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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
What are some SYMPTOMS of anemia
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
26
Define Eryptosis
Premature death of the damaged erythrocyte
27
List the causes of Eryptosis
(1) Dietary Deficiencies (folate, cobalamin) (2) Infection (Malaria) (3) Genetics (Sickle Cell, Thalassemia) (4) Chronic Disease
28
Describe the PATHOPHYSIOLOGY of Megaloblastic/Macrocytic Anemia
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)
29
What is the most common type of Macrocytic-Normochromic Anemia?
Pernicious Anemia (lack of Vitamin B12 or Cobalamin)
30
Which end stage disease is associated with Pernicious Anemia
End stage Type A chronic atrophic (autoimmune) gastritis
31
Define Intrinsic Factor
Transporter Required for gastric absorption of VitB12
32
What is the function of Vit B12
Nuclear maturation and DNA synthesis in RBC
33
What are 2 causes of IF deficiency
(1) Autoimmune disease directed at gastric parietal cells (secondary) (2) Congenital - autosomal recessive inheritance (primary)
34
What other endocrine disorders are associated with pernicious anemia (PA)? Polyendocrinopathy
(1) Type I diabetes (2) Autoimmune Thyroiditis
35
Describe the PATHOPHYSIOLOGY of pernicious anemia SECONDARY to Type A atrophic gastritis
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
What INFECTION predisposes someone to Autoimmune Type A Atrophic Gastritic
H. Pylori infection antigens mimic the H/K ATPase
37
What are EARLY Clinical manifestations of PERNICIOUS ANEMIA
Vague Infections Mood swings GI, Cardiac, Kidney problems
38
What are LATE clinical manifestations of PERNICIOUS ANEMIA
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
What are NEUROLOGICAL manifestations of PERNICIOUS ANEMIA
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
What DISEASE is related to low serum VitB12
Alzheimer's Disease
41
What is the TREATMENT for PERNICIOUS ANEMIA
1000mcg / day of Vitamin B12 (cobalamin) Monthly Vit B12 injections
42
What is the CLINICAL INDICATOR that treatment for PERNICIOUS ANEMIA is working?
Increase in RETICULOCYTE count Blood counts will return to normal in 5-6 weeks
43
How do you DIAGNOSE Pernicious Anemia
Blood Test and Serology Gastric Biopsy (achlorhydria - absence HCl) Antibodies against Parietal Cells and IF
44
What is the function of FOLATE
Folate is a COENZYME required for synthesis of thyamine, adenine, guanine (DNA nucleic acids) and methionine (amino acid)
45
Where do humans get FOLATE
100% from dietary intake 50-200mg/day
46
What populations does FOLATE DEFICIENCY occur more commonly?
Alcoholics Chronic malnourishment Pregnancy
47
What are CLINICAL MANIFESTATIONS of Folate Deficiency Anemia
Cheilosis (scale/fissure of mouth) burning mouth syndrome (ulceration of buccal/tongue) neurological conditions
48
How do you DIAGNOSE folate deficiency anemia
Blood test - serum folate levels clinical symptoms - burning mouth syndrome
49
What is the TREATMENT for folate deficiency anemia
50-200 mg folate / day Resolution 1-2 weeks
50
3 CAUSES of microcytic-hypochromic anemia
Disorders of.... 1. IRON metabolism 2. HEME or PORPHORIN synthesis 3. GLOBIN synthsis
51
What is the MOST COMMON cause of anemia world wide?
Iron Deficiency Anemia (microcytic-microchormic)
52
Two different AETIOLOGIES of Iron deficiency Anemia
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
Both AETIOLOGIES of Iron Deficiency Anemia cause
1. Depletion of iron stores 2. Reduction in haemoglobin synthesis
54
How much BLOOD LOSS is required for the development of IRON DEFICIENCY ANEMIA
2-4mL per day
55
What are SOURCES OF BLOOD LOSS in IRON DEFICIENCY ANEMIA
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
Why does Iron Deficiency Anemia lead to INFECTIONS
Iron is involved in Cytokine activity
57
What groups are HIGH RISK for iron deficiency anemia
Pregnant women Male and Female children Women of child bearing years Anyone at increased risk of bleeding/loss of blood
58
What are EARLY SYMPTOMS of iron deficiency anemia
Fatigue Pale - conjunctiva, palms, earlobes Shortness of breath
59
What haemoglobin level do individuals usually seek TREATMENT for Iron Deficient Anemia
70g/L-80g/L
60
What are late CLINICAL MANIFESTATIONS of Iron Deficient Anemia
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
How is Iron Deficient Anemia DIAGNOSED
Blood and serum tests Ferritin level Transferrin saturation (total iron binding capacity) FEP (Free erythrocyte protoporphyrin - precursor of heme)
62
What is the TREATMENT for Iron Deficiency Anemia
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
What is the goal of SERUM FERRITIN during treatment of Iron Deficiency Anemia
50 microg/L
64
How long should IRON REPLACEMENT continue
6-12 months life long for mentruating women
65
When will a reversal of symptoms be felt if TREATMENT is effective for Iron Deficient Anemia
1 month
66
What is the PATHOPHYSIOLOGY of anemia of chronic infections/inflammation/malignancies
Decrease erythropoeisis Decreased life span of the RBC Disruption iron cycle
67
What are the CLINICAL MANIFESTATIONS of anemia of chronic disease
Mild Disease limits physical activity and demand on haemoglobin
68
What is the TREATMENT for Anemia of Chronic Disease
No treatment unless symptomatic Erythropoietin
69
What will CLINICAL DIAGNOSTICS show of someone with anemia of chronic disease
Iron deficiency in bone marrow Normal/high iron stores
70
What is the most common blood disorder in children What is the most common cause
Anemia Iron deficient anemia
71
What age does iron deficiency anemia show up in children
6 months to age 2
72
Why is it essential to correct anemia in children?
Irreversible changes in brain development
73
Iron deficiency anemia can result from
blood loss lack of dietary intake problems with absorption increased requirement of iron
74
What clinical tests indicate iron deficiency anemia
low ferritin low transferin peripheral blood smear microcytic-hypochromic anemia low hemoglobin low haematocrit
75
What are the clinical manifestations of iron deficiency in children
pallor fatigue decreased play irritability ewakness anxorexia tachycardia systolic murmur widened sutures decreased growth developomental delay pica attention, alertness, learning ability (decreased)
76
What is Sickle Cell Anemia
Genetic autosomal recessive disorder Genetic point mutation in Beta-Hemoglobin Glutamic Acid switched for Valine = Hgb S
77
What causes HgbS to Sickle
decreased oxygen, dehydration, pH trigger sickling HgbS polymerizes resulting in sickling and hemolysis - illness - stress - dehydration - high altitude - temperature changes - exercise
78
Clinical Manifestations of a Vaso-occlusive crisis
"log jam" of sickling in microcirculation infarction of tissues and organs 4-6 days extreme pain
79
Clinical manifestations of Sequestration crisis
blood pools in spleen and liver re-occurs
80
Clinical manifestations of aplastic crisis
decreased erythropoesis Sickle cell erythrocytes only live 10-20 days
81

Year 1: Patho/Pharm (45 decks)

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