Final Exam - Anemias Flashcards
Splenic sequestration
Results when large numbers of sickled erythrocytes become lodged in an engorged, functional spleen during early childhood, resulting in severe anemia and potentially fatal hypovolemic shock, with a mortality rate of 10% to 15%.
Because this condition tends to be recurrent, splenectomy is often performed after the first episode
Signs and symptoms of splenic sequestration
- Abdominal pain
- pallor
- tachycardia
Parent education on splenic sequestration
Early recognition of splenic sequestration can be a lifesaving skill. Parents can be taught to recognize signs of increasing anemia and enlarging spleen.
- Abdominal pain
- pallor
- tachycardia
How to recognize increasing abdominal girth or abdominal pain, as well as how to palpate the spleen.
What type of anemia is folic acid anemia?
macrocytic normochromic anemias in which the cell size is large and irregular
What type of anemia is vitamin B12 deficiency anemia?
macrocytic normochromic anemias in which the cell size is large and irregular
What is Glucose-6-phosphate dehydrogenase (G6PD) deficiency?
An X-linked recessive disorder commonly seen in African American males. It is an enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stress.
Gold standard for diagnosis of sickle cell anemia
a hemoglobin electrophoresis, a test that determines the presence of hemoglobin S
Folate deficiency anemia
Not enough building blocks (vit c, folic acids, B12) to make DNA so cells get bigger instead of dividing
Insufficient folate intake or absorption from diet due to GI problems leads to abnormal blood cell formation and death of immature red blood cells
Causes of folate deficiency anemia
Malnutrition
Alcoholism
Anticonvulsant medications
Iron supplementation
Start with PO ferrous sulfate, can give parenterally if patient cannot tolerate PO or cannot absorb it and levels keep dropping despite iron supplementation
Anemia of chronic disease
A low serum iron level, low total iron binding capacity (TIBC) and low transferrin saturation.
The serum transferrin level is either normal or increased in patients with anaemia of chronic disease
Risk factors for iron deficiency anemia
- older than 60
- poverty
- recent illnesses like ulcer, diverticulitis, colitis, hemorrhoids, and gastrointestinal tumors
How should PO iron be taken?
on an empty stomach
Signs of iron deficiency anemia
- pale conjunctivae and nail beds
- tachycardia
- heart murmur
- cheilosis (reddened lips with fissures at the angles)
- stomatitis
- splenomegaly
- koilonychia (thin and concave fingernails with raised edges)
- glossitis.
Signs may also include esophageal webs (Plummer-Vinson syndrome), melena, and menorrhagia
What does a serum ferritin measurement tell you?
Ferritin is the body’s iron-storing protein, can tell exactly how much iron is on hand in the body. It is the best way to spot an iron deficiency early, before it progresses to full-blown anemia.
If the ferritin level is borderline, a dietary and supplemental regimen of iron will rebuild the iron stores.
What test should be done on all patients suspected to have iron deficiency anemia?
Fecal occult blood test.
In the early stages of iron deficiency anemia, both hemoglobin and hematocrit levels are normal to slightly reduced. It is necessary to determine whether the iron deficiency is related solely to inadequate dietary intake or to decreased absorption or chronic blood loss.
First line treatment for iron deficiency anemia
an increase in dietary iron and thereafter with supplemental iron
Reticulocyte count
The percentage of newly maturing red blood cells (RBCs) released into the circulating blood from the bone marrow.
Is elevated in cases of blood loss as the body tries to replace the loss; it might also be elevated during treatment of anemias (eg, iron, folic acid, and vitamin B12) and bone marrow disorders, when immature RBCs are displaced by other proliferating cells
Mean corpuscular volume (MCV)
MCV indicates the average size of individual red blood cells (RBCs). MCV is increased (macrocytic) in megaloblastic anemias (ie, vitamin B12 deficiency and folate deficiency) and liver disease (such as that resulting from alcohol abuse) as well as with the use of some drugs (eg, zidovudine).
Decreased MCV and MCHC are indicative of a microcytic hypochromic anemia. To make a more final diagnosis, the NP needs to order a serum iron level, a TIBC level, and a serum ferritin level.
Normal range for MCV
76 to 96 fL.
Cause of Megaloblastic/Pernicious anemia
Vitamin B12 deficiency is the most common cause of megaloblastic anemia.
Megaloblastic or pernicious anemia, what show what type of cells?
Macrocytic and normochromic cells
Sideroblastic anemia
Group of blood disorders in which the body has enough iron but is unable to use it to make hemoglobin, which carries oxygen in the blood. As a result, iron accumulates in the mitochondria of red blood cells, giving a ringed appearance to the nucleus
Diagnostic test for sideroblastic anemia
Prussian blue stain is the diagnostic test used to identify sideroblastic anemia. Ringed sideroblasts would be seen in this stain.
Cause of Microcytic Hypochromic Anemia
disruption of iron supply in diet due to decreased iron content in the diet, pathology of the small intestines like sprue and chronic diarrhea, gastrectomy, and deficiency of vitamin C in the diet
Diagnosis of microcytic hypochromic anemia
The absence of iron stores in the bone marrow remains the most definitive test for differentiating iron deficiency from the other microcytic states, ie, anemia of chronic disease, thalassemia, and sideroblastic anemia.
CBC
Peripheral smear
Acute Lymphoblastic Leukemia
A type of cancer characterized by the rapid proliferation of immature lymphoblasts, which are abnormal white blood cells. ALL affects the bone marrow and blood cells.
Commonly affects children
Acute Lymphoblastic Leukemia Risk Factors
- Genetic predisposition
- Exposure to high levels of radiation or chemicals
Symptoms of Acute Lymphoblastic Leukemia
- Fatigue
- Pale skin and shortness of breath
- Frequent infections and fever
- Easy bruising or bleeding
- Bone and joint pain
- Enlarged lymph nodes
Diagnosing Acute Lymphoblastic Leukemia
- Blood tests to analyze blood cell counts and markers
- Bone marrow biopsy
- Lumbar puncture (to check for central nervous system involvement)
Treatment for Acute Lymphoblastic Leukemia
-Chemotherapy
- Radiation therapy (in specific cases)
- Stem cell transplant (in high-risk cases)
- Supportive care (pain management, infection prevention, blood transfusions)
Chronic Lymphocytic Leukemia
A type of cancer affecting the white blood cells (lymphocytes), characterized by the accumulation of abnormal lymphocytes in the bone marrow, blood, and lymph nodes. CLL progresses slowly over time.
Most common leukemia.
Usually found in those over 70.
Risk factors for chronic lymphocytic leukemia
- Age (more common in older adults)
- Family history of CLL or other lymphoid malignancies
- Male gender
- Caucasian race
- Prolonged exposure to certain chemicals
Symptoms of Chronic Lymphocytic Leukemia
- Fatigue and weakness
- Enlarged lymph nodes (neck, armpits, groin)
- Recurrent infections (pneumonia, sinusitis)
- Night sweats
- Unexplained weight loss
- Abdominal discomfort or swelling
- Easy bruising or bleeding
Treatment of Chronic Lymphocytic Leukemia
- Watchful waiting (for early-stage, asymptomatic cases)
- Chemotherapy
- Immunotherapy (e.g., monoclonal antibodies)
- Targeted therapy (e.g., BTK inhibitors, BCL2 inhibitors)
- Stem cell transplant (in select cases)
