Primary Care: Hematologic Conditions Flashcards
What is Anemia (non pregnant)?
Decrease in red blood cell mass or decrease in hemoglobin. Hemoglobin level less than 12
Signs of Anemia
pallor, jaundice, Orthostatic hypotension, peripheral edema, pale mucous membranes and nail beds, smooth, sore tongue, splenomegaly, tachypnea, dyspnea on exertion, tachycardia or flow murmur
Symptoms of Anemia
Fatigue, drowsiness, weakness, dizziness, headaches, malaise, pica, poor appetite, changes in food preferences, changes in sleep habits, changes in mood
Microcytic anemias
iron deficiency, thalassemias, and anemia of inflammation
Macrocytic anemias
folate and vit b12 deficiency, anemia associated with liver disease, increased reticulocyte production, and some medication effects
Normocytic anemias
acute blood loss or conditions such as sickle cell disease, hemoglobin C disease, or glucose-6-phosphate dehydrogenase (G6PD) deficiency.
Aplastic anemia
normocytic but characterized by pancytopenia, reduction in the number of red blood cells (RBCs), white blood cells (WBCs), and platelets.
Which Anemia:
RBC: low
Hgb: Low
MCV: Low
MCH: Low
Reticulocytes: Low
ferritin: Low
Iron: Low
TIBC: High
Iron Deficiency
Which Anemia:
RBC: Low
Hgb: Low
MCV: High
MCH: High
Reticulocytes: Low
Ferritin: High
Iron: High
TIBC: Normal
Vit B12 Deficiency
Which Anemia:
RBC: Low
Hgb: Low
MCV: High
MCH: High
Reticulocytes: Low
Ferritin: High
Iron: High
TIBC: Normal
Folate Deficiency
Which Anemia:
RBC: Normal
Hgb: Low
MCV: Low
MCH: Low
Reticulocytes: High
Ferritin: Normal- High
Iron: Normal- Decreased
TIBC: Variable
Thalassemia
Which Anemia:
RBC: Low
Hgb: Low
MCV: Normal- Low
MCH: Low
Reticulocytes: Low
Ferritin: Normal- High
Iron: Low
TIBC: Low
Chronic Disease
First level of assessment to help differentiate many underlying causes of anemia
CBC
Most sensitive and specific predictor of iron stores; true iron defiency
ferritin level
Recommended intake of iron for 14 to 18 years
15 mg
Recommended iron from 19 to 50
18 mg
Most common causes of iron deficiency anemia in adults
occult blood loss, excessive menstrual loss, and inadequate nutritional intake
Ferritin level that confirms diagnosis of iron deficiency
less than 100-150
Severe anemia
< 9.0
First line tx of iron def anemia
dietary intake of iron risk foods, consumption of vit C- enriched products to enhance absorption of the heme iron
Iron rich foods
green leafy veggies, collard greens, egg yolks, raisins, prunes, liver, oysters, some fortified cereals
Taking iron preparations will..
decrease absorption but will improve GI effects
Antacids will do what to iron supplement absorption
decrease it, should not be taken at the same time
Sickle cell disease
Hb SS, severe illness, sickle cell crisis
Sickle cell trait
Hb SA; mild anemia, increased risk of UTI, may have sickle cell crisis at high altitudes, if dehydrated, or during extreme physical activity
Sickle cell hemoglobin C Disease
Hb SC; mild to moderate anemia and sickle cell crisis; risk for infection, retinopathy, and blindness
Hemoglobin C disease
Hb CC; usually asymptomatic, symptoms may be with splenomegaly
Hemoglobin C trait
HB CA; usually asymptomatic
Beta- thalassemia
Cooley’s anemia, severe anemia- frequent blood transfusions, classic facial features
Thalassemia intermedia
significant anemia but does not need blood transfusions
Thalassemia minor
mild microcytic anemia, individual asymptomatic
Alpha- thalassemia trait
mild microcytic anemia, individual is aymptomatic
Hemoglobin H disease
(alpha- thal) enlarged spleen, bone abnormalities, severe illness
Hemoglobin Bart’s hydrops fetalis
incompatible with life; causes hydrops fetalis
Thalassemias more prevalent in..
Southeast Asia, the Mediterranean, Africa, Middle East, and the Indian sub continent
Alpha- thalassemia most common among..
Chinese and Southeast Asian descent
Beta thalassemia most common among…
Mediterranean, Chinese, Asian, and African women
Diagnosis of Thalassemia, what should be given and not given
YES: Folic acid supplementation may be used
NO IRON PLEASE, INAPPROPRIATE
Common complication for nonpregnant women with sickle cell trait
increase in UTI, lessen the accuracy of hemoglobin A 1c testing ( makes testing for diabetes more difficult)
Glucose 6 Phosphate Dehydrogenase Deficiency
-X linked
-Found in Mediterranean descent and African Americans
-Rarely symptomatic in women
-Can go from being symptomatic to presenting with severe acute or chronic hemolytic anemia
-Hemolysis occurs when the individual has an infection or receives oxidative drugs
-Cannot get sulfa drugs or sulfa derivatives, Macrobid, NSAIDS, toluidine blue, and methylene blue
- No fava beans and some other legumes
-Prompt dx and tx important
Von Willebrand’s Disease
- Autosomal dominant
- Causes defects in protein necessary for plate;et adhesion and affects clotting factor VII
-Heavy menses, prolonged bleeding, and fam hx of bleeding problems - Assess: plaetelet count, ferritin level, bleeding time, and coagulation studies
-Labs: platelets normal; ferritin low; bleeding time prolonged
-Avoid : meds that can make you bleed more, like NSAIDS
