Clin Med/ Pathophys & Diagnostic/Lab methods Flashcards
microcytic iron deficiency anemia etiology
caused by bleeding unless proved otherwise. can be: deficient diet, decreased absorption increased requirements, chronic blood loss, hemoglobinuria , iron sequestration, idiopathic
microcytic iron deficiency anemia signs/sxs
those of anemia itself: fatigue, tachycardia, palpitations, SOB on exertion, smooth tongue, brittle/spooning nails, cheilosis.
microcytic iron deficiency anemia dx workup
low MCV (RBC cell size), low reticulocytes, low ferratin values. Bone marrow bx rarely done. Eval labs and pt’s response to therapeutic trial of iron replacement to determine cause.
microcytic iron deficiency anemia tx
oral/parenteral iron
microcytic iron deficiency anemia complications
long term anemia - heart probs, growth probs, probs during pregnancy
microcytic iron deficiency anemia prevention
take supplements/adequate diet
microcytic thalassemia anemia - major/minor etiology
hereditary disorders characterized by reduction in the synthesis of globin chains. this causes reduced hemoglobin synthesis and thus anemia. 2 types: alpha (caused by gene mutations) and beta (caused by point mutations)
microcytic thalassemia anemia - major/minor signs/sxs
Alpha minor: clinically normal, normal life expectancy, performance status and mild microcytic anemia to pallor/splenomegaly.
Alpha major: no hemoglobin produced. stillborn.
beta minor: clinically insignificant.
beta major: stunted growth bony deformities, HSM, jaundice, cirrhosis, thrombophilia.
microcytic thalassemia anemia - major/minor dx workup
hematocrit, genetic counseling, CBCs, retic count, iron, MCV, blood smears
macrocytic folic acid deficiency anemia etiology
alcohol abuse, anorexia, malnutrition, overcooked foods, concurrent B12 deficiency, decreased absorption of iron (from drugs), increased iron requirement, loss of iron (from dialysis)
macrocytic folic acid deficiency anemia signs and sxs
megaloblastic anemia, glossitis, vague GI disturbances (anorexia, diarrhea)
macrocytic folic acid deficiency anemia dx workup
RBC folic acid level <150ng/mL. B12 can be normal, though.
macrocytic folic acid deficiency anemia tx
folic acid supps
macrocytic B12 deficiency anemia etiology
decreased intrinsic factor production, gastrectomy, dietary deficiency, competition for B12 in gut, decreased absorption, pancreatic insufficiency, H pylori infxn.
macrocytic B12 deficiency anemia signs/sxs
similar to folic acid deficiency + some neuro symptoms. Slow onset anemia such that the sxs might go unnoticed. pallor/mild icterus, glossitis, vague GI issues, neurologic manifestations (peripheral neuropathy, difficulty with position or vibration sensation/balance, dementia).
macrocytic B12 deficiency anemia dx workup
low serum B12 <100.
macrocytic B12 deficiency anemia tx
IM or SubQ inj of B12, PO/sublingual replacements. folic acid replacement, RBC transfusions if severe + diuretics.
macrocytic B12 deficiency anemia complications
altered cerebral fxn, dementia, hypokalemia.
normocytic anemia of chronic disease etiology
associated w chronic diseases: cancer, collagen vascular disease, chronic infections, DM, CAD. caused by low RBC production d/t trapped iron stores in macrophages or reduced uptake in the gut, decreased EPO production, impaired bone marrow response to EPO.
normocytic anemia of chronic disease signs/sxs
mild generalized fatigue, dizziness, mild palpitations, sometimes pallor of palpebral conjunctivae
normocytic anemia of chronic disease dx workup
often diagnosed incidentally by labs: slight Hb decrease (10-11 g/dL), hypo chromic RBCs, MCV normal to low, low absolute retic count, elevated acute phase reactants (ESR, platelets, fibrinogen), reduced transferrin, increased ferritin, low serum iron and total iron binding capacity w normal % saturation
intrinsic defects leading to hemolytic anemias
membrane (hereditary spherocytosis, paroxysmal nocturnal hemoglobulinuria), enzyme systems, hemoglobin (sickle cell, thalassemia)
extrinsic causes leading to hemolytic anemias
immune (autoimmune, lymphoproliferative disease, drug tox), microangiopathic hemolytic anemia (vasculitis), infection of RBCs (malaria, clostridium, lyme dz), hypersplenism, burns.
sickle cell anemia etiology
homozygous mutation in beta Hb chain. Hb molecules w 2 normal and 2 abnormal chains. elongated fibers: sickle cell shaped RBC