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PHAR 253 Module 3 > Anemia > Flashcards

Anemia Flashcards

1
Q

What is anemia?

A

Decrease in # of RBC’s or less than normal quantity of Hgb in the blood

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2
Q

What does anemia primarily result in?

A

Decrease in oxygen carrying capacity in the blood

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3
Q

What is erythropoiesis?

A

formation of RBC’s

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4
Q

What are the components of RBC’s?

A

2 alpha, 2 beta chains
heme group (porphyrin ring +iron)

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5
Q

What is the difference of RBC’s between infants and adults?

A

Infants have gama chains instead of beta chains which are much more affinitive for oxygen?

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6
Q

How does erythropoiesis work?

A

Feedback loop, decrease in tissue oxygen results in stimulation of EPO production and release

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7
Q

Where is EPO released from?

A

90% kidneys

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8
Q

What does EPO do?

A

stimulates stem cells to differentiate, increases release of reticulocytes from bone marrow, induces Hb formation

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9
Q

What are the 3 classifications of anemia (pathophysiology)

A

Blood Loss
Inadequate RBC production
Excessive RBC destruction

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10
Q

What are the classifications of anemia based on RBC morphology?

A

Size:
Microcytic
Normocytic
Macrocytic
- megaloblastic
- non-megaloblastic
Colour:
hypochromic
normochromic
hyperchromic

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11
Q

Describe Microcytic

A

Primarily result in Hb synthesis failure or Hb insuffeciency, can be caused by issue of heme or globin portion
<80 fL (small)

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12
Q

Describe Normocytic

A

Normal size but low number of RBC’s
Decrease production or increase in desctruction/ loss
80-100 fL (normal)

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13
Q

Describe Megaloblastic

A

Impaired DNA synthesis
- B12 deficiency
- folate deficiency

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14
Q

Describe non-megaloblastic

A

Not cuased by DNA synthesis
- liver disease, etc.

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15
Q

What is the general Presentation of Anemia?

A

acute/ devlop slowly (sometimes)
End result of decreased oxygen carrying capacity
perfusion of non-vital organs compromised to sustain vital organs –> itially pts asymptomatic

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16
Q

What are common symptoms of anemia?

A

Fatigue, dizziness, weakness, SOB, tachycardia, decreased mental acuity, pallor(whiteness especialy in eye lids or nail bed), cold extremities, postural hypotension, jaundice(hemolysis), bleeding gums, blood in stool/urine

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17
Q

What medical history do you need to consider for diagnosis?

A

Past and current hgb and blood work
Comorbitites
Transfusion
Family history
Medications
Social history

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18
Q

What is a CBC and what do you use from it?

A

Complete Blood Count
- Hb (amount of hemoglobin in blood)
- Hematocrit (packed cell volume)
- RBC count
- RBC indicies (MCV, MCH, MCHC)

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19
Q

What is MCV?

A

mean corpuscular volume (size, average cell volume)

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20
Q

What is MCH?

A

mean corpuscular hemoglobin (hemoglobin/cell)

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21
Q

What is MCHC?

A

mean corpuscular hemoglobin concentration (colour marker)

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22
Q

What is RDW?

A

red blood cell distribution width (variation in size/width)

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23
Q

What is a peripheral blood smear used for?

A

follow-up of CBC

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24
Q

What is the stool for occult blood used for?

A

Marker of blood loss

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25
Q

What level of hemoglobin is a diagnosis for anemia (male and female numbers)?

A

Men: <130g/L
Women: <120g/L

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26
Q

What factors can affect the number of hemoglobin?

A

Higher altitudes (increases number)
Smoking (increases)
Pregnancy (expansion of plasma volume can be lower)

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27
Q

What are the specific types of anemias?

A

Deficiency related anemia
- Iron
- Folate
- B12
Hemolytic
Sickle cell
Aplastic
Anemia related to otehr diseases/conditions
- chronic disease, CKD, critical illness/blood loss

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28
Q

What is the most common nutritional deficiency world wide?

A

Iron

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29
Q

What symptoms are associated with iron defecient anemia?

A

pallor
cardiovascular symptoms
respiratory
cognitive complications
decrease quality of life

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30
Q

What us the definition of iron deficient anemia?

A

negative state of iron balance where daily iron intake are unable to meet RBC and other body tissue needs

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31
Q

What can cause iron deficient anemia?

A

Low Dietary intake
Blood Loss
Decreased absorption
Increased requirement (infancy, pregnancy)
Impaired utilization

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32
Q

What is NIMBLE?

A

Need
Intake is low
Malabsorption
Blood
Loss
Excessive donation

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33
Q

What is the mortality w/ iron defecient anemia

A

Rarely direct cause of death
Moderate/severe anemia can cause hypoxia, exacerbate pulmonary/CV disorders

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34
Q

Morbitity with iron defecient anemia?

A

Disruptive symptoms
impair to daily functioning
slwoed growth rate in children
decreased ability to learn
lower IQ
Splenomegaly in severe untreated

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35
Q

Effect of Iron defecient anemia in elderly?

A

increased risk of mortality and morbitity
Decreased quality of life
Decrease physical functioning

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36
Q

Effect of iron deficient anemia in pregnancy?

A

low birth wts
preterm delivery
perinatal mortality

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37
Q

Iron Characteristics in the body?

A

3-5g in body, 2g in hemoglobin
significant stores in ferritin or aggregated ferritin in liver, spleen, bone marrow
despite turnaround of RBCs iron stores are usually well preserved
iron metabolism is regulated by hepcidin

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38
Q

What is TIBC?

A

total iron binding capacity

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39
Q

What is Tsat?

A

percent of transferrin saturation
serum iron/TIBC x100

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40
Q

What labs correlate with Iron deficient anemia?

A

decreases in ferritin, serum iron, trasferrin saturation, and Hb and HCT (decline later on in progression)
Increase in TIBC
RBCs: microlytic, hypochromic

41
Q

What is the diagnosis of iron defecient anemia based on?

A

Symptoms, medical histpry, CBC, labs, morphology

42
Q

What are some other symptoms of iron defecient anemia (not including the typical anemia symptoms)

A

brittle nails
Pica
Pagophagia
Smooth tongue

43
Q

Treatment for iron defecient anemia?

A

Iron supplement;
Oral first line
Parental iron therapy only used if needed

44
Q

Adult dosing for iron in iron defecient anemia?

A

105-200mg elemental iron daily

45
Q

Formulation of trablet?

A

basic, enteric coated or altered formulations not great, as iron absorption occurs early in gut

46
Q

Iron supplements and % of elemental iron

A

fumerate: 33%
sulfate: 20%
gluconate: 11%
polysaccharide: 100%
polypeptide: 100%

47
Q

SE’s of rion supplements?

A

NV, constipation (sometimes diarrhea)
dark stool

48
Q

Length of therapy for iron supplement (iron defeceint anemia)

A

3-6 months after normalization

49
Q

What is the dosing for pediatrics with iron?

A

wt based, 3-6mg/kg/d divided TID

50
Q

What are some considerations with liquid iron?

A

iron overdose in children very toxic so counsel appropriately
Store properly so children cannot access iron supplements
Mix with water/juice to prevent teeth staining

51
Q

Iron poisoning decription/treatment?

A

SE’s seen within 6hrs –> severe vomitting, diarrhea, abdominal pain, dehyfration, lethargic, blood in vomit/stool
Treatment: Deferoxamine to bind excess iron

52
Q

How can you make iron supplements more tolerable to take for pts?

A

lower dose
titrated up
alternate day dosing
take w/ food (decreases absorption though)
take before bed (sleep off bothersome SEs)

53
Q

At what time frame is iron defecient anemia usually corrected w/ treatment?

A

~6 weeks but need to continue to prevent relapse and replenish stores

54
Q

What is B12 used for?

A

required for proper RBC formation, neurological function, and DNA synthesis

55
Q

Where is B12 stored?

A

in liver

56
Q

Is B12 defeciency quick?

A

NO, develops over many years

57
Q

How is B12 absorbed?

A

Free B12 binds to intrinsic factor, then IF is discared and bound to transcobalmin II for secretion into the blood

58
Q

What are common causes of B12 defecient anemia?

A

inadequate intake
Malabsorption:
- age
- pernicious anemia
- gastrectomy, bariatric surgery, achlorhydria, small bowel disorders, drugs
Inadequate utilization

59
Q

What is pernicious Anemia?

A

autoimmune disorder affecting gastric mucousa, results in gastric atrpohy; failure of IF production
B12 malabsorption from lacking IF, associated with increased risk of gastric cancer

60
Q

Symptoms of B12 anemia?

A

typical anemia symptoms
Often neurological
- numbness/tingling in extemities
- off balance
- depression, confusion, dementia, poor memory
Soreness of mouth/tongue

61
Q

Can neurological issues occur w/out anemia forB12 deficiency?

A

Yes, are usually progressive and can become irreversible

62
Q

What meds can B12 defeciency be a concern?

A

PPI’s, H2, colchicine, metformin

63
Q

What do you see occur in labs w/ B12 deficiency anemia?

A

decrease n serum/plasma B12 levels
increase in homocysteine levels (early), methylmalonic acid levels
RBC: macrolytic, mormochromic

64
Q

What tests can be done to check for pernicious anemia?

A

Schilling test, antibodies to IF/ parietal cells

65
Q

Treatment for B12 deficient anemia (non-pernicious)

A

100ug/d po to normalize B12 levels within a month

66
Q

When is IM B12 used for treatment?

A

Pernicious anemia
severe malabsorption issues
non-adherent w/ oral
Neurological symptoms

67
Q

What are disadvantages of B12 IM?

A

Expensive, inconvenient, injection related SE’s

68
Q

Were is folate stored? how big of a reseve?

A

Liver, 4-6 months of stores but, can be depleted in ~6 weeks if diet severly laking

68
Q

Lay out treatment regime for B12 deficient anemia and pernicious anemia/other chronic malabsorption

A

Non: Initial: 30g/ug daily SC/IM x 5-10d or 500-2000 ug daily PO.
Maintenance: 100-200ug monthly SC/IM or 250ug daily PO
Pernicious: 100ug daily SC/IM x 1 week; 200ug weekly SC/IM until Hb normalizes
Maintenance: 100ug monthly SC/IM or 1000-2000ug daily po

69
Q

What can cause folate deficiency?

A

inadequate intake
Increased requirements (pregnancy)
Malabsorption
Some drugs

70
Q

What drugs can cause folate deficiency?

A

metformin
methotrexate
sulfasalazine
triamterene
trimethoprim

71
Q

What is a major difference between folate and B12 anemia deficiency symptoms?

A

No neurological SE’s

72
Q

What do you see with labs in folate defecient anemia?

A

decrease in serum folate
increase in homocystiene levels
RBCs: macrocytic, normochromic (same as B12)

73
Q

What is the treatment for folate deficiency?

A

1mg/day or 5mg/d (Rx) if absorption compromised
Duration: ~4months for folate-deficient RBCs to be cleared from circulation
May be on long-term or dietary corrections made.

74
Q

What are the response rates for Reticulocytes, Hb, resolution of anemia, and Neurologic(B12 only) for Folate/B12 defiency

A

Reticulocytes: response within 3-4 days
Hb improving by ~day 10 of treatment
Full resolution of anemia ~2 months
neurological deficiets w/ B12 may take 6 months or longer

75
Q

What is something to watch for with rapid production of hematopoietic cells?

A

Can cause a dramatic shift in K; hypokalemia is possible so monitor for SE’s/ lab work especially in elderly and HF pts

76
Q

Describe hemolytic anemia

A

decreased survival time of RBCs secondary to destruction in the spleen or circulation
RBCs: usually normocytic and normochromic. Increased levels of reticulocytes

77
Q

what causes hemolytic anemia?

A

usually idopathic
Can be caused by immune reactions,
malignancy,
drugs (ACE-I, NSAIDs/ASA, antibiotics),
G6PD enzyme deficiency (inherited defect, normally protects RBCs againt oxidative stress)

78
Q

What is the most common enzyme deficiency?

A

G6PD

79
Q

What is the treatment for hemolytic anemia?

A

correcting underlying cuase (or contorlling)
steroids and other immunosuppressant agents for management of autoimmune
splenectomy sometimes indicated in attempt to reduce RBC destruction

80
Q

What is the cause of sickle cell anemia?

A

autosomal recessive Hgb disorder characterized by a DNA substitution at the beta-globulin gene

81
Q

What happens to hemoglobin/ RBCs in sickle cell anemia?

A

abnormal Hb called hemoglobin S formed
distorts shape of RBC especially when exposed to low O2 levels

82
Q

What is the issue with sickled RBCs?

A

Rigid, do not pass through microvasculature, prone to rupture
- Ischemia, pain
- chronic organ damage

83
Q

What are symptoms of Sickle cell anemia?

A

impaired growth/development
enlarged spleen
chronic damage to many organs
Vaso-occlusive crises
- sludging
- pain in bones of the back, long bones, chest

84
Q

What labs are done to determine sickle cell anemia?

A

Hb electrophoresis, HbS presence
RBCs: mormochromic, normocytic, sickled cells present

85
Q

How do you treat Sickle-cell anemia?

A

Acute: pain meds, hydration
Vaccinations and penicillin prophylaxis for children up to 6
Hydroxyurea
partial blood transfusion
bone marrow transplant (curative but has risks)

86
Q

Describe anemia of inflammation

A

Used to describe both anemia of chronic disease and critical illness
reflects inflammatory process resulting in disturbances in iron homeostasis underlying both types of anemia

87
Q

How is anemia of inflammation diagnosed?

A

Exclusion diagnosis

88
Q

What are symptoms of anemia of chronic disease?

A

mild, non-specific

89
Q

What do labs look like for anemia of chronic disease?

A

decreased hematocrit, serum iron, normal or increased ferritin, normal or decreased TIBC
RBCs: usually normocytic and normochromic (can be microcytic)

90
Q

Compare/ Contrast Anemia of chronic disease vs deficient anemia (serrum ferritin, serum iron, Tsat, TIBC, Hb)

A

Chronic: Decreased or normal, decreased, normal or decreased, normal or decreased, decreased

Deficient: Decreased, decreased, decreased, increased, decreased

91
Q

What is seen in anemia b/c of CKD

A

ERythropoiesis decreased, uremic metabolites decrease life span of RBCs

92
Q

Symptoms of CKD anemia?

A

general anemia sx, angina, ischemia on ECG, CHF

93
Q

How do you treat CKD anemia?

A

Iron
eryhtropoetin stimulating agents
transfusions

94
Q

Which pts are responsive to erythropoisis pharmacological stimulation?

A

chronic renal failure
HIV pts
chronic hep C recieving ribavirin
chemotherapy nonhematologic cancers
surgery pts
low risk myelodysplastic syndrome

95
Q

Describe aplastic anemia

A

failure of pluripotent stem cells in bone marrow; hematopoiesis interupted resulting in anemia neutropenia, thrombocytopenia

96
Q

Which anemias arwe microcytic?

A

Iron deficiency, thalassemia, chronic disease anemia

97
Q

Which anemias are normocytic?

A

SIckle cell, hemolytic, aplastic, chronic disease, CKD, mixed deficiency anemias

98
Q

WHich anemias are macrocytic?

A

B12/folic acid deficiency, liver disease

PHAR 253 Module 3 (3 decks)

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