EXAM #1: ANEMIA 2.0 Flashcards
What is polycythemia?
An abnormal increase in Hb concentration in the blood
What is the RBC count in thalassemia?
High
How do you calculate an absolute retic. count?
(RBC# x %reticulocytes)/ 100
What do you know if the absolute retic. count is less than 100,000 microL?
NO retirculocytosis
What are the two primary causes of megaloblastic anemia?
- Vitamin B12 deficiency
- Folic acid deficiency
*Drugs can also cause megaloblastic anemia
What are the causes of nonmegaloblastic macrocytic anemia?
1) Hypothyroidism
2) Liver disease
3) Alcoholism
4) Myelodysplastic syndromes
Outline the BIG FAT RED CELLS mnemonic.
B= B12 I= Inherited G= GI disease/ surgery
F= Folic acid A= Alcholism T= Thiamine response
R= Reticlocyte miscount E= Endocrine D= Dietary
C= chemotherapy E= Erythro L= Liver L= Lesch-Nyhan Syndrome S= Splenectomy
What are the signs of anemia?
Pallor
Pica
Koilonychia
What are the PBS hallmarks of megaloblastic anemia?
1) MCV greater than 100
2) Hypersegmented neutrophils
How do the total body stores of B12 and Folate compare?
B12= 2-5mg Folate= 5-10mg
How does the daily requirement of B12 and Folate compare?
B12= 1-3 micrograms
Folate= 50-100 mircograms
What is the source of B12? What is the source of Folate?
B12= animals Folate= plants
Compare the sites of absorption for B12 and Folate.
B12= terminal ileum
Folate= proximal jejunum
What is the main difference in symptomatic outcomes of B12 deficiency and Folate deficiency?
B12= neurologic complications
Folate= NTD
List the specific causes of B12 deficiency.
1) Vegans–veggie man
2) Pernicious anemia–prune anemone
3) Gastric bypass–stomach stapler
4) Malabsorption–mallet
5) Celiac spure–sprouts
6) Enteritis–enter intestines
7) Diphyllobathrium latum–fish tapeworm
8) Chron’s Disease
What is the functional role of Vitamin B12?
Vitaminc B12 is an important cofactor for for conversion of:
1) Methylmalonic acid to succinly-CoA (Methylmalonyl-CoA mutase)
2) Methylation of homocysteine to methionine (methionine synthase)
How does B12 deficiency lead to neruologic symptoms?
Build-up of methylmalonic acid
What is difference between folate and B12 deficiency in regards to methylmalonic acid?
B12= methylmalonic acid increase
Folate= no increase
BOTH will be high in homocysteine
What is the presentation of Congenital Transcobalamin II Deficiency?
Infantile anemia in a few weeks of birth
What is the presentation of Congenital Methylmalonic Acidemia?
Infants ill from birth
What is the presentation of excessive NO inhalation?
- Irreversible oxidation of methylcobalamin*
- Presents like B12 deficiency
What is the major difference between the symptoms of B12 deficiency and folate deficiency?
Neurological symptoms
What lab values are diagnostic for B12 deficiency?
1) Increased MCV
2) Decresed retic.
3) High methylmalonic acid
4) High homocysteine
How is B12 deficiency treated?
1) Find the cause
2) Supplement w/ 1,000 micrograms SC or IM for a month, then monthly
What electrolyte needs to be monitored with B12 deficiency?
Potassium
What are the complications of B12 deficiency?
1) Demyelination of the posterior spinal column and lateral corticospinal tract
2) Infertility
3) Cervical smear abnormalities
What post-op patient populations must be B12 supplemented?
Total gastrectomy
What is pernicious anemia?
- Autoimmune disorder directed against gastric parietal cells
- Results in absent gastric acid and IF
What test can be done to diagnose Pernicious Anemia?
Schilling Test
What lab values are diagnostic for Pernicious Anemia?
1) Parietal cells and IF antibody positive
2) High serum gastrin
3) Low pepsingoen
What are the major causes of folate deficiency?
Remember, causes a macrocytic, megaloblastic anemia b/c
1) Malabsorption–mallet
2) Poor dietary intake– my chart
3) Elderly–tea and toast diet
4) Methotrexate- moth-T-rex ate
5) Trimethoprim–tampon
6) Increased need:
- Hemolytic anemia
- Pregnancy
What lab values are diagnostic for Folate Deficiency?
NORMAL Methylmalonic acid
How is a Folate Deficiency treated?
1) Consume foods rich in folic acid
2) Supplement
What is aplastic anemia?
Bone marrow failure to produce RBCs, WBCs, platelets
i.e. bone marrow failure leading to PANCYTOPENIA
What are the major causes of aplastic anemia?
1) SLE
2) Drugs
What are the symptoms of aplastic anemia?
Symptoms are related to the three blood cell line defects:
1) Anemia= weakness/fatigue
2) Neurtopenia= bacterial/fungal infection
3) Thrombocytopenia= bleeding
What are the signs of aplastic anemia?
- Pallor, petechaie, purpura
- HSM?
Is bone pain a normal finding in aplastic anemia?
NO–this is indicative of underlying cancer
What lab values are diagnostic for aplastic anemia?
1) PANCYTOPENIA
2) Reticulocytopenia
How is aplastic anemia treated?
1) Stop offending agent and supportive care
2) Severe cases are treated with bone marrow transplant
