- Transfusions - Marrow transplant in extreme situations

Nov. 4, 2019 Flashcards by Jenna Bakker

What is the role of Fe in the blood?

Binds o2

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Inadeq intake of Fe results in..?

Defective Hgb synth

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Why is CBC not the diagnostic test of choice for IRON DEFICIENT ANEMIA?

RBC count may be normal

- Doesn’t actually measure Fe

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What test should you run for IRON DEF AN?

Ferritin test

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Treatment of IRON DEF AN is..?

Treat the cause by supplementing Fe

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How long should you supplement Fe for?

4-6 months

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Adverse affect of excess Fe:

Toxicity

- Constipation

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What are Vit B12 and folic acid needed for?

Cell division

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What is an adverse affect of inadeq Vit b12 and folic acid?

Abn DNA synth and cellular material resulting in defective B cells

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What is the Tx of B12 and folic acid deficiency?

Supplement

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T or F:

PERNICIOUS ANEMIA is from a deficiency of B12 in diet

F, it is from deficiency in secretion of INTRINSIC FACTOR

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What might result in a deficiency in secretion of INTRINSIC FACTOR?

Damage to gastric mucosa

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Adverse effects of PERNI AN?

Poor to no B12 absorption

- Impaired cell synth

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What is the Tx of PERNI AN?

High dose of B12 PO

- If presenting w more symptoms, give B12 IM

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Should you supplement INSTRIN FACT in PERN AN?

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What cells are involved in APLASTIC AN?

RBCs

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The “A” in APLASTIC AN refers to what?

A = lack of

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What is APLASTIC AN caused by?

Marrow (stem cell) failure

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How does marrow faiure affect RBCs?

Causes defective hematopoiesis

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What is the Et of APLASTIC AN?

65% idiopathic

35% Autoimmune, radiation, toxic chemicals

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Tx of APLASTIC AN

Transfusions

- Marrow transplant in extreme situations

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WHat is the avg lifespan of RBCs?

120 days (~4 months)

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What removes old RBCs?

The spleen

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Where are RBCs recycled?

In the liver

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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?

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