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Anemia
Clinical Medicine II
| Question | Answer |
|---|---|
| What is anemia | ↓ in O2 carrying capacity of blood |
| Factors you need for RBC synthesis | Fxn marrow, Epo, Iron, B12, folate, (Vit C B6, proteins) |
| Two types of anemia | decreased of production and increased destruction, and blood loss |
| General sxs of anemia | fatigue, ↓ stamina, dyspnea, tachy, dizziness, fainting, HA, angina, claudication, limping/lameness |
| What may anemia show up as in the elderly | exacerbation of a cardiac sxs |
| Medications that can cause anemia | NSAIDS, steroids, anticoags, myelosuppriseves, vitamin antagonists |
| Why does jaundice show up in anemia pts | hemolytic: RBC destroyed ↑ bilirubin production |
| How can alcohol consumption precipitate anemia | folic acid and b 12 are not absorbed, GI bleed, immune suppression, liver dz, impaired biosynthetic processes |
| MC anemia in women | menses |
| MC anemia in men | stool occult blood |
| MC anemia post menopause | stool occult blood |
| Nl Hb and nl hematocrit values | F:12.0-15.0 M: 14.0-18.0 HCT: F: 37.9-43.9 M: 42.9-49.1% |
| What is nl MCV | mean corpuscular volume 80-94 or (80-100) |
| When is MCV abnl? | nutritional anemia |
| Causes of microcytic anemia | iron def, ACD/AL, Thalassemia, sideroblastic anemia, chronic blood loss |
| Causes of Macrocytic anemia | B12/folic acid def: percicious anemia, liver dz, hypothyroid, drugs, myelodysplastic syndrome |
| What do the values of MCH look like | in Microcytic, they are low, macro high |
| What reflects color of RBC | mean corpuscular Hb concentration Low: hypochromic, high: hyperchromic |
| MCHC in iron def, thalassemia and acute blood loss | lwo in iron and thalassemia, nl in acute blood loss |
| If retic count is 2.5-3.0 what do we suspect | increased destruction |
| If < 2.0 recic count what does this mean | deficient of some component of RBC, hypoproliferative destruction |
| What is nl retic count | .5-1.5%, would be low if bone marrow issue, can’t make bone marrow |
| Nl serum iron | 80-199ug/dL which Is bound to transferrin |
| Transferrin | iron transport protein |
| TIBC | total iron binding capacity: indirect measure of transferrin % saturation: % iron binded: Iron overlaod →50%nl 25-50% |
| Signs of iron deficiency | low TIBC level, and Higher transferrin |
| What is ferritin and nl values | labile Fe store, 10-150ng/mL female 29-258 |
| What is hemosiderin | less labile Fe store, usually elevated in dx for iron overload, hemochromatosis, hemolysis |
| Causes of anemia d/t acute blood loss | trauma, surgery, GI loss |
| Characteristics of acute blood loss anemia and tx | Char: normochromic RBCs, normocytic, Tx. Volume expansion, trsx |
| What are parasitic infections predispositions for | iron deficiency anemia especially hookworm |
| What are RF’s for iron defiency anemia | growth, AA’s, blood loss: menses, GI loss, renal dz, and Impaired absorption: low gastric pH bowel resection or bypass, crohn’s sprue, celiacs |
| One of the top 4 nutrition def in U.S. | dietary iron deficiency |
| Risk groups for Iron def anemia | growth spurs, AA’s, blood loss: menses, GI etc, impaired absorption |
| Sequence of events for iron defieciency anemia | ↓ intake→pulls from stores (ferritin)→↑iron abs→nl/increase transferrrin→↑TIBC →↓serious iron→↓ % sat →↓ reticulocytes→defective/iron deficient erythropoiesis→↓Hgb, HCT, MCV |
| Why are cells small w/ iron deficiency | no iron to put in the cells, smallcells |
| Why are cell large w/ B-12 and folic acid def | these two needed for DNA synthesis, so cell gets larger but can’t divide |
| Lab results for IDA | all decreased except and ↑ in TIBC (no iron so more is available to bind) |
| Physical findings of IDA | spooning of the nails, Pica (chewing on ice), Plummer-vinson symdrome (Diffucult swallowing, weakness) |
| RDA of Iron in men and women | 8mg men, 18mg women |
| What helps facilitate abs. of non-heme iron, | Vit C but heme-iron more readily absorbed |
| What helps with absorbtion of iron | empty stomach, causes GI upset, dose TID to ↓ SE’s |
| Food high in iron | oysters, beef liver, braised fortified breakfast ceral |
| What causes ACD/AI | Chronic diseases causes ↑ cytokines ↑ iron trapping |
| Common actual causes of ACD | Renal failure, liver dz, COPD, Infx: TB, HIV/AIDS, hepatitis, Osteomyelitis, endocarditis, Chronic inflammatory dz |
| Lab results | low Hgb,serum iron, TIBC, transferrin. Everything else is nl, |
| How do we differentiate b/w iron def, and ACD | ferritin level, low in iron def, nl or high in ACD (marrow shows nl iron) |
| What is an X-linked defect in B-6 metabolism | Sideroblastic anemia |
| Acquired causes of sideroblastic anemia | lead poisoning, ETOH, folic acid/copper def, zinc tox, inflammatory |
| Patho of SBA | defect in heme synthesis, XS iron trapped in mito of RBC causes ringed sideroblasts |
| DX of SBA | low Hgb, ↑ iron, ferritin, % sat, sideroblasts present on smear |
| Tx SBA | D/C offensive agents, trial B-6 supplement, some may need transfusion |
| What must we R/o w/ iron def anemia | occult bleeding (menses and gi bleed for men) |
| Cell changes w/ macrocytic anemia large cells, hypersegmented PMNs, nucleated erythrocytes | |
| Causes of malabsorption B12 def | gastric surgery, Crohn’s/celiac/sprue, bacterial Overgrowth, HIV/AIDS enteritis, fish tapeworm, ETOH, pancreat dz, radiation TX to GI tract for malignancy pernicious anemia |
| How is B12 absorbed | r-protein in saliva binds to B12, IF released by fundus of stomach, pancreatic enzymes in duadnum cleaves B12 from R-protein, and IF binds to it, B12-IF absorbed |
| 3 causes of pernicious anemia | autoimmune against IF, atrophic gastritis (loss of parietal cells that produce IF), ↓ IF production |
| S/S of B12 def | pale, SOB, fatigue, sore mouth/tongue, atrophic glossitis, Neurologic sxs |
| Nero sxs w/ B12 def | ↓ vib and proprioception, peripheral neuropathy, parasthesis (Lots more) |
| Labs for B12 def | ↓ Hgb and HCT and retic count ↑ MCV (>100), low serum B12 |
| Tx pernicious anemia | life-long parenteral B12 |
| Malabsorptive dz | paraenteral/enteral B12 supplements |
| Risks of folic acid def | diet: elderyly, diets lacking greens, anorexia, cancer ↑use: premies, ETOH, hemolytic anemia, dialysis, ICU, pregnancy and lactation , Gastric resection |
| Underlying malnutrition of folic acid | alcohol abuse, PCM, anorexia, GI dz |
| Labs Folic acid | ↓Hgb and HCT ↓ serum folate, ↑ homocysteine |
| Good sources of folic acid | liver, yeast, nuts, dried beans, whole grains, spinach, leafy greens, oranges, avacados |
| RDA and tx of folic acid def | 400ug/day, 1mg/day for 1-2 months |
| Rapid deterioration in nero status w/ progression to irreversible systemic neuro deteroation | happens with FA supplements in the presence of concurrent B12 def |
| Why ↑ neuro sxs w/ FA supplementation w/ B12 def | Both needed for DNA synthesis, B12 coverts thymidine active substance, def will correct anemia but not neuro deterioration |
| What must we R/o prior to supplementing FA | B12 def, MOA of drugs (folate antagonists) |
| Nutritional anemias | Copper: ↓ transport of iron from stores, B6: sideroblastic anemia Vit A,E, thiamine, B6: decreased heme synthesis, Protein malnutrition: ↓transferrin and other transport proteins (tricky w/ iron def and ACD) |
| Causes of normochromic normocytic anemia | AA, myeloma, carcinoma, leukemia, bone marrow failure, Hgbpathis, |
Created by:
becker15
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