Module 2 Anemia and HIV Flashcards
What is the definition of anemia?
Reduction in RBCs, hemoglobin concentration, or hematocrit
What level of hemoglobin in women defines anemia?
Hbg <12
What is the pathophysiology of anemia?
Hgb transports oxygen to tissues. In anemia, there is a decrease in the amount of hgb, which results in inadequate oxygen being carried to tissues.
What are the three causes of anemia?
Decrease in RBCs production (proliferative disorder)
Destruction of RBCs
Blood loss
What is proliferative disorder?
Also known as a decrease in RBC production.
Happens when the bone marrow is not producing properly. Can be caused by hormone imbalances (thyroid), low iron, inflammation, etc.
What is the most common cause of proliferative disorder in women?
Iron deficiency
What is MCV (mean corpuscular volume? What is normal volume? What is normal volume called?
MCV is the size (volume) of a red blood cell.
Normal (normocytic) is 80-100%
What MCV is Macrocytic?
MCV greater than 100
What MCV is Microcytic?
MCV is less than 80
Define hypochromic. Give two examples of hypochromic anemias.
Reduction in red blood cell hemoglobin (pale in color)
Thalassemia and sickle-cell anemia
Define normochromic. Give example of normochromic anemia.
Normal amount of hemoglobin
Anemias from blood loss
What is an erythrocyte and reticulocyte?
Erythrocyte-RBC
Reticulocyte-immature RBC
What are some risk factors for anemia?
Women of African/Mediterranean, middle east, southeast Asia, Indian, and Pakistan descent.
Older women, pregnancy, acute blood loss, CKD, G6PD Deficiency, Autoimmune disorders, chronic disease
What are the differential diagnosis for anemia?
Blood loss
Malignancy
Renal Failure
What subjective data may we see with anemia?
Some may be symptomatic. Specific symptoms depend on the cause.
May see fatigue, racing heart rate, dizziness, peripheral neuropathy, fainting
Severe symptoms: breathlessness, headache, memory loss, angina
What objective data may we see with anemia?
Exam may be normal
May see pallor or tachycardia
What diagnostics may be performed for suspected anemia?
H&H, CBC with indices (MCV, peripheral smear, reticulocytes), iron stores (ferritin, iron, total iron-binding capacity, transferrin saturation percentage)
What type of anemia do these labs indicate? (micro, normo, macro)
Hgb 9.8; MCV 74; TIBC 465ug/dL; Serum ferritin 10ug/dL
microcytic anemia
What type of anemia do these labs indicate? (micro, normo, macro)
Hgb 10.0; MCV 110; TIBC 426; Serum ferritin 50ug/dL
macrocytic anemia
What type of anemia do these labs indicate? (micro, normo, macro)
Hgb 10.8; MCV 92; TIBC 360; Serum ferritin 80ug/dL
normocytic anemia
What type of anemia do these labs indicate?
Hgb 10.6; MCV 76; TIBC 283; Serum ferritin 30ug/dl
thalassemia
Which type of anemia is the most common anemia in elderly populations, and due to hypo-proliferation and reduced response to erythropoietin?
Anemia of chronic disease
A 66-year-old's recent blood tests reveal the following results: Hemoglobin - 11.1 Hematocrit - 33.3 MCV - 92 Serum iron low Serum ferritin is slightly elevated TIBC slightly elevated What type of anemia does she have?
Anemia of chronic disease
What are some types of normocytic anemia?
Acute blood loss, anemia of chronic disease, and early iron deficiency
Chronic diseases examples: Autoimmune diseases, renal failure, liver disease, cancer, IBD
What subjective and objectice data may we see with normocytic anemia?
Subjective: May be asymptomatic, Fatigue, feeling cold, dyspnea with activity
Objective: pallor, fatigue, sallow colored skin (brown/yellow), pale conjunctiva, glossitis (shiny tongue), angular stomatitis (cracked corners of mouth)
What should be included in the exam for normocytic anemia? Why/What might you find?
Cardio-pulmonary (tachycardia, tachypnea, pulmonary edema) abdomen (hepatomegaly/splenomegaly), extremities (poor cap refill, spoon-nails, pale palmar creases, brittle nails, cold hands and feet
What labs/diagnostic results do we expect with normocytic anemia from acute blood loss?
MCV: 80-100,
ferritin normal
reticulocyte high
TIBC normal
How can normocytic anemia be treated?
Early iron deficiency anemia: diet change-increase iron-rich foods
Chronic Disease: referral for disease
Follow up with CBCs and iron studies collab with specialist
What are the two most common Microytic anemias?
Iron deficiency anemia and thalassemia
Note: these are the ones we will see most often in women
What subjective data may we see with microcrytic anemia? What should be sure to ask about?
Fatigue, weakness, tachycardia/palpitations, lightheaded, dyspnea on exertion
Medications- antacids, H2 blockers, PPIs, NSAIDs, ASA, Zinc
Menstrual hx
PICA
Melena in stool
What objective data may we see in microcytic anemia?
Pallor, sallow skin, fatigue, pale conjunctiva, angular stomatitis, atrophic glossitis
What should be included in the exam for microlytic anemia? Why/What might you find?
Cardio-pulmonary (tachycardia, tachypnea, pulmonary edema) abdomen (hepatomegaly/splenomegaly), extremities (poor cap refill, spoon-nails, pale palmar creases, brittle nails, cold hands and feet
What labs/diagnostic results do we expect with microlytic iron deficiency anemia?
MCV: <80 H/H: Low Serum Iron: low Ferritin low Retic low TIBC high MCHC <27
How can microcytic anemia be treated?
Facilitate absorption-increase diet of animal protein, avoid tannins, iron overload, antacids
Supplemental iron (ferrous sulfate 325 po 1-3 times a day (slow Fe, Feratab)
Recheck H&H in 2 months
In pregnancy: treat with elemental iron 60-120 mg daily then decrease to 30 mg once normalized
What is the inherited form of hemolytic anemia? What patient are highest risk?
Thalassemia (microcytic)
Women of African/Mediterranean, middle east, southeast Asia, Indian, and Pakistan descent.
When do I need to order electrophoresis?
When a patient has relatives with thalassemia or suspected thalassemia
What subjective and objective data do we see with thalassemia?
Subjective: may be asymptomatic or have mild-severe anemic symptoms
Objective: Pallor, sallow skin, fatigue, pale conjunctiva, angular stomatitis, atrophic glossitis
What lab results do we expect to find in alpha thalassemia?
Ferritin: normal Reticulocyte: normal TIBC: normal MCV: <80 H/H: low RBC: Normal-elevates 4 genes-one or all four are damaged or missing
What lab results do we expect to find in beta thalassemia?
Ferritin: normal to high Reticulocyte: low TIBC: normal MCV: <80 RBC: normal or elevated 2 genes
How do we manage Thalassemia?
DO NOT treat with iron, may cause severe organ damage
Refer to hematologist
Blood transfusions
Genetic counseling
What are the most common causes of macrocytic anemia?
Nutritional deficiency (B12 or Folate)
Pernicious Anemia
Alcohol abuse
Hypothyroidism
What can cause vitamin B12 deficiency? Why is it important?
B12 is needed to make red blood cells and to keep nerve cells healthy
Can be caused by inadequate intake, intrinsic factor deficiency (pernicious anemia or gastrectomy, chron’s, malabsorption)
What subjective data do we see in vitamin B12 deficiency?
Memory issues, fatigue, SOB, diarrhea, pain/tingling, peripheral neuropathy, depression, irritability, difficulty walking
Medications: antacids, H2, PPIs, metformin
Medical sx history: thyroid disorder
alcohol use
What patients we most often see pernicious anemia in?
The elderly and chronic disease