Gas Exchange (Anemia)

Question 1

What are some causes of anemia ?

Answer 1

• decreased RBC production
• blood loss
• increased RBC destruction
• renal and liver failure

Question 2

Which anemia’s are megaloblastic ?

Answer 2

• pernicious
• folic acid

Question 3

What does a megaloblastic anemia mean ?

Answer 3

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

Question 4

What is the importance of intrinsic factor ?

Answer 4

need this factor to absorb extrinsic factor/cobalamin/vita. B12
- need to make RBCs

Question 5

Where is intrinsic factor secreted ?

Answer 5

the parietal cells of the gastric mucosa
- this factor depends upon the parietal cells and an acidic environment

Question 6

What is the importance of B12 ?

Answer 6

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

Question 7

What are some causes of pernicious anemia ?

Answer 7

• 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

Question 8

What are some S&S of pernicious anemia ?

Answer 8

• 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

Question 9

Why is B12 important for the nervous system ?

Answer 9

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

Question 10

Which lab values measures the size of RBCs ?

Answer 10

mean corpuscular volume (MCV)
- increased MCV means a megaloblastic anemia

Question 11

What are expected lab values for pernicious anemia ?

Answer 11

• 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

Question 12

Why wouldn’t B12 supplements be the best for treatment of pernicious anemia ?

Answer 12

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

Question 13

What is the treatment for pernicious anemia ?

Answer 13

• 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

Question 14

What are some foods high in B12 ?

Answer 14

• red meats (liver)
• organ meats
• sardines
• eggs
• enriched grains
• milk/dairy
• fish

Question 15

What is the function of folic acid ?

Answer 15

• RBC formation
• formation of the neural tube in a fetus

Question 16

What are some causes of folic acid deficiency ?

Answer 16

• 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

Question 17

What are some S&S of folic acid deficiency ?

Answer 17

• no neuro symptoms
• sore, red, “beefy”, tongue,
• mouth sores
• weakness
• pallor
• dyspnea/tachypnea
• tachycardia
• loss of appetite/anorexia
• N/V

Question 18

What are some expected lab values for folic acid deficiency ?

Answer 18

• increased mean corpuscular volume (MCV)
• decreased hemoglobin
• decreased hematocrit
• normal B12 and iron
• decreased folate

Question 19

What is the treatment for folic acid deficiency ?

Answer 19

PO supplements
- 1 mg per day up to 5 mg per day in cases of poor absorption/alcohol use

Question 20

Which foods are high in folic acid ?

Answer 20

• liver
• green, leafy vegetables
• legumes
• whole grains
• orange juice
• meat/fish
• peanuts

Question 21

What are some causes of iron deficiency anemia ?

Answer 21

• poor diet
• poor absorption
• blood loss
• increased need (pregnancy or menstruating women)

Question 22

What are some S&S of iron deficiency anemia ?

Answer 22

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)

Question 23

What are some expected lab values for iron deficiency anemia ?

Answer 23

• low MCV
• low hemoglobin
• low hematocrit
• normal B12 and folate
• low serum iron/ferotin
  Ferotin is the storage of iron

Question 24

What are the treatments for iron deficiency anemia ?

Answer 24

• increase dietary intake
• oral iron (best before meals)
• IV/parenteral iron in severe cases (risk of allergy so monitor pt)

Question 25

What are some considerations for oral iron supplements ?

Answer 25

• GI side effects: N,C and dark stool
• take with vitamin C, like orange juice, to aid in absorption

Question 26

What are foods that are high in Iron ?

Answer 26

• red meats
• spinach
• tofu
• organ meats
• beans