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Year 1: Patho/Pharm > Module 2 - Anemia(s) > Flashcards

Module 2 - Anemia(s) Flashcards

1
Q

Define Anemia

A

Reduction of the total NUMBER of erythrocytes in the blood
OR
a reduction in QUALITY or QUANTITY (ie. structure/function) of haemoglobin.

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2
Q

Define Polycythemia

A

Erythrocyte NUMBER or VOLUME are excessive

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3
Q

4 Things that result in Anemia

A

(1) Blood loss
(2) Decreased Production
(3) Increased destruction
(4) Combination of all

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4
Q

Anemias classified by

A

(1) Cause (ie. iron deficiency anemia)
(2) size, shape, content of haemoglobin (ie. Microcytic -hypochromic anemia)

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5
Q

The result of Anemia is

A

Reduced oxygen carrying capacity of the blood

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6
Q

What happens to the blood with a reduction of RBC

Initial Compensation

A

Change in blood CONSISTENCY and VOLUME

(1) Movement of interstitial fluid into the blood, increase PLASMA VOLUME
(2) Decrease VISCOSITY

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7
Q

Compensation for Anemia involves which 3 sytems

A

(1) CARDIOVASCULAR (heart)
(2) RESPIRATORY (lungs)
(3) HEMATOLOGICAL (blood)

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8
Q

What is Normocytic-Normochromic Anemia

A

NORMAL erythrocyte size
NORMAL hemoglobin concentraiton

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9
Q

List the 5 types of Normochromic-Normocytic Anemia

A

(1) Aplastic Anemia (erythropoiesis)
(2) Post hemorrhagic Anemia (blood loss)
(3) Hemolytic Anemia (lysis)
(4) Sickle Cell Anemia (genetic)
(5) Anemia of Chronic Disease (increase demand)

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10
Q

Mechanism of Action, and Cause

Aplastic Anemia

A

(1) Insufficient erythropoesis

(2) Depressed stem cell proliferation

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11
Q

Mechanism of Action, and Cause

Posthemorrhagic Anemia

A

MECHANISM - Blood Loss

CAUSE - Injury results in increased
erythropoesis and iron depletion

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12
Q

Mechanism of Action and Cause

Sick Cell Anemia*

A

MECHANISM - Abnormal Hgb Synthesis (HgS)

CAUSE - Congenital dysfunction of hemoglobin synthesis. Homozygous recessive. Hgb S. More fragile to lysis.

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13
Q

Mechanism of Action and Cause

Anemia of Chronic Disease*

A

MECHANISM - Increase DEMAND for hemoglobin

CAUSE - chronic infection, inflammation, malignancy (increase metabolism and oxygen demand)

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14
Q

Define Microcytic-Hypochromic anemia

A

SMALL abnormally shaped erythrocytes

SMALL hemoglobin concentration (pale)

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15
Q

List 3 microcytic-hypochromic anemias

A

(1) IRON DEFICIENCY anemia (lack of iron)
(2) SIDEROBLASTIC anemia (dysfunctional iron updake)
(3) THALASSEMIA (impaired synthesis hemoglobin)

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16
Q

Mechanism and Cause

Iron Deficiency Anemia*

A

MECHANISM
-Lack of Iron for hemoglobin production

CAUSE
- blood loss
- diet
- iron cycle
- iron metabolism

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17
Q

Mechanism and Cause

Sideroblastic Anemia

A

MECHANISM
- dysfunctional iron uptake by erythroblasts
- dysfunctional porphyrin and heme synthesis

CAUSE
- Congenital
- Acquired by toxins/Medications

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18
Q

Mechanism and Cause

Thalassemia

A

MECHANISM
- impaired synthesis of alpha / beta hemeoglobin
- increased phagocytosis of abnormal erythroblasts in bone marrow

CAUSE
- congenital genetic

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19
Q

List 2 Macrocytic (Magaloblastic)-Normochromic Anemias

A

(1) Pernicious Anemia (VitB12)

(2) Folate Deficiency Anemia

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20
Q

Mechanism and Cause

Pernicious Anemia*

A

MECHANISM - lack of Vitamin B12, abnormal DNA and RNA synthesis in erythroblasts, premature cell death

CAUSE - congenital or acquired deficiency intrinsic factor, genetic disorder DNA

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21
Q

Mechanism and Cause

Folate Deficiency Anemia

A

MECHANISM - lack of folate (coenzyme in thymine, adenine, guanine, methionine) premature cell death

CAUSE - dietary deficiency

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22
Q

What is the long term IMPACT of Anemia on the

CARDIAC SYSTEM

A

increased PLASMA VOLUME
decreased VISCOSITY
Blood flow is FASTER and TURBULENT
LARGER stroke volume and HEART RATE
….
CARDIAC DILATION and HEART VALVE INSUFFICIENCY if not corrected

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23
Q

What is the long term impact of Anemia on the

PERIPHERAL VASCULAR SYSTEM (and heart)

A

increased DILATION of arterioles, capillaries, venuoles (1) prevent cardiopulmonary congestion (2) meet tissue oxygen demand

increased VENOUS RETURN to the heart which increases STROKE VOLUME and HEART RATE
…
Can lead to Cardiac Failure

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24
Q

What is the impact of anemia on the RESPIRATORY SYSTEM

A

increase RATE of breathing
increase DEPTH of breathing

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25
Q

What are some SYMPTOMS of anemia

A

Dyspnea

Pounding heart beat

Pale - skin, mucous membranes, lips, nail bed, conjunctivae

Skin - Pale, loss of elasticity or Jaundice (hemolytic)

Hair - loss, grey

Nervous System (VitB12) - myelin degeneration, paraestheisas, falls, Weakness, spasticity, reflex abnormalities

GI - nausea, vomiting, anorexia

Fever - ischemic tissues release pyrogens

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26
Q

Define Eryptosis

A

Premature death of the damaged erythrocyte

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27
Q

List the causes of Eryptosis

A

(1) Dietary Deficiencies (folate, cobalamin)

(2) Infection (Malaria)

(3) Genetics (Sickle Cell, Thalassemia)

(4) Chronic Disease

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28
Q

Describe the PATHOPHYSIOLOGY of
Megaloblastic/Macrocytic Anemia

A

ASYNCHRONOUS DNA and RNA synthesis

DNA Synthesis is delayed or blocked due to lack of VitB12 or Folate

RNA Synthesis of hemoglobin is normal (Normochromic)

…

This results in an abnormally small nucleus (DNA) and abnormally large eyrhtrocyte (RNA)

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29
Q

What is the most common type of Macrocytic-Normochromic Anemia?

A

Pernicious Anemia
(lack of Vitamin B12 or Cobalamin)

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30
Q

Which end stage disease is associated with Pernicious Anemia

A

End stage Type A chronic atrophic (autoimmune) gastritis

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31
Q

Define Intrinsic Factor

A

Transporter

Required for gastric absorption of VitB12

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32
Q

What is the function of Vit B12

A

Nuclear maturation and DNA synthesis in RBC

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33
Q

What are 2 causes of IF deficiency

A

(1) Autoimmune disease directed at gastric parietal cells (secondary)

(2) Congenital - autosomal recessive inheritance (primary)

34
Q

What other endocrine disorders are associated with pernicious anemia (PA)?

Polyendocrinopathy

A

(1) Type I diabetes
(2) Autoimmune Thyroiditis

35
Q

Describe the PATHOPHYSIOLOGY of pernicious anemia SECONDARY to Type A atrophic gastritis

A

ANTIBODIES against the H/K ATPase results in atrophy of mucosal membrane

DISTRUCTION of parietal cells

DECREASE in Intrinsic factor production and all secretions (pepsin, HCl)

Auto-antibody NEUTRALIZE intrinsic factor

36
Q

What INFECTION predisposes someone to Autoimmune

Type A Atrophic Gastritic

A

H. Pylori infection

antigens mimic the H/K ATPase

37
Q

What are EARLY Clinical manifestations of PERNICIOUS ANEMIA

A

Vague

Infections
Mood swings
GI, Cardiac, Kidney problems

38
Q

What are LATE clinical manifestations of PERNICIOUS ANEMIA

A

Classic symptoms of anemia

  • weakness
  • fatigue
  • paraesthesia to feet and fingers
  • difficulty walking
  • loss of appetite
  • abdominal pain
  • weight loss
  • sore, smooth, beefy red tongue
  • lemon yellow (sallow) skin - pallor and jaundice
  • Hepatomegaly (heart failure)
  • Splenomegaly
39
Q

What are NEUROLOGICAL manifestations of PERNICIOUS ANEMIA

A

NOT reversible

Demyelination of nerves resulting in neuronal death

POSTERIOR and LATERAL column of spinal cord

Loss of position and vibration sense, ataxia, spasticity

DEPRESSIVE affect (cerebrum)

40
Q

What DISEASE is related to low serum VitB12

A

Alzheimer’s Disease

41
Q

What is the TREATMENT for PERNICIOUS ANEMIA

A

1000mcg / day of Vitamin B12 (cobalamin)

Monthly Vit B12 injections

42
Q

What is the CLINICAL INDICATOR that treatment for PERNICIOUS ANEMIA is working?

A

Increase in RETICULOCYTE count

Blood counts will return to normal in 5-6 weeks

43
Q

How do you DIAGNOSE Pernicious Anemia

A

Blood Test and Serology

Gastric Biopsy (achlorhydria - absence HCl)

Antibodies against Parietal Cells and IF

44
Q

What is the function of FOLATE

A

Folate is a COENZYME required for synthesis of thyamine, adenine, guanine (DNA nucleic acids) and methionine (amino acid)

45
Q

Where do humans get FOLATE

A

100% from dietary intake

50-200mg/day

46
Q

What populations does FOLATE DEFICIENCY occur more commonly?

A

Alcoholics

Chronic malnourishment

Pregnancy

47
Q

What are CLINICAL MANIFESTATIONS of Folate Deficiency Anemia

A

Cheilosis (scale/fissure of mouth)

burning mouth syndrome (ulceration of buccal/tongue)

neurological conditions

48
Q

How do you DIAGNOSE folate deficiency anemia

A

Blood test - serum folate levels

clinical symptoms - burning mouth syndrome

49
Q

What is the TREATMENT for folate deficiency anemia

A

50-200 mg folate / day

Resolution 1-2 weeks

50
Q

3 CAUSES of microcytic-hypochromic anemia

A

Disorders of….

  1. IRON metabolism
  2. HEME or PORPHORIN synthesis
  3. GLOBIN synthsis
51
Q

What is the MOST COMMON cause of anemia world wide?

A

Iron Deficiency Anemia
(microcytic-microchormic)

52
Q

Two different AETIOLOGIES of Iron deficiency Anemia

A
  1. NO dysfunction of iron metabolism
    Ex. decreased dietary intake of iron
  2. Dysfunction of iron metabolism
    Ex. Unable to absorb to erythroblasts
    Ex. Unable to transport to bone marrow
53
Q

Both AETIOLOGIES of Iron Deficiency Anemia cause

A
  1. Depletion of iron stores
  2. Reduction in haemoglobin synthesis
54
Q

How much BLOOD LOSS is required for the development of IRON DEFICIENCY ANEMIA

A

2-4mL per day

55
Q

What are SOURCES OF BLOOD LOSS in IRON DEFICIENCY ANEMIA

A

Menorrhagia (excessive mentrual bleeding)

Ulcers

Esophageal varacies

Cirrhosis

Hemorrhoids

ulcerative collitis

cancer

Medications that cause GI bleeding (ASA, NSAIDS)

Procedures that speed gastric emptying

Insufficent dietary intake

Eating disorders

H. Pylori

56
Q

Why does Iron Deficiency Anemia lead to INFECTIONS

A

Iron is involved in Cytokine activity

57
Q

What groups are HIGH RISK for iron deficiency anemia

A

Pregnant women

Male and Female children

Women of child bearing years

Anyone at increased risk of bleeding/loss of blood

58
Q

What are EARLY SYMPTOMS of iron deficiency anemia

A

Fatigue

Pale - conjunctiva, palms, earlobes

Shortness of breath

59
Q

What haemoglobin level do individuals usually seek TREATMENT for Iron Deficient Anemia

A

70g/L-80g/L

60
Q

What are late CLINICAL MANIFESTATIONS of Iron Deficient Anemia

A

STRUCTURAL and FUNCTIONAL changes in the epithelium

  • Brittle spoon shaped nails (Koilonychia)
  • Tongue papillae atrophy (redness and burning, bald, fissured appearance)
  • Angular stomatitis (dry sore corners of mouth)
  • Dysphagia (mucous and inflammatory cells at esophagus)

PHYSIOLOGICAL CHANGES (lack of iron for enzyme functions)

  • gastritis
  • neuromuscular changes
  • irritable
  • head ache
  • numbness, tingling
  • vasomotor disturbance
  • memory loss, confusion, disorientation
61
Q

How is Iron Deficient Anemia DIAGNOSED

A

Blood and serum tests

Ferritin level

Transferrin saturation (total iron binding capacity)

FEP (Free erythrocyte protoporphyrin - precursor of heme)

62
Q

What is the TREATMENT for Iron Deficiency Anemia

A
  1. Find and correct the SOURCE (diet? blood loss?)
  2. Iron Replacement Therapy
  3. Parenteral Iron Replacement
    (malabsorption, lack of adherence, chronic uncontrolled blood loss, intolerance PO)
63
Q

What is the goal of SERUM FERRITIN during treatment of Iron Deficiency Anemia

A

50 microg/L

64
Q

How long should IRON REPLACEMENT continue

A

6-12 months

life long for mentruating women

65
Q

When will a reversal of symptoms be felt if TREATMENT is effective for Iron Deficient Anemia

A

1 month

66
Q

What is the PATHOPHYSIOLOGY of anemia of chronic infections/inflammation/malignancies

A

Decrease erythropoeisis

Decreased life span of the RBC

Disruption iron cycle

67
Q

What are the CLINICAL MANIFESTATIONS of anemia of chronic disease

A

Mild

Disease limits physical activity and demand on haemoglobin

68
Q

What is the TREATMENT for Anemia of Chronic Disease

A

No treatment unless symptomatic

Erythropoietin

69
Q

What will CLINICAL DIAGNOSTICS show of someone with anemia of chronic disease

A

Iron deficiency in bone marrow

Normal/high iron stores

70
Q

What is the most common blood disorder in children

What is the most common cause

A

Anemia

Iron deficient anemia

71
Q

What age does iron deficiency anemia show up in children

A

6 months to age 2

72
Q

Why is it essential to correct anemia in children?

A

Irreversible changes in brain development

73
Q

Iron deficiency anemia can result from

A

blood loss
lack of dietary intake
problems with absorption
increased requirement of iron

74
Q

What clinical tests indicate iron deficiency anemia

A

low ferritin

low transferin

peripheral blood smear microcytic-hypochromic anemia

low hemoglobin

low haematocrit

75
Q

What are the clinical manifestations of iron deficiency in children

A

pallor
fatigue
decreased play
irritability
ewakness
anxorexia
tachycardia
systolic murmur
widened sutures
decreased growth
developomental delay
pica
attention, alertness, learning ability (decreased)

76
Q

What is Sickle Cell Anemia

A

Genetic autosomal recessive disorder

Genetic point mutation in Beta-Hemoglobin Glutamic Acid switched for Valine = Hgb S

77
Q

What causes HgbS to Sickle

A

decreased oxygen, dehydration, pH trigger sickling

HgbS polymerizes resulting in sickling and hemolysis

  • illness
  • stress
  • dehydration
  • high altitude
  • temperature changes
  • exercise
78
Q

Clinical Manifestations of a Vaso-occlusive crisis

A

“log jam” of sickling in microcirculation
infarction of tissues and organs
4-6 days
extreme pain

79
Q

Clinical manifestations of Sequestration crisis

A

blood pools in spleen and liver
re-occurs

80
Q

Clinical manifestations of aplastic crisis

A

decreased erythropoesis
Sickle cell erythrocytes only live 10-20 days

81
Q
A

Year 1: Patho/Pharm (39 decks)

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