of megaloblastic naemia from b12 or folic acid deficiencies
inflamation of mouth (stomatitis)
inflammation of tongue (glossitis)
psychiatric and neurologic problems (numbness, tingling, depression, memory loss, irritability
symptoms of pernicious anemia because of B12 deficiency
numbness tingling depression memory loss irritability
advanced nerve damage
because of B12 deficiency can cause?
loss of balance staggering confusion dementia spasticity loss of bladder control erectile dysfunction
folic acid deficiency symtpoms
irritable
forgetful
personality changes
describe macrocytic normochromic megaloblastic anemia
abnormally large RBCs decreased RBCs decreased hemoglobin increased MCV normal/increased MCH increased iron increased ferritin decreased B12 or folate hyper segmented neutrophils
describe macroytic normochromic nonmegaloblastic anemia
chronic liver disease, alcoholism increased MCV, abnormally large RBCs increased liver enzymes increased bilirubin signs and symptoms of liver disease and/or alcoholism
