Lecture 8: Anemia Case Studies Flashcards

1
Q

What are 3 common symptoms and 4 common signs of anemia?

A

Symptoms: fatigue, exercise intolerance, rapid heartbeat

Signs: pallor (conjunctiva or muscosa), tachycardia, systolic murmur, edema

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2
Q

What is the earliest and most sensitive sign of Iron Deficiency Anemia?

A

increased RDW (Red Cell Distribution Width)

  • also called Anisocytosis
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3
Q

What are three indications of low iron? What are 2 indications that the body is WAITING for iron?

A
  • low serum iron, low serum ferritin (reflects iron stores), and low transferrin/TIBC (total iron binding capacity)
  • increased TIBC and transferrin receptor (TFR)
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4
Q

What do the terms “onychoschizia” and “koilonychia” mean?

A

O - split nails

K - spooned nails

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5
Q

What are common signs of Iron Deficiency Anemia?

A

tired, weight loss (cancer/inadequate nutrition), nail problems

  • also: conjunctival pallor and cheilosis (angular stomatitis –> around mouth)

PICA –> compulsion to eat substances such as ice, chalk, soil, paper

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6
Q

What should you look for in postmenopausal females or males suspected of iron deficiency anemia?

A

sources of gastrointestinal blood loss

  • do a stool guaiac test (positive for fecal occult blood)
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7
Q

How does anemia of blood loss present? What are 3 common results of anemia from acute blood loss?

A
  • presentation is ACUTE (hypovolemia/heart attack)

FIND THE BLEEDING AND STOP IT

results –> hypovolemia, myocardial ischemia (supply vs demand), renal failure

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8
Q

How much should a single unit of RBC increase Hgb by?

A

1 g/dL

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9
Q

What blood type is the universal donor and what type is the universal acceptor? How does Rh +/- factor into blood transfusions?

A

UD: type O blood (has no antigens on it)

  • RBCs can be given to anyone
  • can receive all types of plasma (no Ags on it)

UR: type AB (produces no antibodies)
- plasma can be given to anyone

  • only give Rh+ blood to blood types that are positive, Rh- can give blood to their own type and AB- (O- can be given to anyone regardless of +/-)
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10
Q

What is Sickle Cell Disease?

A
  • autosomal recessive causing predominately HbS hemoglobin (rather than HbA) due to Glutamic Acid –> Valine mutation
  • particularly prominent in West Africans (survival against endemic malaria)

African Americans have an 8% prevalence

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11
Q

What is the confirmatory test for Sickle Cell Anemia?

A

gel electrophoresis

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12
Q

How does sickle cell anemia cause stroke, acute chest pain, and renal manifestations?

A

S - vaso-occulsion (affects 15% of children)
- TRANSFUSION helps

ACP - common cause of death in adults with SCA

  • vaso-occlusion by marrow emboli of necrotic bone
  • pulmonary vaso-occlusion dec. oxygen count

RM - urine cannot be concentrated due to damage
- hematuria (even in heterozygous peeps)

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13
Q

What bone manifestation can occur in Sickle Cell Anemia?

A

Avascular Necrosis

  • can lead to long-term disability
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14
Q

What are common therapies for Sickle Cell Anemia?

A
  • start oxygen, give NSAIDS (hydrocodone) for pain
  • avoid high altitudes and intense exercise
  • Hydroxyurea (dec. HbS, more HbF) and transfusions
  • possible stem cell transplant
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15
Q

Who would be the best person to receive a blood transfusion from and why?

A
  • we can potentially generate alloantibodies against transfusions unless we possess that antigen
  • chronic transfusions should be received from a donor pool as genetically identical to you as possible
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16
Q

What is Aplastic Anemia? Who does it affect?

A
  • a pancytopenia with bone marrow HYPOcellularity
  • typically presents in adolescents and young adults
  • bleeding is usually first indication something is wrong
17
Q

What 6 common drugs can lead to Aplastic Anemia? (CCNAHS)

A

Chloramphenicol, Chloroquines, NSAIDS, anticonvulsants, heavy metals, sulfonamides

18
Q

How can Aplastic Anemia be treated?

A
  • transfusion or growth factor support

- if no spontaneous resolution, try stem cell transplant