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My MNTII Test 2 > From Review: Anemia > Flashcards

From Review: Anemia Flashcards

1
Q

what is hemosiderosis

A

iron overload w/high oral iron intake (or even regular diet), accumulate in body. asymptomatic until burden exceeds 5 g

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2
Q

who has hemosiderosis

A

in ppl w/hemochromatosis, acerulopasminemia, hypotransferrinemia/atransferrinemia

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3
Q

what occurs in hemochromatosis

A

more iron is absorbed than normal, and serum ferritin > 300 mg/dL

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4
Q

what is hemochromatosis

A

1% of ppl. hereditary disorder where iron stores reach 20-40 g (N: 1-3 g)

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5
Q
  • s/s hemochromatosis
A

cirrhosis, liver cancer, diabetes, bronze skin, cardiomyopathy, arrhythmias, heart failure, ad pain, arthritis

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6
Q

hemosiderosis & hemochromatosis Tx

A

phlebotomy. removing 500mL of blood removes 250 mg of Fe.

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7
Q

iron toxicity associated w/

A

multiple blood transfusions in pts w/hereditary anemias, then Deferoxamine is used to remove excess iron as phlebotomy would make anemia worse

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8
Q

IM & IV Fe sups

A

Iron dextan - Imferon, Infed, DexFerrum

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9
Q

IM & IV iron sup dose

A

up to 100 mg/day based on wt and blood values

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10
Q

IM & IV Fe sup side effects

A

anaphylaxis, fever, lymphadenopathy, vomit, flushing, headache, dizziness, seizure, syncope, hypotension, tachycardia, taste disorder, urticariapain and staining at injection site, phlebitis, cancer

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11
Q
  • multiple doses of … (less adverse reactions)
A

iron sucrose (venofer) or ferric gluconate (ferrlecit) can also be used to treat Fe deficiency

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12
Q

sickle cell anemia: serum ferritin may be

A

falsely elevated during a SCE crisis

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13
Q
  • false high serum ferritin may occur in
A 
infection/inflammation
inflammatory bowel diseases 
some cancers like Hodgkin's and leukemia
liver disease
RA
recent blood transfusion
menstruation
some meds
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14
Q

in underproduction

A

reticulocyte ct is low

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15
Q

in loss or destruction

A

reticulocyte ct is high

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16
Q

usual % reticulocytes

A

slides say > 5% (case study in note say 0.5-1.5% normal)

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17
Q

mean reticulocyte hemoglobin content (CHr)

A

normal > 27 pg per cell

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18
Q

reticulocytosis

A

increased RBC production

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19
Q

reticulocytopenia

A

decreased RBC production

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20
Q

anisocytosis

A

varied RBC size

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21
Q

poikilocytosis

A

varied RBC shape

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22
Q

microcytosis

A

decrease in RBC size

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23
Q

hypochromasia

A

pale RBCs

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24
Q

Cobalamin status assessments

A
  1. plasma or serum B12
  2. methylmalonic acid excretion and serum MMA
  3. serum total homocysteine
  4. deoxyuridine suppression test
  5. schilling test
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25
Q
  1. plasma/serum B12
A

low level indicates deficiency. (N > 300 pg/mL)

26
Q
  1. serum methylmalonic acid and (MMA) excretion
A

elevated MMA indicates B12 deficiency, as high as 300 mg/day (N 0-3.5 mg/24 hr)

earlier indication then plasma cobalamin

27
Q
  1. serum total homocysteine
A

elevated in cobalamin def, also in folate and pyridoxine defs.

28
Q

Deoxyuridine (dU) –>

A

thymidine (w/adequate B12/folate)

29
Q
  1. deoxyuridine suppression test
A

cobalamin/folate def cause suppression (less incorporation).

test is ran w/both vits add to test separately to determine which vit is lacking.

30
Q
  1. schilling test
A

test of cobalamin absorption. low urine excretion of radioactive cobalamin = cobalamin malabsorption

31
Q

folic acid status assessment

A
  1. serum/plasma folate
  2. erythrocyte folate
  3. FIGLU excretion
  4. dU suppression test
  5. serum homocysteine
32
Q
  1. serum/plasma folate
A 
def < 3ng/mL
(3-6 marginal status)
33
Q
  1. erythrocyte folate
A

less sensitive to short term fluctuation than plasma, better reflects tissue stores

34
Q
  1. Formiminoglutamate (FIGLU) excretion
A

elevated in folate & B12 def, also liver disease, cancer, TB

35
Q

FIGLU excretion may be low even when folate def is present in

A

kwashiorkor, pregnancy, anticonvulsants

36
Q

histidine w/adequate folate

A

–> glutamic acid

37
Q

histidine w/out adequate folate

A

–> FIGLU

38
Q
  1. deoxyuridine (dU) suppression test
A

assess ability of nonradioactive dU to suppress labeled thymidine incorporation into . folate or B12 def cause suppression (less incorporation).

39
Q
  1. serum total homocysteine
A

elevated in folate, B12, B6 defs

40
Q

anemia of chronic disease like

A

RA, lupus, cancer, chronic infections, inflammatory bowel diseases. may be normocytic/microcytic.

41
Q

anemia of chronic disease characteristics

A

poor response to erythropoietin, high cytokine mediated, short RBC half-life, high hepcidin causes poor iron mobilization/efflux from storage, inflammation.

no nutr Tx

42
Q

normocytic: aplastic anemia

A

bone marrow failure, pancytopenia, congenital like Fanconi’s anemia, viral/drug/chemical exposure, no nutr tx, only cure is bone marrow transplant (BMT)

43
Q

normocytic: myelopathic disorders/ myelodysplasis

A

usually have pancytopenia. ex. preleukemia or stem cell disorders. give transfusions, no nutr tx, cure MBT

44
Q

normocytic: myelodysplastic syndrome pts may get

A

acquired sideroblastic/refractory anemia w/ringed sideroblasts (RARS)

45
Q

RARS may be d/t

A

INH, cycloserine, chloroamphenicol & alcohol, lead or zinc toxicity

46
Q

RARS try giving

A

100-200 mg pyroxene per day

47
Q

normocytic: PEM

A

provide pt/ NS to correct PEM

48
Q

normocytic: CKD

A

give EPO and hematopoietic nutrients as needed

49
Q

normocytic: hepatic disorders

A

anemia is often mildly macrocytic, no nutr tx

50
Q

normocytic: endocrine disorders

A

treat underlying condition, not nutr tx

51
Q

normocytic: chemotherapy/med related anemia

A

chemo and AIDS treatments like AZT often cause anemia. usually respond to Procrit (epoetin alfa) erythropoietin injections

52
Q

folate deficiency can be induced by

A

methrotrexate (amethopterin, folex, rheumatrex) cancer chemo agent and treat RA and psoriasis

53
Q

methotrexate taken as chemo agent

A

high folate intake may decrease med’s effectiveness

54
Q

methotrexate taken for other disorders

A

folate sups may be used prophylactically and do not decrease med’s effectiveness

55
Q

Phenytoin (Dilantin) therapy

A

folate status decline and def (macrocytic anemia) has been reported

56
Q

folate sup may

A

decrease Dilantin’s anticonvulsant effect so min amt of folate should be used to control def symtoms

57
Q

dilantin: 800 mcg folate

A

may increase seizure frequency in some cases

“typical dose 250-1000 mcg/day”

58
Q

meds and folic acid

A 
antacids
anticonvulsants
aspirin
cycloserine
diuretics
famotidine
59
Q

meds that impact B12 status/absorption

A

nitrous oxide, cholestyramine, INH, neomycin, metformin, H2 receptor blockers, PPIs (Nexium, Prevacid, Prilosec), psychiatric (phenobarbital, dilantin)

60
Q

hydroxyurea med

A

decreases painful episodes of sickle cell anemia

61
Q

hemolytic anemias avoid

A

fava beans, some dyes, and some meds: antimalarials and aspirin (cause oxidative stress and hemolytic attack)

62
Q

meds that decrease iron absorption

A

cholestryramine, clofibrate, neomycin, PAS

My MNTII Test 2 (7 decks)

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