Nov. 4, 2019 Flashcards
What is the role of Fe in the blood?
Binds o2
Inadeq intake of Fe results in..?
Defective Hgb synth
Why is CBC not the diagnostic test of choice for IRON DEFICIENT ANEMIA?
- RBC count may be normal
- Doesn’t actually measure Fe
What test should you run for IRON DEF AN?
Ferritin test
Treatment of IRON DEF AN is..?
Treat the cause by supplementing Fe
How long should you supplement Fe for?
4-6 months
Adverse affect of excess Fe:
- Toxicity
- Constipation
What are Vit B12 and folic acid needed for?
Cell division
What is an adverse affect of inadeq Vit b12 and folic acid?
Abn DNA synth and cellular material resulting in defective B cells
What is the Tx of B12 and folic acid deficiency?
Supplement
T or F:
PERNICIOUS ANEMIA is from a deficiency of B12 in diet
F, it is from deficiency in secretion of INTRINSIC FACTOR
What might result in a deficiency in secretion of INTRINSIC FACTOR?
Damage to gastric mucosa
Adverse effects of PERNI AN?
- Poor to no B12 absorption
- Impaired cell synth
What is the Tx of PERNI AN?
- High dose of B12 PO
- If presenting w more symptoms, give B12 IM
Should you supplement INSTRIN FACT in PERN AN?
No
What cells are involved in APLASTIC AN?
RBCs
The “A” in APLASTIC AN refers to what?
A = lack of
What is APLASTIC AN caused by?
Marrow (stem cell) failure
How does marrow faiure affect RBCs?
Causes defective hematopoiesis
What is the Et of APLASTIC AN?
65% idiopathic
35% Autoimmune, radiation, toxic chemicals
Tx of APLASTIC AN
- Transfusions
- Marrow transplant in extreme situations
WHat is the avg lifespan of RBCs?
120 days (~4 months)
What removes old RBCs?
The spleen
Where are RBCs recycled?
In the liver
What causes HEMOLYTIC AN?
Premature or excessive HEMOLYSIS
What might cause HEMOLYTIC AN?
- May be d/t genetics (eg THALASSEMIA)
- Acquired (eg autoimmune, drugs)
Define THALASSEMIA
Genetic, causes abn form or inadeq amounts of Hgb
Mnfts of HEMOLYTIC AN
- The ones from other ANs
- Jaundice
- Splenomegaly (enlarged spleen)
- Hepatomegaly (enlarged liver)
Why does JAUNDICE occur in HEMOLYTIC AN?
If liver is not working properly, bilirubin will accum in the liver, go through circulation, and deposit in tissues
Why does SPLENOMEGALY occur in HEMOLYTIC AN?
Spleen is under enormous pressure and enlarges in an attempt to meet the additional workload
Why does HEPATOMEGALY occur in HEMOLYTIC AN?
Liver is under enormous pressure and enlarges in an attempt to meet the additional workload
What is the Tx for HEMOLYTIC AN?
- o2 for hypoxia
- Steroids
- Transfusion
- Splenectomy if extreme
Define ACUTE HEMORRHAGIC AN
- Rapid onset
- severity based on site, rate, and vol
Define CHRONIC HEMOR AN
- Gradual bleed
- Subtle, concealed
4 things that may result in HEMOR AN:
1) Peptic ulcer disease (PUD)
2) Tumor
3) Heavy menses
4) Hemorrhoids
How does PUD mnft?
As occult blood in stool
What are hemorrhoids?
Varicose veins in rectal area
What is the Tx of HEMOR AN?
Treat the cause
Is SICKLE CELL AN ACUTE or CHRONIC?
CHRONIC
What kind of GENETIC DISEASE is SI CELL AN?
Recessive
In SI CELL AN, what GENE is mutated?
The GENE that codes for Hgb
T or F:
In SI CELL AN, HbA is created instead of HbS
F, other way around
How many affected ALLELES in SI CELL TRAIT?
1
If someone hase the SI CELL AN TRAIT, would that be considered homozygous or heterozygous?
hetero
What is GLUTAMIC ACID?
HbA
What is VALINE?
HbS
Explain the relationship between HbA, HbS, and SI CELL AN?
HbS replaces HbA in the beta hemoglobin chain
T or F:
Loads at high pCO2, dissociates at low pCO2
T, but I don’t know what it means…?
Why are HbSs lysed?
Because the body doesn’t recognize them and they are therefore destroyed
What happens when the SI CELLS are lysed?
The crystals inside of them are released
What happens to the B as a result of crystals being released?
The viscosity of the B is increased
Why does SI CELL AN cause obstructed flow?
Because their shape is not ideal for flowing easily through BVs
What is caused by uncontrolled ISCHEMIA?
INFARCTION
When the vessels are obstructed, what is caused?
HYPOXIA
In someone with SI CELL AN, HYPOXIA leads to..?
More sickeling
WHy does HYPOX lead to more sickeling?
HYPOXIA lowers the pO2, which causes more dissociating
Is SI CELL AN a local or systemic disease?
systemic, affects any tissue requiring O2
What are 4 mnfts of SI CELL AN?
- HEMOLYSIS
- Inc BILIRUBIN
- THROMBOSIS
- INFARCT
Why do many components of SI CELL AN end up in the KIDNEYS?
Because the LIVER cannot handle it all
Tx for SI CELL AN?
- Supportive
- Rest, O2, pain control, fluids, lytes
- Hypertransfusion
- Give donor B until they have 50% donor B with HbA
- Hydroxyurea
- used rarely
- can cause leukemia,
- hepatotoxic
- toxic to marrow
- Facilitates production of fetal Hgb
- Limits hemolysis of sickle cells
- Marrow transplant
Define HYPERFX:
Endocrine gland secretes too much of a hormone
Define HYPOFX:
Endo gland secretes little to no hormone
What might cause HYPERFX?
Inc tropic stimulation (you need negative feedback to keep control of this)
What might result in HYPOFX?
- No tropic stimulation (leads to atrophy)
- Receptor defect
- Immune disorder
- Suppressive Tx
- Lack of iodine in diet (needed for thyroid Fx)
- Metb deficiency
What is the leading ENDO DISEASE?
DIABETES MELLITUS (DM)
DM is caused by a deficiency of INSULIN in either ________ or ________
Quality, action
2 other causes of DM?
1) Compromised glucose homeostasis
2) Widespread metb problems
