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Pathopharmacology I > Wk 1 Anemia > Flashcards

Wk 1 Anemia Flashcards

1
Q

What is the center of all hemoglobin molecules?

A

Iron

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2
Q

Hemoglobin reversibly binds to __ and __ for transport

A

oxygen and CO2

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3
Q

CO2 is a waste product and is usually in the form of

A

sodium bicarbonate in the plasma

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4
Q

What does hemoglobin bind to more readily than oxygen?

A

carbon monoxide

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5
Q

How is carbon monoxide poisoning treated?

A

100% oxygen and maybe ventilation

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6
Q

What permanently binds to hemoglobin?

A

Glucose

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7
Q

What is the lifespan of a RBC?

A

120 days / three months

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8
Q

Oxygen binds to __ on the hemoglobin molecule

A

heme

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9
Q

The more saturated with oxygen an RBC, the more

A

red it appears

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10
Q

Pulse oximetry looks at how __ the blood is

A

red

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11
Q

What is an absolute decrease in red blood cells?

A

Do not have enough number of red blood cells

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12
Q

What is a relative decrease in red blood cells?

A

Dilutional

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13
Q

Why does a pregnant woman have a relative decrease in red blood cells?

A

Plasma volume increases by 50%, but RBC count increases only 30%

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14
Q

What are two examples of relative decrease in RBCs?

A

Fluid volume overload and athletes

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15
Q

If someone is very dehydrated the could have a relative __ in RBCs

A

increase

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16
Q

Normal hematocrit = about

A

45%

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17
Q

Anemia hematocrit = about

A

30%

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18
Q

Polycythemia hematocrit = about

A

70%

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19
Q

8 causes of anemia

A

1) Inflammation
2) Neoplasia
3) Chronic disease
4) Marrow damage
5) Acute bleeding
6) Hemolytic anemia
7) Maturation disorders
8) Iron deficiency

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20
Q

What is the main cause in western culture of anemia?

A

Iron deficiency

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21
Q

What are hemolytic anemias?

A

Autoimmune diseases where our bodies attack our own RBCs and destroy them

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22
Q

What are maturation disorders?

A

Cells can’t carry oxygen effectively

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23
Q

With bone marrow damage you would also see a decrease in….

A

WBCs and platelets

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24
Q

Why does chronic kidney disease lead to anemia?

A

Kidneys are not secreting erythropoietin

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25
Q

What does erythropoietin do to red bone marrow?

A

Stimulates it to make red blood cells

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26
Q

What would someone with anemia look like?

A 
Pale
Fatigue quickly
Hypotensive
Tachycardia, especially with exertion 
Tachypnea
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27
Q

Why is someone with anemia tired?

A

Their muscles go into anaerobic metabolism due to the lack of oxygen, and create lactic acid and muscle fatigue

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28
Q

What are the symptoms of severe anemia?

A

Chest pain, angina, heart attack, worsening CHF, syncope

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29
Q

Anemia also has these neuro symptoms

A

Memory, cognition, insomnia

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30
Q

Moderate anemia symptoms

A

fatigue
weakness
tachycardia
dyspnea

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31
Q

Severe anemia symptoms

A

tachypnea
tachycardia
hypotension, pallor, faintness
cardiovascular symptoms, especially with exertion

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32
Q

What causes bone pain in a person with anemia?

A

Increased production of erythropoietin

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33
Q

Where is erythropoietin secreted?

A

Kidneys

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34
Q

An example of abnormal hemoglobin

A

sickle cell disease

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35
Q

Normal hematocrit for females

A

37-48

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36
Q

Normal hematocrit for males

A

45-52

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37
Q

With abnormal hemoglobin, the count of red blood cells would be __

A

normal

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38
Q

How do they test for abnormal shapes of red blood cells?

A

hemogram

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39
Q

Two examples of abnormal hemoglobin pathologies

A

Sickle cell anemia and Thalassemia

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40
Q

Misshapen RBCs have a __ life span

A

shorter

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41
Q

With sickle cell anemia, hemoglobin tend to become distorted and this occurs under __

A

stress

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42
Q

What are examples of stressors that can cause someone with sickle cell anemia to have misshapen hemoglobin

A

Infection, dehydration, hypoxia, anything that can cause stress on the body

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43
Q

RBCs can go back to their normal shape, so…

A

they can sickle and then return to the round shape

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44
Q

What is thalassemia?

A

A genetic disorder that causes defective hemoglobin, and hemolysis

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45
Q

Where are defective cells destroyed (in thalassemia)?

A

bone marrow or spleen

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46
Q

When RBCs are sickled they tend too…

A

Clump together and can block blood flow

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47
Q

If RBCs are clumped together and blocking off blood flow, what can this lead to?

A

Pain and ischemia distal to the clot

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48
Q

What are common sites for blockages in a patient with sickle cell anemia?

A

Liver, spleen, heart, kidneys, and retina

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49
Q

What nutrient deficiencies can cause anemia? (3)

A

Iron, folate, b12

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50
Q

Iron is essential to…

A

normal hemoglobin production

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51
Q

B12 and folate are required for normal __ __

A

DNA synthesis

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52
Q

How are anemias classified?

A

Size and shape of the red blood cell

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53
Q

What does mcv blood test stand for?

A

Mean corpuscular volume

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54
Q

What will the MCV be of someone with iron deficiency anemia?

A

Less than 80, so the RBC will be smaller

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55
Q

Iron deficiency anemia is a __ anemia

A

microlytic

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56
Q

If someone has a folate or vitamin b12 deficiency anemia, what will the MCV be?

A

Greater than 100, so the RBC will be larger

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57
Q

Folate and vitamin b12 deficiency anemias are __ anemias

A

macrolytic

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58
Q

What is a normal MCV?

A

80-100

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59
Q

What is a reticulocyte count?

A

Immature red blood cell count

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60
Q

If someone has a high reticulocyte count, what does that mean?

A

They have high immature RBCs, which means they are anemic or experiencing blood loss

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61
Q

What is the most prevalent type of anemia?

A

Iron-deficiency anemia

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62
Q

Only 10% of iron deficiency anemia is in where?

A

developed countries

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63
Q

What vitamin deficiency can cause an iron deficiency anemia?

A

Vitamin C

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64
Q

What two drinks decrease absorption of iron?

A

Tea and coffee

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65
Q

What is an example of an increased demand for iron, that can lead to iron deficiency anemia?

A

Pregnancy

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66
Q

What are two examples where excessive blood loss can lead to iron deficiency anemia?

A

Heavy mentsruation and GI bleeding (occult)

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67
Q

What is visible blood called?

A

frank blood

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68
Q

4 GI disorders that can cause iron deficiency anemia

A

Ulcerations
Inflammation
Hemorrhoids
Colon cancer

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69
Q

Why does iron deficiency lead to anemia?

A

Your body can’t make hemoglobin without iron

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70
Q

5 demographic factors that put someone at higher risk for iron deficiency anemia

A 
Elderly
Teenager
Female
Immigrant
Widower
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71
Q

5 dietary factors that put someone at higher risk for iron deficiency anemia

A 
Low iron intake
Low vitamin C
Excess phytate (phosphorous) intake
Excess tea/coffee
Fad diets
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72
Q

5 social factors that put someone at higher risk for iron deficiency anemia

A 
Poverty
Poor detention 
Alcohol abuse
GIT disease
depression
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73
Q

__ is needed to synthesize hemoglobin

A

Iron

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74
Q

Where is iron absorbed?

A

Duodenum

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75
Q

Why does it take a long time to become anemic from an iron deficiency?

A

Iron is reused when erythrocytes die

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76
Q

All anemias lead to… (3 things)

A

Fatigue
Weakness
Exercise intolerance

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77
Q

__ __ is a symptom specific to iron deficiency anemia

A

Epithelial atrophy

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78
Q

What is a sign of epithelial atrophy?

A

Brittle hair and nails

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79
Q

What are spoon shaped nails called?

A

Koilonychia

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80
Q

Why does iron-deficiency anemia cause epithelial atrophy?

A

It’s secondary to the tissues having a lack of oxygen

81
Q

What are 3 GI symptoms of iron-deficiency anemia

A

Smooth tongue
Mouth sores
Dysphagia

82
Q

What is a unique symptom of iron deficiency anemia related to appetite?

A

PICA

83
Q

What is pagophasia?

A

Chewing or eating ice

84
Q

What is cobalamin?

A

Vitamin b12

85
Q

What does vitamin b12 do to folic acid?

A

It turns inactive folic acid to active folic acid

86
Q

Why is active folic acid important?

A

It’s needed for normal maturation of erythrocytes

87
Q

What is the problem with administering folic acid?

A

It can mask vitamin b12 deficiency because it bypasses the step of vitamin b12 converting inactive folic acid to active folic acid

88
Q

Folic acid deficiency is a problem with…

A

red blood cell production

89
Q

Folic acid deficiency is a __ anemia

A

megaloblastic

90
Q

In megaloblastic anemias, the MCV is…

A

High

91
Q

Inflammation of the __ is common with folic acid deficiency

A

tongue

92
Q

Vitamin b12 is important in the synthesis of RBCs but also the…

A

synthesis of myelin sheath of neurons

93
Q

B12 deficiency can lead to what 3 manifestations

A

Anemia
Glossitis
Neurologic disease/ subacute combined degeneration

94
Q

What is glossitis?

A

Inflammation of the tongue

95
Q

What are symptoms of a vitamin b12 deficiency

A

Balance/gait problems
Numbness and tingling in hands/feet
Memory loss
irritability

96
Q

Folate deficiency is not a problem with __

A

absorption

97
Q

The body can store a few __ worth of folate

A

months

98
Q

3 reasons you might see decreased intake of folate in the diet

A

Alcoholism
Dieting
Cirrhosis

99
Q

Who has an increased need of folate?

A

Pregnant women

100
Q

The body can store __ worth of vitamin b12

A

years

101
Q

What is vitamin b12 deficiency anemia called?

A

pernicious anemia

102
Q

Where is vitamin b12 absorbed?

A

terminal ileum

103
Q

What does vitamin b12 need to be able to be absorbed?

A

intrinsic factor

104
Q

Where is intrinsic factor secreted?

A

in the gastric parietal cells

105
Q

3 conditions that reduce the production of intrinsic factor

A

Gastric bypass
Gastrectomy
Bowel resection, especially if the terminal ileum

106
Q

Pernicious anemia normal symptoms (6)

A 
Fatigue
Exercise intolerance
Weakness
Tachycardia
Dyspnea
Glossitis
107
Q

Neurological symptoms of vitamin b12 deficiency (8)

A 
Depression
Paranoia
Confusion
Irritability
Anxiety
Balance issues
Gait issues 
Memory loss
108
Q

What 3 things lead to anemia

A

Abnormal hemoglobin
Decreased hemoglobin content on RBC
Decreased number of circulating erythrocytes

109
Q

What is an example of abnormal hemoglobin cause of anemia?

A

Sickle cell disease

110
Q

What are two example of causes of decreased hemoglobin content on RBC?

A

Loss or iron

Loss of key nutrients

111
Q

What are three causes of decreased number in circulating erythrocytes?

A

Decreased production
Increased destruction
Blood loss

112
Q

Why does chronic kidney disease lead to anemia?

A

In a healthy kidney, erythropoietin is secreted to stimulate bone marrow to create RBCs

113
Q

A patient with chronic kidney disease may have very little symptoms despite having a very low h&h. Why?

A

Because kidney disease progresses so slowly that their body has time to compensate

114
Q

It’s not uncommon to see a patient with chronic kidney disease have a hemoglobin of __-__

A

5-6

115
Q

What is the treatment for patients with anemia who have chronic kidney disease?

A

Treat them with recombinant erythropoietin

116
Q

Aplastic anemia is a __ cell disorder

A

stem

117
Q

What is aplastic anemia characterized by?

A

pancytopenia

118
Q

What is pancytopenia?

A

Reduction in RBCs, WBCs, AND platelets

119
Q

What are the two classifications of aplastic anemia?

A

Congenital or acquired

120
Q

Acquired aplastic anemia is often __

A

idiopathic

121
Q

Acquired aplastic anemia can also be an __ __.

A

Autoimmune disorder

122
Q

What is a possible trigger of acquired aplastic anemia?

A

Radiation/chemo treatment

123
Q

A patient with aplastic anemia will be at high risk for __ and __

A

infection and bleeding

124
Q

What are some autoimmune triggers for aplastic anemia?

A

Complications of infection such as hepatitis or mononucleosis

125
Q

Absent or decreased production of hemoglobin is what type of anemia?

A

Thalassemia

126
Q

Abnormal hemoglobin and decreased lifespan of RBC is what type of anemia?

A

Sickle cell

127
Q

What are two types of thalassemia?

A

Alpha and beta

128
Q

What is acquired hemolytic anemia?

A

Premature destruction of RBCs by some external agent

129
Q

What are common causes of acquired hemolytic anemia? (4)

A

Blood incompatibilities
Drug reactions
Severe burns
Microangiopathy

130
Q

Acquired hemolytic anemia is an __ attack

A

Autoimmune

131
Q

What are examples of blood incompatibilities that can lead to acquired hemolytic anemia? (2)

A

Blood transfusion with wrong type

Rh factor issues with pregnancy

132
Q

What 3 drug classes have been linked to hemolytic anemia?

A

Penicillins
Cephalosporins
NSAIDs

133
Q

What happens in hemolytic anemia?

A

We get these immune complexes that amount a direct attack on the cell and cause lysis

134
Q

Why is low hemoglobin a symptom of hemolytic anemia?

A

Because of the destruction of RBCs

135
Q

What are specific signs/symptoms to look for in a patient with hemolytic anemia? (5)

A 
Low hemoglobin
Increased reticulocyte count
Mild jaundice
Hemoglobinuria 
Decreased haptoglobin
136
Q

Why does a patient with hemolytic anemia have mild jaundice?

A

Some bilirubin escapes when RBCs are destroyed

137
Q

Why does a patient with hemolytic anemia have increased reticulocyte count?

A

Bone marrow increases production to compensate for RBC destruction/low count

138
Q

Where is haptoglobin made?

A

The liver

139
Q

What does haptoglobin do?

A

It attaches to hemoglobin and helps carry it to the reticuloendothelial system

140
Q

Blood loss anemia results from __ and __ blood loss

A

Gross and occult

141
Q

What is a normal person’s normal blood volume?

A

About 5000 mL

142
Q

If someone loses 10% (500ml) of their blood volume, what are their s/s?

A

Usually none, but maybe syncope or dizziness

143
Q

If someone loses 20% (1000ml) of BV, what are their s/s?

A

No symptoms at rest but tachycardia with exercise

144
Q

If someone loses 30% (1500ml) of BV, what are their s/s? (3)

A

Flat neck veins when supine
Tachycardia with exertion
Orthostatic hypotension

145
Q

If someone loses 40% (2000ml) of BV, what is their s/s? (4)

A

Tachycardia
Hypotension when supine
Air hunger
Cool, clammy skin

146
Q

If someone loses 50% (2500ml) of BC, what is their s/s?

A

Shock and death

147
Q

What organs are important to watch with someone who is experiencing blood loss?

A

Heart
Brain
Lungs
Kidneys

148
Q

A patient with chronic blood loss may be asymptotic until their hemoglobin reaches…?

A

8 or less

149
Q

Someone with chronic blood loss will have the __ __ __ but less cells in it

A

same blood volume

150
Q

What symptoms might someone have if their hemoglobin is 8 or less?

A

Pallor
Tachycardia
Tachypnea

151
Q

What are potential issues a person may have that is causing their chronic blood loss?

A

GI erosion

Diverticulitis

152
Q

Chronic blood loss can lead to what type of anemia?

A

iron deficiency anemia

153
Q

What type of drug is epoetin alfa?

A

Erythropoietin stimulating agent

154
Q

What are brand names for epoetin alfa?

A

Epogen and procrit

155
Q

What is the MOA of epoetin alfa?

A

Mimics the function of human erythropoietin

156
Q

What are some indications of epoetin alfa?

A

Maintains RBCs in patients with chronic kidney failure, HIV infection on drug therapy, preop for patients with anemia, anemia secondary to chemo

157
Q

What routes if epoetin alfa given?

A

SQ

158
Q

If you give a patient with chronic kidney disease epoetin alfa, what are the risks?

A

Puts them at increased risk for increased mortality and serious cardiovascular events

159
Q

If you give a patient with cancer epoetin alfa, what are the risks?

A

Increased mortality and tumor progression

160
Q

If you give a patient who is undergoing surgery epoetin alfa, what are the risks?

A

Puts them at risk for thromboembolic events and mortality

161
Q

What does the CDC recommend for epoetin alfa? (3)

A

Weigh risks versus benefits
Do not administer if hgb about 10 or higher
Use lowest dose possible to reduce need for transfusion

162
Q

What are nursing implications for epoetin alfa? (3)

A

Administer BP before and during therapy
Monitor Hgb levels
Teach patient to take iron supplements

163
Q

When should you hold epoetin alfa?

A

Someone with uncontrolled hypertension

Hgb level of 10 or higher

164
Q

What can happen concerning blood pressure when administering epoetin alfa?

A

Patient can become hypotensive

165
Q

What are the two forms of dietary iron?

A

heme and non-heme iron

166
Q

Heme iron makes up 40% of the iron in…

A

meat, fish, poultry

167
Q

Heme iron is __ __

A

well absorbed

168
Q

Non-heme iron is 60% of __ __

A

animal tissue

169
Q

What type of iron is in plants?

A

Non-heme iron

170
Q

Non-heme iron is what compared to heme iron?

A

not as well absorbed

171
Q

What are iron rich vegetables?

A

Green leafy vegetables, broccoli, tomatoes, green beans

172
Q

What is recommended for pregnant women so they don’t become iron deficient?

A

ferrous sulfate

173
Q

What is the MOA of ferrous sulfate?

A

Taken up by bone marrow cells to make hgb

174
Q

What are the adverse effects of ferrous sulfate? (3)

A

GI disturbances
teeth staining
tarry stools

175
Q

What type of drug is ferrous sulfate?

A

iron replacement therapy

176
Q

Ferrous sulfate only contains __% of elemental iron

A

20%

177
Q

If a patient needs a 100mg dose of elemental iron, how much ferrous sulfate will they need to take?

A

500mg

178
Q

__ reduce absorption of iron

A

Antacids

179
Q

Food can help decrease the GI side effects of iron, but what adverse effect does this have?

A

Decreases the absorption of the iron

180
Q

Food decreases absorption of iron by __-__%

A

50-70%

181
Q

Recommend patients take iron on an __ __ if they can tolerate it

A

empty stomach

182
Q

What is the leading cause of death in children concerning iron?

A

Iron toxicity, overdose

183
Q

What is the parenteral iron therapy drug called?

A

Iron dextran

184
Q

What is the brand name of iron dextran?

A

DexFerrum

185
Q

What are the indications for iron dextran?

A

Iron deficiency or

Oral iron is intolerable or ineffective

186
Q

Why is there a black box warning for iron dextran?

A

Potentially fatal anaphylaxis

187
Q

What are three safety considerations for administering iron dextran?

A

Only use when absolutely necessary
Have epi and CPR equipment close by
Do a small “test” dose before each administration

188
Q

What are the routes of iron dextran?

A

IV or IM

189
Q

What are three adverse effects of iron dextran?

A

Persistent pain
Discoloration at the site
Tumors

190
Q

When giving iron dextran IM, what is important to do?

A

Use the z track method

191
Q

The discoloration on the skin caused by iron dextran is __

A

permanent

192
Q

What is the drug called used for vitamin b12 replacement?

A

Cyanocobalamin

193
Q

What is the preferred route for cyanocobalamin?

A

PO

194
Q

What is an adverse effect of cyanocobalamin?

A

hypokalemia

195
Q

Why use caution when administering cyanocobalamin with __ __ because it may mask b12 deficiency

A

folic acid

196
Q

With oral cyanocobalamin, the doses need to be __

A

larger

197
Q

What is the MOA of folic acid administration?

A

Converts to the active form of folic acid after administering

198
Q

What are the 3 indications for folic acid admin?

A

Folic acid deficiency anemia
Prophylaxis to folic acid anemia
Initial treatment of severe anemia due to vitamin b12 deficiency

199
Q

When taking folic acid a patient may report they feel…

A

flushed

Pathopharmacology I (33 decks)

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