Gas Exchange (Anemia) Flashcards
What are some causes of anemia ?
- decreased RBC production
- blood loss
- increased RBC destruction
- renal and liver failure
Which anemia’s are megaloblastic ?
- pernicious
- folic acid
What does a megaloblastic anemia mean ?
RBCs are bigger which means they aren’t as effective
- since they are bigger they take up more space and there isn’t enough of them
What is the importance of intrinsic factor ?
need this factor to absorb extrinsic factor/cobalamin/vita. B12
- need to make RBCs
Where is intrinsic factor secreted ?
the parietal cells of the gastric mucosa
- this factor depends upon the parietal cells and an acidic environment
What is the importance of B12 ?
need this to convert folate into normal RBCs
- without B12 or if it can’t be absorbed then the RBCs are stuck in a specific phase which cause them to be large and misshapen
What are some causes of pernicious anemia ?
- autoimmune diseases that destroy the parietal cells
- decrease in stomach size (gastric bypass gastrectomy)
- ileum resection
- chronic gastritis, Crohns
- chronic use of acid reducing medications
- poor intake of B12-rich foods
What are some S&S of pernicious anemia ?
- sore, red, “beefy”, tongue
- numbness/tingling (decreased sensation)
- muscle ataxia
- mouth sores
- pallor
- dyspnea/tachypnea
- tachycardia
- loss of appetite/anorexia
- N/V
- weakness
- impaired though processes
Why is B12 important for the nervous system ?
helps maintain it and if pernicious anemia is left untreated it damages the myelin sheath around the nerves
- if not enough B12 then it can cause irreversible nerve damage
- can cause progressive muscle coordination loss
Which lab values measures the size of RBCs ?
mean corpuscular volume (MCV)
- increased MCV means a megaloblastic anemia
What are expected lab values for pernicious anemia ?
- increased mean corpuscular volume (MCV)
- decreased hemoglobin
- decreased hematocrit
- decreased serum B12
- normal iron & folate
- can also test for intrinsic factor antibodies if autoimmune component is suspected
Why wouldn’t B12 supplements be the best for treatment of pernicious anemia ?
these oral supplements have to be digested and this anemia is caused by an impaired stomach
- injections are best because they bypass the digestive system
What is the treatment for pernicious anemia ?
- B12 IM injections (daily then bi-weekly and ultimately monthly)
- nasal spray also available (expensive)
- in some cases, if GI system and absorption is intact then high doses or PO of sublingual B12 can be used and encouraged dietary intake
What are some foods high in B12 ?
- red meats (liver)
- organ meats
- sardines
- eggs
- enriched grains
- milk/dairy
- fish
What is the function of folic acid ?
- RBC formation
- formation of the neural tube in a fetus
What are some causes of folic acid deficiency ?
- poor dietary intake/anorexia
- alcoholism (get calories from alcohol so they don’t feel hungry and won’t eat a proper meal which causes a deficiency and it changes the way we absorb)
- malabsorption syndromes (Crohns, etc)
- medications that block uptake of folic acid (methotrexate, anti-seizure meds)
- hemodialysis (folic acid removed in dialysis)
- pregnancy
What are some S&S of folic acid deficiency ?
- no neuro symptoms
- sore, red, “beefy”, tongue,
- mouth sores
- weakness
- pallor
- dyspnea/tachypnea
- tachycardia
- loss of appetite/anorexia
- N/V
What are some expected lab values for folic acid deficiency ?
- increased mean corpuscular volume (MCV)
- decreased hemoglobin
- decreased hematocrit
- normal B12 and iron
- decreased folate
What is the treatment for folic acid deficiency ?
PO supplements
- 1 mg per day up to 5 mg per day in cases of poor absorption/alcohol use
Which foods are high in folic acid ?
- liver
- green, leafy vegetables
- legumes
- whole grains
- orange juice
- meat/fish
- peanuts
What are some causes of iron deficiency anemia ?
- poor diet
- poor absorption
- blood loss
- increased need (pregnancy or menstruating women)
What are some S&S of iron deficiency anemia ?
may be asymptomatic
- general symptoms of anemia
- start to feel symptoms when doing activities that require exertion
- pallor
- glossitis (shiny tongue) and may feel tingly (not nerve damage)
- cheilitis (lip inflammation)
What are some expected lab values for iron deficiency anemia ?
- low MCV
- low hemoglobin
- low hematocrit
- normal B12 and folate
- low serum iron/ferotin
Ferotin is the storage of iron
What are the treatments for iron deficiency anemia ?
- increase dietary intake
- oral iron (best before meals)
- IV/parenteral iron in severe cases (risk of allergy so monitor pt)
What are some considerations for oral iron supplements ?
- GI side effects: N,C and dark stool
- take with vitamin C, like orange juice, to aid in absorption
What are foods that are high in Iron ?
- red meats
- spinach
- tofu
- organ meats
- beans