Nu 735Anemia Flashcards
Hematopoisis
On going formation blood cells
Erythropoises (EPO)
lHormone regulate RBC
Linked to O2
Produced in Kidney
Apoptosis> Abcess of EPO leading to cel death
Iron, B12, Folate (B9)
Iron > “fuel hormone”
Erythroblast require productio of : B12 and Folate B9
Erythropoiesis.> Deficiensy in B12 and Folate
RBC
Hgb: blood’s O2 carrying capacity
Hct: volume of RBC to whole blood
MCV: Size RBC
MCH: amount of Hgb in RBC
MPV: average of plt
Reticulocyte Count: **immature **RBC > measure production and rease RBV
Mean Corpuscular Volume (MCV) =
Determine Size RBC
MCV< 80 : micro
a. Iron Deficiensy Anemia ( Not enough Iron to make Hgb leading fewer RBC formed
MCV: 80 to 100 = Normocytic
MCV>100 macrocytic
a. Folate / B9 deficiecy
B12 deficiency
Reticulocyte Count
- “Immature RBC”
Measures Production of RBC by bone marrow and -
Elevated RC = Hemolysis (Hemolytic Anemia, Acute Blood loss; Vitamin B12 B9 defifiensy)
*** Low RC **> Erythropoiesis > 2/2 bone marrow due to reduction erythroblast .
Lactate Dehydrogenase (LDH)
Ensyme Found in all body tissues
Catalyzes to pyruvate (production of glycolysis )
Elevated Hemolitic Anemia b/c it’s floating around
Haptoglobin
Plasma protenin produce in Liver
Clear free RBC
Low : Hemoliti Anemia
Hemolitic Anemia Labs
LDH = High
Haptoglobin = low
Reticolyte count = Hight
Ferritin and Fe +
Ferrtin is protein that contains iron
**Primary stored iron **
Fe require for cell groth
Low Iron leading to Toxicity and Death
Transferrin, TIBC % Saturation
Measure capacity to transfer Iron
Reticular Counnt deficiensy
Hypo- Proliferative Anemia
**Key Points: **
* 75 % of all cases has
* Low Reticulocytes with **normal **RBC Morphology
* Reticulocyte production index <2
*** Causes: **
* Mild to mod Fe deficiency
* Marrow damage
* Inadeuate EPO production
* Impaired O2 d/t metabolic Diseases
Maturation Anemia
Reticular Count Formation
Low Reticular Count +
Both Macrocytic /Microcytic Anemia
RC normal index <2
Types of Anemia
Iron Def Anemia
TX Plan
- Fe Sul 300 to 325 mg po TID
Duration : 3month
Improve around 2 month
Increased storage in around 6 month
Considratiion: **
Take on empty stomach
Avoid antacids or milk
Add Vit C (increase absorption)
Venofer
Indication: GI intolernce or malabsortion
Duratio 5 days
Iron Deficiensy **
**Iron Deficiency Anemia :
Most common cause of Anemia
- Bleedding
- Nutrition Defficit **
*
-
Diagnosis:
MCV <80 > micrositic
MCH low > Hyochromic - **Pathophysiology: ***
Fe + loss > storage - Etiology:
Chronic blood loss
Indadequate Fe intake
Impair absorption
*** S/s : **
Smooth tonque
Brittle or spoon nails aka koilonychia
PICA aka ice chewing, unusual cravings for food (consider malabsorption )
Lab
Low Hgb, Hct, RBC
Low MCV, MCHC
Low Ferritin/Iron
**High TIBC **
% transfering saturation
****Common patient charateristics : **
Infant, Pregnant, Female, or Elderly
Next Step”
Search for underlying cause (source of
bleeding,
nutrition deficiency
-
**Population **
Infant
Pregnant
Female
Elderly
Vitamin B12 Deficiency
-
Dx
High MCV > Macrocytic -
Pathophysiology
a. B12+Intrinsic factor (glycoprotein) made from stomach lining
Asorpotion: absorption occur ilium (last part of small intestine just last part of large intestine )
b. B12 require for RBC division > RBC enlarged > macrocytic
c. RBC not able to leave marrow > Anemia
B12 Etiology
- Vegan Diet : lack of B12
- **Pernicious Anemia : Auto-immune destroy Intrinsic Factor **
- Post-Gastrectomy: Mechanical loos of stomach lining
- **Ileal Resection: Celiac Diseas (insrisit factor ) (deodenum and jejunum) **
- Sevre chronic Pancreitis
- Alcoholism
- Crohn’s Disease
B12 S/s
a. ** Neurologic**
B12 require for myelination CNC
> Paresthesia: tingling
> Memory Loss:
**b. Increase Homocystine **
Increase riskCVD
c. Glossitis : Inflemation of tonque
**d. GI :
Supplemental ?
Pernicious Anemia
Auto-immune destroys intrinsic factor
* **Check Homocysteine: **
Hight level can lead to CVP
Intrinsic Factor (IF):
Type I : blocks combining IF and B12
Type II: Prevent attachment fo IF to Ilium
**Absorption of B12: **
in illium : last part of small intestine befor large int
B12 TX
**Permicious Anemia :
Life long B12
**Anemia due to poor absorption:
**vit B12 1000mg SQ IMQD
For 7 days; then
weekly for 4 wks
Montly maintance **
**Anemia or Chronic Disease: **
Second most common after Iron Deficiensy
Dx: **
Mild to Moderate microcytic or Normacytic
Pathyphysiology:
Decrease Erthrocytes lifespan
**Dx: **
Mild to Moderate microcytic or Normacytic
Pathyphysiology:
Decrease Erthrocytes lifespan
Etiology
Inlflamation, Organ Failure, Advanced age, Malignancy, Cirrhosis
**Lab and Dianositic
**Microcytic/Normacitic
** Ferritin : normal to high
* Iron: High
*TIBC : Low
% Tranfering : HigH
* RBW: Normal
* Iflammatory Markers: ESR and CRP
**Treatmen: **
Manage underlying Pathology
**Erythropoietin (procrit): ** Indication Hgb <10 + anemia
Transfusion
Consult HemOnc + GI
*
**Common Patient : **
Treat underlying contidtion;
Consider Erythropoesis
Blood Loss/Hemolysis Anemia
**Pathophysiology: **
Increased RBC destructio
**Labs: **
Reticulocyte >2.5
**Hemolysis:
**Destruction RBC Increased
Elevation reticular Count >300%
Hemorrhagic
Less retic production 2/2 limited Fe +
Blood Loss/Hemolysis Anemia: Causes
a. Hemorrhage
**b. Hemoglobinopathy: **
- Sickle Cell (Intravascular +Extravascular)
- Thalassemia
- **c. Hemolytic **
Intravascular (Mechanical and toxic damage
Extavascular (RBC are destroyed: Spleen , liver)
