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clin med IV > microcytic anemias > Flashcards

microcytic anemias Flashcards

1
Q

definition of microcytic anemia

A
  • MCV < 80
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2
Q

common microcytic anemias

A
  • iron def anemia
  • anemia of chronic disease
  • thalassemia
  • sideroblastic anemia
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3
Q

what is the most common cause of anemia

A
  • iron deficiency anemia
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4
Q

what is the most common cause of iron def anemia

A
  • GI bleeding

- menstrual bleeding

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5
Q

stages of iron def anemia

A
  • depletion of iron stores without anemia
  • anemia with normal RBC size
  • anemia with reduced RBC size
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6
Q

clues in pts hx to think of iron def anemia

A
  • diet
  • PICA
  • phagophagia
  • glossitis
  • mouth soreness
  • angular cheilitis
  • Koionychia
  • dysphagia
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7
Q

where is iron absorbed

A
  • acidic conditions
  • stomach, duodenum, jejunum
  • avg diet has 10-15 mg of iron, only absorb 1.5%
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8
Q

iron requirement in males and non-menstruating females

A
  • 1 mg/d
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9
Q

iron requirements in menstruating females

A
  • 3-4 mg/d
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10
Q

iron requirements in pregnant females

A
  • 2-5 mg/d
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11
Q

what is the role of transferrin

A
  • transports iron
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12
Q

what is the role of ferritin

A
  • stores iron (simple)
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13
Q

what is the role of hemosiderin

A
  • complex iron stores in macrophages

- helpful with insoluble Fe

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14
Q

iron deficiency categories

A
  • deficient intake/ decreased absorption
  • increased requirement
  • blood loss
  • other: hemoglobinuria, idiopathic, Fe sequestration
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15
Q

work up for iron def anemia

A
  • low serum iron, transferrin, ferritin
  • high TIBC
  • usu low retic count
  • low MCV and MCH
  • peripheral smear: hypochromic and microcytic
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16
Q

si/sx of iron def anemia

A
  • easily fatigued
  • conjunctival pallor
  • tachycardia, palpitations
  • DOE
  • pica
  • severe: smooth tongue, brittle nails, koilonychia, chelosis
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17
Q

treatment for iron def anemia

A
  • ferrous sulfate TID- tae with vit C/ OJ to increase absorption
  • try cooking in cast iron skillet
  • parenteral options
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18
Q

why give parenteral options in iron def anemia

A
  • pt cant tolerate PO
  • refractory to PO
  • GI dz that limits absorption
  • continued blood loss
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19
Q

side effect of iron supplementation

A
  • constipation
  • GI upset
  • give colase
  • titrate up to TID to mitigate
20
Q

anemia of chronic disease

A
  • usu MCV < 80 but can also be normocytic
  • problem with iron utilization
  • bone marrow unable to respond to EPO
21
Q

causes of anemia of chronic disease

A
  • inflammation
  • endocrine disorders
  • infection
  • chronic liver dz
  • CT disorders- SLE, RA
  • endocarditis
  • cancers- liquid and solid tumors
  • *IS NOT the same as anemia of CKD
22
Q

what disease states is anemia of chronic disease NOT seen in

A
  • DM
  • COPD
  • CHF
  • HTN
23
Q

etiology of anemia of chronic disease

A
  • “iron is there but vault is locked”
  • lg amount of inflam cytokines released
  • stim hpatocytes to make massive amounts of hepcidin
  • prevents release of iron from macrophages and liver stores
24
Q

lab findings for anemia of chronic disease

A
  • microcytic or normocytic
  • normochromic
  • low retic count
  • normal/ elevated serum ferritin
  • decreased iron
  • decreased-normal TIBC
  • ferritin up or normal
  • increased ESR and CPR
  • bone marrow bx only in difficult cases
25
Q

treatment of anemia of chronic disease

A
  • treat underlying condition
  • supplemental iron
  • ok to use EPO - edu pt on risk
26
Q

thalassemia

A
  • defect in alpha or beta globin chains
  • mild - severe depending on number of genes with mutations
  • often confused with iron def d/t low MCV
27
Q

alpha thalassemia

A
  • gene deletion -> reduced alpha globin chain synthesis
  • depends on how many genes deleted (1-4)
  • common in Asia/ china
28
Q

3 copies of alpha chain

A
  • carrier

- no sx

29
Q

2 copies of alpha chain

A
  • minor

- mild sx

30
Q

1 copy of alpha chain

A
  • HbH disase
31
Q

0 copies of alpha chain

A
  • not compatible with life
32
Q

si/sx of alpha thalassmia

A
  • carriers have no sx
  • fatigue, weakness
  • pallor
  • splenomegaly
33
Q

lab findings for alpha thalassemia

A
  • hypochromic, microcytic anemia
  • smear: normal, target cells, heinz bodies
  • get ferritin to r/o iron def
  • Hgb electrophoresis*
34
Q

treatment for alpha thalassemia carriers

A
  • no treatment
  • transfuse as needed
  • can supplement with folic acid and iron
  • offer genetic counseling
35
Q

treatment for alpha thalassemia disease

A
  • transfusion as needed
  • consider iron chelation if overloaded
    splenectomy and SCT in severe cases
  • off genetic counseling
36
Q

beta thalassemia

A
  • point mutation -> defective beta chains
  • decreased production of normal Hgb, relative excess alpha
  • more common in mediterranean
  • major vs minor disease
37
Q

major beta thalassemia

A
  • homozygois

- two mutations -> no beta globin

38
Q

minor beta thalassemia

A
  • heterozygous

- one mutation -> less beta globin production

39
Q

si/sx of minor beta thalassemia

A
  • most asymptomatic
  • hypochromic, microcytic
  • may note target cells, dacrocytes, basophillic stippling
40
Q

si/sx of major beta thalassemia

A
  • severe anemia
  • pallor, irritability, growth retardation, abd swelling
  • hypochromic, microcytic
  • smear: poikilocytosis, target cells, basophilic stippling
  • RDW- normal
  • ferritin- normal
41
Q

treatment for major beta thalassemia

A
  • transfusions as needed- esp periods of rapid growth
  • consider splenectomy and SCT
  • supplemental folic acid
  • offer genetic couseling
42
Q

sideroblastic anemia

A
  • make ringed sideroblasts- iron cannot be incorporated
  • assoc with copper def
  • results in iron overload
43
Q

causes of sideroblastic anemia

A
  • hereditary or acquired

- drugs: chloramphenicol, linezolid

44
Q

si/sx of sideroblastic anemia

A
  • pale
  • dizziness, fatigue
  • hepatosplenomegaly
45
Q

lab findings for sideroblastic anemia

A
  • microcytic, hypochromic
  • neutropenia if Cu def
  • liver and kidney abnormalities d/t iron overload
  • increased serum iron, transferrin, serum ferritin
  • decreased TIBC
  • get lead or copper lev if suspected
  • peripheral smears
46
Q

peripheral smear findings for sideroblastic anemia

A
  • abnormal cell shapes
  • basophilic stippling
  • target cells
  • pappenheimer bodies
47
Q

treatment for sideroblastic anemia

A
  • transfusion and chelation as needed
  • if INH induced start B6 repletion
  • if CU def then replete
  • splenectomy c/i in congenital
  • doesnt respond to EPO
  • severe- bone marrow transplant

clin med IV (23 decks)

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