Module 12 - Anemia Flashcards
- Classifications
Size
1. Macrocytic Anemia (large)
2. Normocytic Anemia (normal)
3. Microcytic Anemia (small)
Hemoglobin Content
1. Normochromic (normal amount)
2. Hypochromic (decreased amount)
Physical Manifestations:
1. Folic Acid Deficiency
2. Riboflavin Deficiency
3. Chelosis
- Folic Acid Deficiency
- shiny, smooth, red tongue - Riboflavin Deficiency
- chronic etoh, sore swollen magenta tongue - Chelosis
- vertical fissuring and ulceration of lips
- Iron Replacement
100-200 mg of elemental iron/day
- Ferrous gluconate 324mg TID
- Ferrous sulfate 200mg BID
- Ferrous fumarate 150mg BID
- Give with Vitamin C
- Stools can be black
- Stool softeners may be needed
- Start low go slow
- HCT increases in 2 weeks
- Fe stores take 4-6 mo to correct
- Iron Replacement Side Effects
S/E
- nausea
- constipation
- heart burn
- upper GI discomfort
- black stools
- sometimes diarrhea
Instructions:
- Take 30 minutes before meal with ascorbic acid (OJ)
* Increases iron absorption by 10%
* If taken with meals, reduces absorption by 40-50%
- Macrocytic Normochromic Anemia
- Termed megaloblastic anemia
- DNA synthesis is defective
- due to deficiencies in vitamin B12 or folate
- Vitamin B12 Deficiency
macrocytic normochromic deficiency
Causes:
- gastrectomy/lb loss surgery that bypass stomach
-VEGETARIAN
- long term PPI use !!!!!!!!!
- Pernicious Anemia
Autoantibodies against intrinsic factor = pernicious anemia
- lacks intrinsic factor from gastric parietal cells that is required for B12 absorption
Clinical Manifestations:
- weakness, fatigue
- paresthesia of feet and fingers
* difficulty walking
- loss of appetite, abdominal pain, weight loss
- sore tongue: smooth, beefy red, secondary to atrophic glossitis
- lemon yellow (sallow) skin color as a result of combo of pallor and icterus
- Neurologic symptoms from nerve demyelination
-Not reversible, even with treatment if present for longer than 3 months - Is often unrecognizable in older adults because of its subtle, slow onset and presentation.
- Evaluation of megaloblastic anemia
Causes: B12 and Folate
also called macro normochromic
- Iron Deficiency Anemia
micro hypo
GI BLEED/MENSTRUATION
Clinical manifestations
* Classic Symptoms plus:
* Brittle, thin, coarsely ridged, and spoon-shaped (concaveor koilonychia) nails
* Red, sore, painful tongue - glossitis
* Angular stomatitis: Dryness and soreness in the corners ofthe mouth
* Become symptomatic: When hemoglobin (Hgb) 7.5g/d
- Iron Rich Foods
Heme: Meats
Non Heme: Veggies
- Know differences between B12 and pernicious anemia
B12 is a lack of diet in B12 and pernicious is lack of intrinsic factors that allow you absorb B12 vitamins
Sources of B12
- Meats – especially fish
- Fortified cereals
- Others
- Folic Acid Anemia
ALCOHOLIC
- Clinical manifestations
- Severe cheilosis: Scales and fissures of the lips and corners of the mouth
- Stomatitis: Mouth inflammation
- Painful ulcerations of the buccal mucosa and tongue
- Neurologic symptoms: Usually not seen
- Treatment
- Oral dose of folate is administered daily until normal blood levels are obtained.
- Life-long treatment is not necessary
- Folic Acid Replacement
Need 1 mg/d
- Green leafy vegetables
- Broccoli
- Asparagus
- Beans and Legumes
- Citrus
Thalassemia Anemia
Mediterranean
Macrocytic Normochromic Types
- Pernicious
- B12
- Folate
- High MCV
- Normal MCH + MCHC
TIBC is most closely associated with which of the following?
Transferrin
What is the hereditary disease that is characterized by a decrease in TIBC with no anemia or abnormal RBC morphology?
hemochromatosis
Which of the following iron studies should have its reference range raised to detect iron deficiency in a patient with RA?
serum ferritin
Transferrin saturation
FE/TIBCx 100
Most common cause of iron deficiency
chronic blood loss
Which of the following iron study results is most characteristic of ACD
low iron
low TIBC
low transferrin saturation
ferritin normal or increased
