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Clinical Medicine II

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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