Anemia Flashcards by Sydney Perry

Deficiency in the number of RBCs or in
the amount of hemoglobin they contain

anemia

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anemia limits the exchange of _________ between the blood and the tissue cells

oxygen & carbon
dioxide

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cell size classification of anemia

Microcytic (small)
Normocytic (normal)
Macrocytic (large)

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Hemoglobin (Hgb) content in classification

Decreased=>Hypochromic (pale color)
Normochromic

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biochemical data to look at anemia

Red Blood Cell Count (RBC)
Hemoglobin (Hgb)
Hematocrit (Hct)
Red Blood Cell Indices
Mean Corpuscular Volume (MCV)

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Hemoglobin (Hgb) is the ___________

Protein in RBC that carries O2
Index of the blood’s O 2 carrying capacity

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Decreased levels of hemoglobin indicate anemia
Normal levels:
Men: _______ g/dL
Women: ______ g/dL

14-17
12-15

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what is democrat (Hct)

Percentage of the total blood volume
that is made up by RBC

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Decreased levels indicate anemia
Normal levels:
Men: ______%
Females: ______%

42-52
35-47

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M ean Corpuscular Volume (MCV)

A measure of the average volume or
size of a RBC

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Normal values of MCV: ______ fL

Decreased MCV=> ______RBC=> __________

Increased MCV=> ______ RBC=> ___________

80-95

small
microcytic anemia

large
macrocytic anemia

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Causes of Anemia

Nutritional deficiencies
Hemorrhage
Genetic abnormalities
Chronic disease states: cancer, renal disease
Medications

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Smaller than normal size RBC with less Hgb content

Microcytic, Hypochromic Anemia

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Microcytic, Hypochromic Anemia

Due to decreased production of _____

Biochemical data=> decreased ________; decreased ____

Hgb
Hgb & Hct
MCV

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microcytic hypo chromic anemia is caused by

Iron deficiency anemia
Thalassemia
Sideroblastic Anemia
Copper deficiency

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Macrocytic or Megaloblastic Anemias occur from ________ and produce ______ with ______ Hgb, ______ Hct, and _____ MCV

Defective DNA synthesis
abnormally large, immature RBC
decreased Hgb & Hct; increased MCV

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microcytic or megaloblastic anemias are cause by _______ deficiency, _______ deficiency, or ________ such as ________

vitamin B12
folate
drug induced disorders of DNA synthesis
chemo

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Normocytic, normochromic anemias cause ___________ with ________.

____ RBC count
_____ Hgb
______ Hct
______ MCV

destruction of RBC
decreased RBC production

low
low
low
WNL (within normal limits)

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Normocytic, normochromic anemias can be caused by

hemorrhage
aplastic anemia
anemia of chronic disease
hemolytic anemia
pregnancy

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anemia of chronic disease for normocytic anemia includes

chronic kidney disease (decreased erythropoietin production)

leukemia

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nutritional anemias include what nutrients ?

iron
vitamin B12
folic acid
protein
pyridoxine
copper

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Iron Deficiency Anemia (IDA) is a ______________ anemia

Iron deficiency is the most common and widespread nutrition deficiency in the world
- Affects _____% of the world’s population

Microcytic, hypochromic anemia

25%

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high risk groups for iron IDA

Menstruating women
Pregnant & lactating women
Infants & children
Conditions which cause blood loss=>peptic ulcer disease, ulcerative colitis, colon cancer, chronic aspirin therapy
Children living at or below the poverty level

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iron deficiency can occur from

Inadequate ________ of iron
Inadequate absorption
_________________________
Increased excretion=>_________
Increased iron _________ for growth of blood volume
Defective release from storage

dietary intake
achlorhydria, intestinal disease, medications
blood loss
requirement

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Stages of IDA

1. early negative iron balance 2. iron depletion 3. iron deficient erythropoiesis 4. IDA

Stage 1 of IDA Iron needs or losses exceed intake=> moderately depleted iron stores - Serum ________ decreases (Best indicator of early negative iron balance) Hgb is _________ Compensation: _________________ _______________

ferritin normal Rate of GI absorption enhanced Increase in the concentration of serum transferrin

stage two of IDA iron stores are __________ if iron deficiency is treated in stage 1 or 2 ________

severely depleted no dysfunction

Stage 3 of IDA Iron Deficiency=> inadequate _____ iron _________ but no ________ Decreased serum ______ Transferrin saturation is _______

body Dysfunction anemia iron <15%

stage 4 of IDA what occurs

displaying symptoms

symptoms of anemia

muscle weakness fatigue anorexia pale skin abnormal cognitive development in children growth abnormalities pica reduced immunocompetence defects in structure and function of epithelial cells cardiac failure

defects in structure and function of epithelial cells can include ?

glossitis (inflamed tongue) Koilonychia (thin spoon shaped fingernails) Angular Stomatitis (inflamed and cracking of mouth corners)

in diagnosis of IDA are these high or low serum ferritin serum iron serum transferrin transferrin saturation hemoglobin & hematocrit MCV

low low high high low low

For treatment of IDA, Identify & treat the ____________ Repletion of iron stores=> _____ iron supplementation in the _______ form - _____________ most common (contains ____% elemental iron) - Best absorbed if taken on an empty stomach; however, can cause _________

underlying cause oral ferrous Ferrous sulfate 20% gastric irritation

GI side effects of iron: _____________ Daily dose: Continue supplementation for _____ months to replete stores Adults: _______ mg of elemental iron per day Children: __________ of body weight

nausea GERD constipation 3-6 months 150-200 mg 2-6 mg/kg

reasons for iron supplementation failure

Non-compliance due to GI side effects Bleeding continues Iron supplement is not being absorbed

Heme examples of iron

liver beef pork poultry clams, oysters

non-heme iron examples

fortified foods dried peas and beans tofu spinach nuts and seeds lentils baked potato with skin

what are some factors that increase iron absorption?

heme iron better absorbed than nonheme iron vitamin C increased absorption if taken with iron source heme-iron sources increase absorption of non-heme iron in other foods

inhibitors of iron absorption

tannins (tea and coffee) phytates (whole grain breads, cereals, legumes) oxalates (dark leafy greens) phosphates calcium phosvitin (egg yolks)

MNT to increase iron

increase intake of dietary iron include source of meat, fish, or poultry at every meal if possible include source of vitamin C at every meal avoid drinking large amounts of tea or coffee with meals

Folate is needed for __________________ Deficiency can cause=>_______________ Body stores are depleted within __________ on a folate-deficient diet

synthesis of DNA and maturation of RBC macrocytic, megaloblastic anemia 2-4 months

causes of folate deficiency Inadequate ingestion from ____________ Inadequate absorption from __________

Poor quality diet Celiac disease Medications=>sulfasalazine Alcohol

causes of folate deficiency Inadequate utilization from _____________

Drugs=> anticonvulsants, methotrexate Vitamin B12 deficiency=> methylfolate trap Alcoholism Methylenetetrahydrofolate reductase (MTHFR) gene mutation

causes of folate deficiency increases requirements for growth such as _________ increased excretion from ___________

Pregnancy Infancy Increased hematopoiesis Dialysis Vitamin B12 deficiency

clinical sign of folate deficiency

fatigue dyspnea (difficulty breathing) glossitis diarrhea irritability forgetfulness anorexia and weight loss

Diagnosis of Folate Deficiency Very low serum folate levels (<_____ ng/mL) Low RBC folate (<_____ ng/mL) Both serum folate and______ levels should be measured to differentiate deficiencies Folic acid supplementation can mask __________ deficiency

3 140 vitamin B12 vitamin B12

Treatment 1. Determine & treat the cause of deficiency 2. Replenish folate stores with supplementation: _________ per day for _________ 3. If long-term supplementation needed due to alcoholism, medications, malabsorption ________ folic acid daily

1 mg folic acid 2-3 weeks 0.5-1 mg

MNT for Folate Deficiency Increase dietary folate sources - Consume multiple servings of __________ or a glass of fruit or vegetable juice daily - Fortified ___________

fresh fruits and/or dark green vegetables grain products, fish, legumes

what is pernicious Anemia

A type of macrocytic, megaloblastic anemia caused by a deficiency of vitamin B 12

vitamin B12 is needed for _____________

synthesis of DNA and maturation of RBCs

Causes of Vitamin B 12 Deficiency Inadequate absorption from ________ Inadequate intake Increased excretion=>_________

Lack of intrinsic factor (IF) - Gastric surgery, bariatric surgery, atrophic gastritis Ileal disease Pancreatic insufficiency liver disease

Clinical Signs of Vitamin B 12 Deficiency

Pernicious anemia: - Fatigue - Irritability - Glossitis - N/V/D/C - Anorexia; weight loss -inadequate myelination of nerves

Inadequate myelination of nerves can cause ?

Paresthesia Poor muscular coordination & weakness Ataxia Depression Poor memory Hallucinations Paraplegia * If untreated, may be irreversible

Diagnosis of B12 deficiency Serum vitamin B 12 <____ pg/mL _________ value <____ pg/mL is a sign of early B12 deficiency

200 A holo TCII 40

treatment of pernicious anemia first ____________ After initial response=>_______________ Can also give very large doses (_______ µg/d) of oral vitamin crystalline B12 even in the absence of IF because 1% will be absorbed by diffusion ________________ are also available

Intra-muscular (IM) injection of 1000 µg of vitamin B 12 once per week Monthly injections of 1000 µg 1000-2000 Nasal sprays & sublingual tablets

MNT for pernicious anemia

Increase dietary sources of Vitamin B12 High protein diet: 1.5 g/kg

Food Sources of Vitamin B12

Liver Beef Pork Fish Eggs Dairy products Fortified cereals

Decreased MCV=> ____________=> __________

microcytic anemia possible Iron deficiency anemia

Increased MCV=> __________ anemia=>______________

macrocytic possible vitamin B12 or folate deficiency anemia

Sick Cell Anemia is not caused by _________ but can cause ______________

nutrition nutrition problems

what is sickle cell anemia ? Inherited condition Affects ~_______ Americans Occurs in about _______ Black American births in the U.S.

Chronic hemolytic anemia caused by defective hemoglobin synthesis 100,000 1/365

Clinical Manifestations of sickle cell anemia Deformed RBC=> do not carry O2 well - fragile, & _______- capillaries Severe _________ anemia Pain crises=> often severe_______ _______ due to hemolysis of RBC Impeded blood flow - Organ failure=>liver, kidney - Stroke

occlude hemolytic abd. pain Jaundice

Medical Management of sickle cell anemia - _____________ - Medication=>______________ - ______ management - Providing ______ - _______ supplementation, which increases the _______ of RBC and is Needed for growth

Blood transfusions hydroxyurea Pain oxygen Zinc oxygen affinity

Nutrition Implications of sickle cell anemia Children=> poor _______ - Decreased intake due to frequent _________ - Increased ____ - _________ is common

growth abdominal pain REE Malnutrition

MNT for Sickle Cell Anemia Well-balanced, high ______/high _____ diet; ______% DRI for kcal & protein Drink plenty of fluids Increase dietary _______ sources Avoid _____ supplements May need to reduce dietary______ intake

kcal protein 120-150 folate iron iron

Anemia Flashcards

(65 cards)